With a Little Help From a-friend: Participatory Intervention Development of a Peer-Guided Self-Help App for Anxiety Disorder

Background: Internet-based self-help interventions offer a promising possibility to meet the growing demand for psychological support. However, a common challenge is low adherence, leading to only modest reductions in symptoms. One way to increase acceptability is to involve individuals with lived experience in the design and development of interventions. This paper focuses on the participatory development of an internet-based self-help intervention designed for anxiety symptoms that integrates peer-to-peer support.Methods: The intervention development process is based on the Integrate, Design, Assess, and Share (IDEAS) framework. In a first step, test user input on the Prototype was assessed qualitatively in one focus group with N=5 and in individual interviews with N=4 participants affected by anxiety symptoms. In a second step, we pilot-tested the minimum viable product (MVP) with N=128 self-help seeking participants. We assessed usage data and mental health outcomes. Results: During prototype testing, users expressed a need for more clear guidance through the app functions and for more means of direct communication with other users. The MVP testing revealed that a high percentage of the participants (68.8%) did not use the app more than once. Only a subset of N=24 participants filled in the baseline mental health questionnaires, indicating moderate levels of anxiety and low levels of social support. Due to the small sample size, we did not analyze changes in outcome measures. Conclusion: Despite the integration of individuals with lived experience from the beginning of app development, qualitative feedback, as well as quantitative usage data, revealed low feasibility and acceptability of the app. Fostering communication among peers and simplifying the app might contribute to the efficacy of peer support in self-help interventions.