Co-creation of digital mental health interventions with experts-by-experience: ZeroOCD, an augmented reality exposure therapy for fear of contamination

Introduction: Fear of contamination is one of the most reported symptoms among individuals with obsessive-compulsive disorder (OCD). Digital interventions may address treatment gap caused by geographical constraints, long waiting lists, or reluctance to seek help. Yet, involvement of people with lived experience is necessary for effective implementation and sensible use of resources in health care innovations. We developed ZeroOCD, an augmented reality exposure therapy smartphone application for fear of contamination, while involving experts-by-experience in the whole development, from the first draft to user testing of the final version of the application.

Methods: Following the co-creation framework, we conducted focus groups with eight experts-by-experience and four OCD therapists to address their needs and preferences. Upon the development of the app, we conducted user testing with the same sample to address user-friendliness. We consequently conducted a feasibility study involving 20 participants who followed the intervention with therapeutic support on request.

Results: Based on the insights of the participants, we iteratively co-created nine modules of the app, and the content of the augmented reality exposure. User-centered methodology enabled us to identify topics the participants were particularly interested in, such as specific exposure focus, accessible therapist involvement, or flexible gamification-based reward system, address design challenges, and improve user satisfaction.

Conclusions: Employing co-creation framework involving experts-by-experience may identify unexpected challenges in the intervention design and shed light on content necessary to improve user satisfaction. Thus, it is highly beneficial in the development of mental health innovation and may lead to adherence improvement.