In this study, a mobile-based self-care application was designed and developed for patients with depression and anxiety disorders. Analysis of education-informational needs and capabilities showed in the point of view of patients, most of the education- informational needs and capabilities are necessary for designing and implementing self-care applications. These education-informational needs and capabilities included six main parts include: user profile, clinical history, lifestyle, disease and control management, calm instructions, and application capabilities. Out of 80 information-educational needs and application capabilities, only 11 needs and capabilities (national code, age, education, and place of residence, contact number in user profile category, underlying diseases in clinical history category, calculate BMI, and lectures and provide clinical history in the category of application capabilities) were not considered in the design and development of the application. The designed application allows the patient to register and enter through a username and password and record their clinical history in PDF format and send it to the doctor. Also, this app can help to improve patients' lifestyles by providing educational information on reducing and controlling anxiety and depression in the form of videos, text and voice. Also, management of medications dose and time of use, the ability to record activities, personal goals and habits in a diary, the introduction of depression and anxiety treatment centers, communication with other patients and doctors were other features of this application.
Wasil R et al. [28] reviewed applications were designed for depressive and anxiety disorders in a review study. The most common features used in this applications included educational and self-assessment services to patients, how to gain calm, concentration and meditation. Also, in our study, educational services were provided to improve self-care processes and how to achieve relaxation, concentration and meditation. Instructions for concentration and relaxation let person to get rid of internal and external factors that bother him/her. These instructions can help people to return to a normal state and perform daily routine activities in the present [29] and reduce stress and anxiety in people with depressive and anxiety disorders.[30–32] Fuller-Tyszkiewicz et al. [33] also designed a self-monitoring application with name BlueWatch to improve the well-being of adults with depressive symptoms. This app is organized based on the principles of Cognitive Behavioral Therapy (CBT) in six modules of psychological education about depression and an introduction to CBT, behavioral activation, cognitive reconstruction, problem-solving skills, assertiveness, and treatment methods to prevent Recurrence of disease. Blue Watch features also included short audio education activities, daily practice and self-monitoring functions (using daily mood recordings), short welcome video, training with the app and dashboard (to store patient activities and texts). The present study provides daily exercises in the form of relaxation instructions in the designed application. Patients by performing daily exercises such as calm and regular breathing, muscle strengthening, prayer, music therapy, aromatherapy, mental imagery, mindfulness, meditation, walking with mindfulness or yoga, repeating soothing words help themselves to reduce stress and anxiety .
Music therapy, meditation, relaxation breathing training, yoga, information about mental health care and healthy lifestyle (diet, exercise benefits and appropriate sleep) are other features of the application designed in our study and the application designed by Won Ju Hwang [34]. Several studies have shown that factors such as appropriate sleep hygiene and management [35], exercise and physical activity [36], meditation [37] can lead to a reduction in depressive and anxiety disorders, so it is necessary these factors consider in time of design self-care and self-management applications. Also Jamie M Kawadler et al. [38] who designed and developed BioBase, an application to reduce anxiety and increase the mental health of people in the workplace showed physical activity and sleep management were considered as part of the education-informational needs and capabilities of this application.
Management of smoking, shisha, alcohol and drugs was another feature of the application designed in our study. Deady et al. [39] also were considered a section for managing of smoking, hookahs, alcohol, and drugs in their application, along with other information-educational needs and capabilities such as training programs ( prevention of exacerbation of effects of anxiety and depression disorders, overcoming stress and negative thoughts, how to get away from relationships and stressful environments) relaxation instruction, sleep management, physical activity and exercise, and daily programming. Other studies [40–42] have shown that there is a direct link between depression and anxiety and smoking. They can increase the severity of anxiety and depression in these patients over the time. So, in self-care applications for these patients, it is better to allocate a section for smoking, shisha, alcohol management.
Patient management of medications was another feature of the application designed in the present study. This feature can help patients to enter the name of the drug, dosage, drug allergies and drug use date. In order to take the medicine, the necessary warnings were given to the patient according to the time and date of use. Philip Kaare Løventoft et al. [43] designed an application called life management to support patients with depression. This application has various capabilities for user registration, measuring the patient's depression based on the WHO Major Depression Inventory (MDI) questionnaire, Mood, appetite and sleep registration, calendar and event types, location tracking and mapping (providing data on patient movement patterns for Predicting phases of depression) and routine management (to help users with daily tasks such as getting out of bed, taking a shower, and daily programming). Also, it had capabilities to record a list of drugs that could be edited by the user, reminding the use of drugs in the Medication management section.
Patients' communication with doctors, consultants and other patient through social networks such as WhatsApp and Telegram was another feature of our application. Some studies have shown that social networks such as WhatsApp, Telegram, Facebook and Instagram are among the very helpful tools in promoting self-care processes [44]. Social networks create channels and discussion groups with the participation of patients and physicians, the exchange of educational and medical documents (e-books, articles, etc.), the exchange of multimedia files such as pictures or videos, video chat, access to counseling. Improved telecommunications and simplification of tasks reduce the consultation time, and promotion a participatory environment to improve the level of health care [45–48]. Ha Seung Wan et al. [49] designed a mobile-based application to address the problems posed by traditional and face-to-face counseling for people with depression. This application has different capabilities as well “semi-crowdsourced counseling, immediate intervention from multiple counselors, cognitive behavioral therapy (CBT)-based short comments and gasification”. These features help patients to receive counseling without visit a doctor.
In general, the application designed in this study, along with the introduced applications were includes information-educationalal content and various capabilities, such as: educational-therapeutic programs to overcome stress and anxiety, daily exercises (meditation, yoga), smoking and drinking alcohol, activities physical and exercise management, medication management, daily programming and sleep management. Depression and anxiety are the most common mental disorders. Disease management with self-care processes by using such applications will reduce the in-person visits, treatment costs and save time for patients. Immediate access to a physician to monitor patients' condition, communication with other patient, availability of scheduling are other benefits of these applications. It should be noted that these capabilities, will improve anxiety disorders and depression if properly used by patients [50].
Limitations
Patients' education-informational needs and application capabilities required to design the application were identified only in accordance with the opinions of patients referred to Hamzeh in Fasa speciality and sub-speciality clinics and were not used viewpoint of psychologists and psychiatrists. It is suggested that the opinions of psychologists and psychiatrists be used in future studies. Also, in this study, the usability of the designed application were not evaluated and its effects on improving and reducing anxiety and stress were not considered. In another study, the usability and effects of app on improving and reducing anxiety and stress will investigated.