Afraid of the dentist? There's an app for that: Development and usability testing of a cognitive behavior therapy-based mobile app

Kelly A Daly; Kiara A Diaz-Gutierrez; Armon Beheshtian; Richard E Heyman; Amy M Smith Slep; Mark S Wolff

doi:10.1371/journal.pdig.0000690

Afraid of the dentist? There's an app for that: Development and usability testing of a cognitive behavior therapy-based mobile app

PLOS Digit Health. 2024 Dec 11;3(12):e0000690. doi: 10.1371/journal.pdig.0000690. eCollection 2024 Dec.

Authors

Kelly A Daly¹, Kiara A Diaz-Gutierrez¹, Armon Beheshtian¹, Richard E Heyman¹, Amy M Smith Slep¹, Mark S Wolff²

Affiliations

¹ Center for Oral Health Policy & Management, New York University College of Dentistry, New York, New York, United States of America.
² University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, United States of America.

Abstract

Objectives: Although several brief cognitive behavior therapy (CBT)-based treatments for dental fear have proven efficacious, these interventions remain largely unavailable outside of the specialty clinics in which they were developed. Leveraging technology, we sought to increase access to treatment for individuals with dental fear through the development of a mobile application (Dental FearLess).

Materials and methods: To assess the resonance of our app as an avenue for dental fear treatment, we conducted a study assessing the usability, feasibility, and acceptability of the beta app. Participants with moderate to severe dental fear (N = 80) completed the app and reported on the perceived usability of the mobile interface (Systems Usability Scale, SUS; α = .82) and credibility of the intervention (Credibility and Expectancy Questionnaire, CEQ; α = .88). A sub-sample of participants naïve to the app (n = 10) completed the app during a think-aloud procedure, sharing their candid thoughts and reactions while using the app, prior to reporting on usability and credibility metrics.

Results: Overall usability (M = 78.5, SD = 17.7) and credibility (M = 21.7, SD = 5.5) of the beta version of the app were good. The think-aloud data further corroborated the app's acceptability, while highlighting several areas for user improvement (i.e., aesthetics, navigation, engagement).

Conclusions: Usability and acceptability results are promising for the viability of an accessible, feasible, self-administered intervention for dental fear. Refinements made based on user feedback have produced a clinical-trial-ready mobile application. App refinement decisions, informed by user feedback, are representative of the larger literature-that is, of the ubiquitous negotiations m-health developers must make across treatment fidelity, usability, and engagement. Implications for future research are discussed.

Copyright: © 2024 Daly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by a grant from the National Institute of Dental and Craniofacial Research (UG3DE029453) awarded to Co-Primary Investigators RE, MW, AS. https://www.nidcr.nih.gov/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.