Acceptability and satisfaction with emma, a smartphone application dedicated to suicide ecological assessment and prevention

BACKGROUND: As mHealth may contribute to suicide prevention, we developed emma, an application using Ecological Momentary Assessment and Intervention (EMA/EMI). OBJECTIVE: This study evaluated emma usage rate and acceptability during the first month and satisfaction after 1 and 6 months of use. METHODS: Ninety-nine patients at high risk of suicide used emma for 6 months. The acceptability and usage rate of the EMA and EMI modules were monitored during the first month. Satisfaction was assessed by questions in the monthly EMA (Likert scale from 0 to 10) and the Mobile App Rating Scale (MARS; score: 0–5) completed at month 6. After inclusion, three follow-up visits (months 1, 3, and 6) took place. RESULTS: Seventy-five patients completed at least one of the proposed EMAs. Completion rates were lower for the daily than weekly EMAs (60 and 82%, respectively). The daily completion rates varied according to the question position in the questionnaire (lower for the last questions, LRT = 604.26, df = 1, p-value < 0.0001). Completion rates for the daily EMA were higher in patients with suicidal ideation and/or depression than in those without. The most used EMI was the emergency call module (n = 12). Many users said that they would recommend this application (mean satisfaction score of 6.92 ± 2.78) and the MARS score at month 6 was relatively high (overall rating: 3.3 ± 0.87). CONCLUSION: Emma can target and involve patients at high risk of suicide. Given the promising users’ satisfaction level, emma could rapidly evolve into a complementary tool for suicide prevention.