Berry K, Salter A, Morris R, James S, Bucci S. (2018). Assessing therapeutic alliance in the context of mHealth interventions for mental health problems: Development of the Mobile Agnew Relationship Measure (mARM) questionnaire. Journal of Medical Internet Research. 20(4): e90. doi: 10.2196/jmir.8252
Researchers conducted a three-phase study to guide adaptation of the Agnew Relationship Measure (ARM) for mobile mental health interventions as a part of a larger trial of a mobile application (app) for people experiencing early psychosis (Acticisst). First, researchers interviewed 9 mental health service users about their perceptions of their therapeutic alliance with Actissist. Researchers identified 2 recurring themes: 1) the bond formed with the app and 2) advantages to mobile delivery over face-to-face therapy. In the second stage, 14 mental health service users and 10 mental health service staff members rated the relevance of adapted ARM items (replacing “therapist” with “app”) for evaluating therapeutic alliance with mobile interventions. Participants rated items referring to techniques used in an app (e.g. “I have confidence in the app and its techniques”), an app’s capacity to help (e.g. “I am optimistic about my progress”), and expressing thoughts and emotions to an app (e.g., “I can openly express my thoughts and feelings when using the app”) as relevant. Items that anthropomorphized apps (e.g. “The app is supportive”) were given low relevance ratings by participants and mental health service providers suggested qualifying these items by referring to them as perceived traits of the app (e.g. “The app seems supportive”). Based on stakeholder feedback, researchers edited the wording of 16 items, removed 4 items, added 1 item (i.e. “The app is like having a member of my care team in my pocket”) and retained 8 items to create a final version of the Mobile Agnew Relationship Measure (mARM). Researchers emphasized that mARM should be validated with populations outside of adults experiencing first episode psychosis.