{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:51:25Z","timestamp":1774929085725,"version":"3.50.1"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T00:00:00Z","timestamp":1581552000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T00:00:00Z","timestamp":1581552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002706","name":"AFA F\u00f6rs\u00e4kring","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002706","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Accessibility of evidence-based behavioral health interventions is one of the main challenges in health care and effective treatment approaches are not always available for patients that would benefit from them. Digitization has dramatically changed the health care landscape. Although mHealth has shown promise in addressing issues of accessibility and reach, there is vast room for improvements. The integration of technical innovations and theory driven development is a key concern. Digital solutions developed by industry alone often lack a clear theoretical framework and the solutions are not properly evaluated to meet the standards of scientifically proven efficacy. On the other hand, mHealth interventions developed in academia may be theory driven but lack user friendliness and are commonly technically outdated by the time they are implemented in regular care, if they ever are. In an ongoing project aimed at scientific innovation, the mHealth Agile Development and Evaluation Lifecycle was used to combine strengths from both industry and academia in the development of ACTsmart \u2013 a smartphone-based Acceptance and Commitment Therapy treatment for adult chronic pain patients. The present study describes the early development of ACTsmart, in the process of moving the product from alpha testing to a clinical trial ready solution.<\/jats:p>","DOI":"10.1038\/s41746-020-0228-4","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T11:03:11Z","timestamp":1581591791000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["ACTsmart \u2013 development and feasibility of digital Acceptance and Commitment Therapy for adults with chronic pain"],"prefix":"10.1038","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-7043","authenticated-orcid":false,"given":"Charlotte","family":"Gentili","sequence":"first","affiliation":[]},{"given":"Vendela","family":"Zetterqvist","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-0158","authenticated-orcid":false,"given":"Jenny","family":"Rickardsson","sequence":"additional","affiliation":[]},{"given":"Linda","family":"Holmstr\u00f6m","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3395-9483","authenticated-orcid":false,"given":"Laura E.","family":"Simons","sequence":"additional","affiliation":[]},{"given":"Rikard K.","family":"Wicksell","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,2,13]]},"reference":[{"key":"228_CR1","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1002\/wps.20151","volume":"13","author":"G Andersson","year":"2014","unstructured":"Andersson, G., Cuijpers, P., Carlbring, P., Riper, H. & Hedman, E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13, 288\u2013295 (2014).","journal-title":"World Psychiatry"},{"key":"228_CR2","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1177\/1090198112452126","volume":"40","author":"LT Cowan","year":"2012","unstructured":"Cowan, L. T. et al. Apps of steel: are exercise apps providing consumers with realistic expectations?: a content analysis of exercise apps for presence of behavior change theory. Health Educ. Behav. 40, 133\u2013139 (2012).","journal-title":"Health Educ. Behav."},{"key":"228_CR3","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s13142-011-0021-7","volume":"1","author":"WT Riley","year":"2011","unstructured":"Riley, W. T. et al. Health behavior models in the age of mobile interventions: are our theories up to the task? Transl. Behav. Med. 1, 53\u201371 (2011).","journal-title":"Transl. Behav. Med."},{"key":"228_CR4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/10350330903438386","volume":"20","author":"L Neuhauser","year":"2010","unstructured":"Neuhauser, L. & Kreps, G. L. eHealth communication and behavior change: promise and performance. Soc. Semiotics 20, 9\u201327 (2010).","journal-title":"Soc. Semiotics"},{"key":"228_CR5","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.2196\/resprot.2205","volume":"1","author":"L Hebden","year":"2012","unstructured":"Hebden, L., Cook, A., van der Ploeg, H. P. & Allman-Farinelli, M. Development of smartphone applications for nutrition and physical activity behavior change. JMIR Res. Protoc. 1, e9\u2013e9 (2012).","journal-title":"JMIR Res. Protoc."},{"key":"228_CR6","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.amepre.2010.11.014","volume":"40","author":"CL Backinger","year":"2011","unstructured":"Backinger, C. L. & Augustson, E. M. Where there\u2019s an app, there\u2019s a way? Am. J. Prev. Med. 40, 390\u2013391 (2011).","journal-title":"Am. J. Prev. Med."},{"key":"228_CR7","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/s13142-011-0076-5","volume":"1","author":"ER Breton","year":"2011","unstructured":"Breton, E. R., Abroms, L. C. & Fuemmeler, B. F. Weight loss\u2014there is an app for that! But does it adhere to evidence-informed practices? Transl. Behav. Med. 1, 523\u2013529 (2011).","journal-title":"Transl. Behav. Med."},{"key":"228_CR8","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.amepre.2010.10.032","volume":"40","author":"LC Abroms","year":"2011","unstructured":"Abroms, L. C., Padmanabhan, N., Thaweethai, L. & Phillips, T. iPhone apps for smoking cessation: a content analysis. Am. J. Prev. Med. 40, 279\u2013285 (2011).","journal-title":"Am. J. Prev. Med."},{"key":"228_CR9","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.amepre.2013.07.005","volume":"45","author":"KMJ Azar","year":"2013","unstructured":"Azar, K. M. J. et al. Mobile applications for weight management: theory-based content analysis. Am. J. Prev. Med. 45, 583\u2013589 (2013).","journal-title":"Am. J. Prev. Med."},{"key":"228_CR10","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.2196\/mhealth.3335","volume":"3","author":"HE Payne","year":"2015","unstructured":"Payne, H. E., Lister, C., West, J. H. & Bernhardt, J. M. Behavioral functionality of mobile apps in health interventions: a systematic review of the literature. JMIR MHealth UHealth 3, e20\u2013e20 (2015).","journal-title":"JMIR MHealth UHealth"},{"key":"228_CR11","doi-asserted-by":"publisher","first-page":"e36","DOI":"10.2196\/jmir.2925","volume":"16","author":"TB Baker","year":"2014","unstructured":"Baker, T. B., Gustafson, D. H. & Shah, D. How can research keep up with eHealth? Ten strategies for increasing the timeliness and usefulness of eHealth research. J. Med. Internet Res. 16, e36\u2013e36 (2014).","journal-title":"J. Med. Internet Res."},{"key":"228_CR12","doi-asserted-by":"publisher","first-page":"e104","DOI":"10.2196\/mhealth.4334","volume":"3","author":"J Chen","year":"2015","unstructured":"Chen, J., Cade, J. E. & Allman-Farinelli, M. The most popular smartphone apps for weight loss: a quality assessment. JMIR MHealth UHealth 3, e104\u2013e104 (2015).","journal-title":"JMIR MHealth UHealth"},{"key":"228_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-7-34","volume":"7","author":"SL Thomas","year":"2008","unstructured":"Thomas, S. L., Hyde, J., Karunaratne, A., Kausman, R. & Komesaroff, P. A. \u201cThey all work\u2026when you stick to them\u201d: a qualitative investigation of dieting, weight loss, and physical exercise, in obese individuals. Nutr. J. 7, 34 (2008).","journal-title":"Nutr. J."},{"key":"228_CR14","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.ejpain.2005.06.009","volume":"10","author":"H Breivik","year":"2006","unstructured":"Breivik, H., Collett, B., Ventafridda, V., Cohen, R. & Gallacher, D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur. J. Pain 10, 287\u2013333 (2006).","journal-title":"Eur. J. Pain"},{"key":"228_CR15","doi-asserted-by":"crossref","unstructured":"Tunks, E. R., Crook, J. & Weir, R. Epidemiology of Chronic Pain with Psychological Comorbidity: Prevalence, Risk, Course, and Prognosis. Vol. 53, pp. 224\u2013234 (Los Angeles, CA, 2008).","DOI":"10.1177\/070674370805300403"},{"key":"228_CR16","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1146\/annurev-clinpsy-090310-120430","volume":"7","author":"RD Kerns","year":"2011","unstructured":"Kerns, R. D., Sellinger, J. & Goodin, B. R. Psychological treatment of chronic pain. Annu. Rev. Clin. Psychol. 7, 411\u2013434 (2011).","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"228_CR17","doi-asserted-by":"publisher","unstructured":"Williams, A. C., Eccleston, C. & Morley, S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Pain Palliative Supportive Care Group 11, https:\/\/doi.org\/10.1002\/14651858.CD007407.pub3 (2012).","DOI":"10.1002\/14651858.CD007407.pub3"},{"key":"228_CR18","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1037\/a0035641","volume":"69","author":"MP Jensen","year":"2014","unstructured":"Jensen, M. P. & Turk, D. C. Contributions of psychology to the understanding and treatment of people with chronic pain: why it matters to ALL psychologists. Am. Psychologist 69, 105 (2014).","journal-title":"Am. Psychologist"},{"key":"228_CR19","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1258\/jtt.2011.101102","volume":"17","author":"BA Rosser","year":"2011","unstructured":"Rosser, B. A. & Eccleston, C. Smartphone applications for pain management. J. Telemed. Telecare 17, 308\u2013312 (2011).","journal-title":"J. Telemed. Telecare"},{"key":"228_CR20","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1097\/AJP.0000000000000171","volume":"31","author":"AC Lalloo","year":"2015","unstructured":"Lalloo, A. C., Jibb, N. L., Rivera, N. J., Agarwal, N. A. & Stinson, N. J. \u201cThere\u2019s a pain app for that\u201d: review of patient-targeted smartphone applications for pain management. Clin. J. Pain. 31, 557\u2013563 (2015).","journal-title":"Clin. J. Pain."},{"key":"228_CR21","unstructured":"Hayes, S. C., Strosahl, K. D. & Wilson, K. G. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. 1st edn (Guilford Press, 1999)."},{"key":"228_CR22","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.jpain.2013.10.014","volume":"15","author":"LM McCracken","year":"2014","unstructured":"McCracken, L. M. & Morley, S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. J. Pain. 15, 221\u2013234 (2014).","journal-title":"J. Pain."},{"key":"228_CR23","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1037\/a0035623","volume":"69","author":"LM McCracken","year":"2014","unstructured":"McCracken, L. M. & Vowles, K. E. Acceptance and commitment therapy and mindfulness for chronic pain. Am. Psychol. 69, 178\u2013187 (2014).","journal-title":"Am. Psychol."},{"key":"228_CR24","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1146\/annurev-clinpsy-021815-093006","volume":"12","author":"G Andersson","year":"2016","unstructured":"Andersson, G. Internet-delivered psychological treatments. Annu. Rev. Clin. Psychol. 12, 157\u2013179 (2016).","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"228_CR25","doi-asserted-by":"publisher","unstructured":"Wilson, K., Bell, C., Wilson, L. & Witteman, H. Agile research to complement agile development: a proposal for an mHealth research lifecycle. npj Digital Med. 1, https:\/\/doi.org\/10.1038\/s41746-018-0053-1 (2018).","DOI":"10.1038\/s41746-018-0053-1"},{"key":"228_CR26","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.janxdis.2018.01.001","volume":"55","author":"G Andrews","year":"2018","unstructured":"Andrews, G. et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J. Anxiety Disord. 55, 70\u201378 (2018).","journal-title":"J. Anxiety Disord."},{"key":"228_CR27","doi-asserted-by":"publisher","first-page":"337","DOI":"10.3109\/00048674.2010.538840","volume":"45","author":"G Andrews","year":"2011","unstructured":"Andrews, G., Davies, M. & Titov, N. Effectiveness randomized controlled trial of face to face versus internet cognitive behaviour therapy for social phobia. Aust. N. Z. J. Psychiatry 45, 337\u2013340 (2011).","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"228_CR28","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.cpr.2014.05.006","volume":"41","author":"G Andrews","year":"2015","unstructured":"Andrews, G. & Williams, A. D. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: a model for dissemination into primary care. Clin. Psychol. Rev. 41, 40\u201348 (2015).","journal-title":"Clin. Psychol. Rev."},{"key":"228_CR29","doi-asserted-by":"publisher","unstructured":"Lindner, P., Ivanova, E., Ly, K. H., Andersson, G. & Carlbring, P. Guided and unguided CBT for social anxiety disorder and\/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial.(Clinical report). Trials 14, https:\/\/doi.org\/10.1186\/1745-6215-14-437 (2013).","DOI":"10.1186\/1745-6215-14-437"},{"key":"228_CR30","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1111\/aas.12599","volume":"60","author":"MK Kemani","year":"2016","unstructured":"Kemani, M. K., Zetterqvist, V., Kanstrup, M., Holmstr\u00f6m, L. & Wicksell, R. K. A validation of the pain interference index in adults with long\u2010standing pain. Acta Anaesthesiol. Scand. 60, 250\u2013258 (2016).","journal-title":"Acta Anaesthesiol. Scand."},{"key":"228_CR31","first-page":"1059.e1051","volume":"14","author":"RK Wicksell","year":"2010","unstructured":"Wicksell, R. K., Olsson, G. L. & Hayes, S. C. Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. Eur. J. Pain 14, 1059.e1051\u20131059.e1011 (2010).","journal-title":"Eur. J. Pain"},{"key":"228_CR32","unstructured":"Gothelf, J. Lean UX: Applying Lean Principles To Improve User Experience. (\u201cO\u2019Reilly Media, Inc.\u201d, 2013)."},{"key":"228_CR33","unstructured":"Schwaber, K. & Beedle, M. Agile Software Development With Scrum. Vol. 1 (Prentice Hall Upper Saddle River, 2002)."},{"key":"228_CR34","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1080\/16506070802078970","volume":"37","author":"KR Wicksell","year":"2008","unstructured":"Wicksell, K. R., Ahlqvist, J., Bring, A., Melin, L. & Olsson, G. L. Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and Whiplash\u2010Associated Disorders (WAD)? A randomized controlled trial. Cogn. Behav. Ther. 37, 169\u2013182 (2008).","journal-title":"Cogn. Behav. Ther."},{"key":"228_CR35","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.pain.2008.11.006","volume":"141","author":"KR Wicksell","year":"2009","unstructured":"Wicksell, K. R., Melin, L. L., Lekander, L. M. & Olsson, L. G. Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain \u2013 a randomized controlled trial. Pain 141, 248\u2013257 (2009).","journal-title":"Pain"},{"key":"228_CR36","doi-asserted-by":"publisher","first-page":"2792","DOI":"10.1016\/j.pain.2011.09.003","volume":"152","author":"KR Wicksell","year":"2011","unstructured":"Wicksell, K. R., Olsson, L. G. & Hayes, C. S. Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain. Pain 152, 2792\u20132801 (2011).","journal-title":"Pain"},{"key":"228_CR37","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1002\/j.1532-2149.2012.00224.x","volume":"17","author":"RK Wicksell","year":"2013","unstructured":"Wicksell, R. K. et al. Acceptance and commitment therapy for fibromyalgia: a randomized controlled trial. Eur. J. Pain 17, 599\u2013611 (2013).","journal-title":"Eur. J. Pain"},{"key":"228_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.brat.2005.06.006","volume":"44","author":"SC Hayes","year":"2006","unstructured":"Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. & Lillis, J. Acceptance and Commitment Therapy: Model, processes and outcomes. Behav. Res. Ther. 44, 1\u201325 (2006).","journal-title":"Behav. Res. Ther."},{"key":"228_CR39","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1037\/0022-006X.76.3.397","volume":"76","author":"KE Vowles","year":"2008","unstructured":"Vowles, K. E. & McCracken, L. M. Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J. Consult. Clin. Psychol. 76, 397\u2013407 (2008).","journal-title":"J. Consult. Clin. Psychol."},{"key":"228_CR40","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1017\/S1352465808004670","volume":"36","author":"E Morris","year":"2008","unstructured":"Morris, E. Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists Jason B. Luoma, Steven C. Hayes and Robyn D. Walser Oakland, CA: New Harbinger Publications, 2007. pp. 352. \u00a322.68 (pb). Behav. Cogn. Psychother. 36, 634\u2013635 (2008).","journal-title":"Behav. Cogn. Psychother."},{"key":"228_CR41","unstructured":"Bruck, P. A., Motiwalla, L. & Foerster, F. Mobile Learning with Micro-content: A Framework and Evaluation. In BLED 2012 Proceedings 2 (2012)."},{"key":"228_CR42","doi-asserted-by":"publisher","first-page":"E19","DOI":"10.1111\/j.1467-8535.2011.01245.x","volume":"43","author":"LH Wong","year":"2012","unstructured":"Wong, L. H. A learner\u2010centric view of mobile seamless learning. Br. J. Educ. Technol. 43, E19\u2013E23 (2012).","journal-title":"Br. J. Educ. Technol."},{"key":"228_CR43","doi-asserted-by":"crossref","unstructured":"Ally, M. Mobile Learning: Transforming the Delivery of Education and Training. Vol. 50; 10 Jahre Vorsprung Baden-W\u00fcrttemberg (Athabasca University Press, 2009).","DOI":"10.15215\/aupress\/9781897425435.01"},{"key":"228_CR44","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.amepre.2009.02.002","volume":"36","author":"DJ Bowen","year":"2009","unstructured":"Bowen, D. J. et al. How We Design Feasibility Studies. Am. J. Preventive Med. 36, 452\u2013457 (2009).","journal-title":"Am. J. Preventive Med."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-020-0228-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-020-0228-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-020-0228-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T20:44:30Z","timestamp":1695761070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-020-0228-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,13]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["228"],"URL":"https:\/\/doi.org\/10.1038\/s41746-020-0228-4","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,13]]},"assertion":[{"value":"26 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20"}}