{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:21:37Z","timestamp":1785536497248,"version":"3.56.0"},"reference-count":45,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n US Navy sailors experience a range of personal and interpersonal stressors due to challenging operational tempos that can contribute to psychological distress and increased suicide risk. Digital mental fitness tools offer scalable, stigma-reducing solutions to support psychological readiness. However, many existing digital mental health interventions use top-down designs that lack input from the target population and focus on treating psychological symptoms rather than improving overall mental fitness.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to design a mobile app version of the Rational Thinking, Emotion Regulation, and Problem Solving (REPS) program and evaluate usability and user experience. REPS is grounded in cognitive-behavioral and rational emotive behavior therapy principles. We examined sailor feedback across two evaluation phases to make iterative improvements to the app.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Two rounds of usability testing were conducted with 13 first-term Navy sailors over a 2-month period in spring of 2024. Sailors on duty at a naval ship were recruited by their commanding officer. Evaluation phase 1 (n=8) included exploratory interviews and concept testing using an initial prototype that covered a learning objective of the first module. Sailor feedback from phase 1 informed iterative refinements, including a gamified badge feature and dedicated skill practice session. Evaluation phase 2 (n=5) included a think-aloud protocol using an updated, fully functioning prototype of the first module, with three structured learning objectives. Both phases assessed sailor feedback through qualitative interviews and the System Usability Scale (SUS). Thematic analysis identified core themes related to user needs and app characteristics, and SUS scores were summarized to describe usability.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Sailors found the REPS app prototype to be culturally relevant and relatable to their daily life within the Navy. Sailors also commented that the app had an intuitive, user-friendly design and praised the modern and visually appealing interface. Sailors reported liking the scenario-based situations and clear explanation of how thoughts, feelings, and actions are intertwined. Sailors also identified ways to enhance user engagement, including clearly defining psychological terminology, introducing gamified rewards, outlining learning objectives, and incorporating more prominent visual cues to enhance the discoverability of interactive content. Quantitatively, SUS scores for both evaluation phases were in the excellent range (phase 1: median 92.50, range 72.5\u201095.0; phase 2: median 85.00, range 80.0\u201092.5).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The REPS mobile app was rated as highly relevant and usable by newly enlisted Navy sailors. Scenario-based activities, intuitive design, and relatability with lived military experiences were identified as core strengths. Iterative feedback emphasized the importance of human-centered design in refining app functionality, esthetics, and information. These findings support REPS as a promising, scalable digital tool to enhance mental fitness and contribute to universal suicide prevention in the Navy.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89994","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:53:27Z","timestamp":1785527607000},"page":"e89994-e89994","source":"Crossref","is-referenced-by-count":0,"title":["Development of the Rational Thinking, Emotion Regulation, and Problem-Solving Mental Fitness Mobile App for US Navy Sailors: Qualitative and Quantitative Usability Evaluation"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1318-4043","authenticated-orcid":false,"given":"David P","family":"Cenkner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2228-0131","authenticated-orcid":false,"given":"Jennifer","family":"June","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1003-0399","authenticated-orcid":false,"given":"Stephen M","family":"Schueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5159-8431","authenticated-orcid":false,"given":"Alyson K","family":"Zalta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4280-0200","authenticated-orcid":false,"given":"Joseph","family":"Grammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9534-4038","authenticated-orcid":false,"given":"Eric","family":"Ekman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8823-1846","authenticated-orcid":false,"given":"Kailee","family":"Baldini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4040-4275","authenticated-orcid":false,"given":"Jessica M","family":"LaCroix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8377-3698","authenticated-orcid":false,"given":"Marjan","family":"Ghahramanlou-Holloway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"issue":"12","key":"R1","first-page":"2","volume":"31","author":"Armed Forces Health Surveillance Division","journal-title":"MSMR"},{"key":"R2","unstructured":"U.S. active duty military deaths by year and manner. Defense Casualty Analysis System. URL: https:\/\/dcas.dmdc.osd.mil\/dcas\/app\/summaryData\/deaths\/byYearManner [Accessed 13-04-2025]"},{"issue":"7","key":"R3","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1001\/jamapsychiatry.2016.0600","article-title":"Risk factors, methods, and timing of suicide attempts among US Army soldiers","volume":"73","author":"Ursano","journal-title":"JAMA Psychiatry"},{"issue":"9","key":"R4","doi-asserted-by":"publisher","first-page":"849","DOI":"10.7205\/milmed.171.9.849","article-title":"Stress, mental health, and job performance among active duty military personnel: findings from the 2002 Department of Defense Health-Related Behaviors Survey","volume":"171","author":"Hourani","journal-title":"Mil Med"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1521\/psyc.2013.76.2.97","article-title":"Suicide among soldiers: a review of psychosocial risk and protective factors","volume":"76","author":"Nock","journal-title":"Psychiatry"},{"key":"R6","unstructured":"Examination of mental health accession screening: predictive value of current measures and processes. Defense Health Board; 2020. URL: https:\/\/apps.dtic.mil\/sti\/pdfs\/AD1114379.pdf [Accessed 08-08-2025]"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2017.01.008","article-title":"A systematic review of help-seeking and mental health service utilization among military service members","volume":"53","author":"Hom","journal-title":"Clin Psychol Rev"},{"key":"R8","unstructured":"Ho TE Hesse CM Osborn MM et al. Mental health and help-seeking in the US military: survey and focus group findings. Defense Personnel and Security Research Center, Office of People Analytics; 2018. URL: https:\/\/apps.dtic.mil\/sti\/trecms\/pdf\/AD1059321.pdf [Accessed 22-07-2026]"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3933","article-title":"Internet-based cognitive behavioral therapy to reduce suicidal ideation: a systematic review and meta-analysis","volume":"3","author":"B\u00fcscher","journal-title":"JAMA Netw Open"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2024.102515","article-title":"Efficacy of app-based mobile health interventions for stress management: a systematic review and meta-analysis of self-reported, physiological, and neuroendocrine stress-related outcomes","volume":"114","author":"S\u00eerbu","journal-title":"Clin Psychol Rev"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1037\/ser0000289","article-title":"Veterans affairs and the Department of Defense mental health apps: a systematic literature review","volume":"16","author":"Gould","journal-title":"Psychol Serv"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2019.11.167","article-title":"Dropout rates in clinical trials of smartphone apps for depressive symptoms: a systematic review and meta-analysis","volume":"263","author":"Torous","journal-title":"J Affect Disord"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.10918","article-title":"Digital health and engagement-looking behind the measures and methods","volume":"3","author":"Torous","journal-title":"JAMA Netw Open"},{"issue":"3","key":"R14","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1136\/eb-2018-102891","article-title":"Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements","volume":"21","author":"Torous","journal-title":"Evid Based Ment Health"},{"issue":"5","key":"R15","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s10488-020-01038-x","article-title":"Designing the future of children\u2019s mental health services","volume":"47","author":"Lyon","journal-title":"Adm Policy Ment Health"},{"issue":"6","key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/35591","article-title":"Human-centered design approaches in digital mental health interventions: exploratory mapping review","volume":"9","author":"Vial","journal-title":"JMIR Ment Health"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1146\/annurev-publhealth-071823-122337","article-title":"Human-centered design to enhance implementation and impact in health","volume":"46","author":"Lyon","journal-title":"Annu Rev Public Health"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/24387","article-title":"Barriers to and facilitators of user engagement with digital mental health interventions: systematic review","volume":"23","author":"Borghouts","journal-title":"J Med Internet Res"},{"issue":"12","key":"R19","doi-asserted-by":"publisher","DOI":"10.2196\/31367","article-title":"Centering lived experience in developing digital interventions for suicide and self-injurious behaviors: user-centered design approach","volume":"8","author":"Kruzan","journal-title":"JMIR Ment Health"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/41422","article-title":"ReachCare mobile apps for patients experiencing suicidality in the emergency department: development and usability testing using mixed methods","volume":"7","author":"Larkin","journal-title":"JMIR Form Res"},{"key":"R21","unstructured":"Data statistics. MyNavy HR. URL: https:\/\/www.mynavyhr.navy.mil\/Support-Services\/Culture-Resilience\/Suicide-Prevention\/Data-Statistics\/ [Accessed 06-08-2025]"},{"key":"R22","unstructured":"Mongilio H . Enlisted sailors report high levels of stress in new Navy survey. USNI News. 2024. URL: https:\/\/news.usni.org\/2024\/02\/16\/enlisted-sailors-report-high-levels-of-stress-in-new-navy-survey [Accessed 06-08-2025]"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-022-00850-4","article-title":"Mental health and psychological wellbeing of maritime personnel: a systematic review","volume":"10","author":"Brooks","journal-title":"BMC Psychol"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7111","article-title":"Internet-delivered health interventions that work: systematic review of meta-analyses and evaluation of website availability","volume":"19","author":"Rogers","journal-title":"J Med Internet Res"},{"key":"R25","unstructured":"Care S Initiative R . Prevention, and Research Initiative Building Mastery of Rational-Thinking and Emotional-Regulation through Problem Solving (REPS) During Military Basic Training: Final Report. Uniformed Services University of the Health Sciences; 2022."},{"key":"R26","unstructured":"Ellis A Dryden W . The Practice of Rational-Emotive Therapy (RET). Springer Publishing Co; 1987:243. ISBN: 9780826154705"},{"issue":"4","key":"R27","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.appsy.2008.05.001","article-title":"A cognitive model of suicidal behavior: theory and treatment","volume":"12","author":"Wenzel","journal-title":"Appl Prev Psychol"},{"issue":"8S","key":"R28","doi-asserted-by":"publisher","first-page":"21","DOI":"10.7205\/MILMED-D-10-00073","article-title":"Psychological fitness","volume":"175","author":"Bates","journal-title":"Mil Med"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s11423-022-10084-1","article-title":"The effects of microlearning: a scoping review","volume":"70","author":"Taylor","journal-title":"Educ Technol Res Dev"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1186\/s12909-022-03726-8","article-title":"The effect of micro-learning on learning and self-efficacy of nursing students: an interventional study","volume":"22","author":"Zarshenas","journal-title":"BMC Med Educ"},{"issue":"3","key":"R31","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1080\/09639284.2024.2326009","article-title":"Improving retention while enhancing student engagement and learning outcomes using gamified mobile technology","volume":"34","author":"James","journal-title":"Account Educ"},{"key":"R32","doi-asserted-by":"crossref","unstructured":"Mayer RE . Multimedia learning. In: Psychology of Learning and Motivation. Academic Press; 2002:85-139. [doi: 10.1016\/S0079-7421(02)80005-6]","DOI":"10.1016\/S0079-7421(02)80005-6"},{"key":"R33","unstructured":"Merrill MD . First Principles of Instruction. John Wiley & Sons; 2012. ISBN: 978-0470900406"},{"key":"R34","doi-asserted-by":"crossref","unstructured":"Brooke J . SUS: a \u201cquick and dirty\u201d usability scale. In: Usability Evaluation In Industry. CRC Press; 1996. [doi: 10.1201\/9781498710411-35]","DOI":"10.1201\/9781498710411-35"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.3422","article-title":"Mobile App Rating Scale: a new tool for assessing the quality of health mobile apps","volume":"3","author":"Stoyanov","journal-title":"JMIR mHealth uHealth"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/1098214005283748","article-title":"A general inductive approach for analyzing qualitative evaluation data","volume":"27","author":"Thomas","journal-title":"Am J Eval"},{"key":"R38","unstructured":"Holtzblatt K Beyer H . Contextual Design: Design for Life. Morgan Kaufmann; 2016:532. ISBN: 978-0-12-800894-2"},{"key":"R39","unstructured":"Miles MB Huberman AM Salda\u00f1a J . Qualitative Data Analysis: A Methods Sourcebook. 4th ed. SAGE; 2020. ISBN: 9781506353074"},{"issue":"6","key":"R40","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1080\/10447310802205776","article-title":"An empirical evaluation of the System Usability Scale","volume":"24","author":"Bangor","journal-title":"Int J Hum-Comput Interact"},{"issue":"8","key":"R41","doi-asserted-by":"publisher","DOI":"10.2196\/37290","article-title":"System Usability Scale benchmarking for digital health apps: meta-analysis","volume":"10","author":"Hyzy","journal-title":"JMIR Mhealth Uhealth"},{"issue":"6","key":"R42","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1007\/s10488-013-0532-2","article-title":"Clinician perceptions of using a smartphone app with prolonged exposure therapy","volume":"41","author":"Kuhn","journal-title":"Adm Policy Ment Health"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2018.05.07","article-title":"VA mobile apps for PTSD and related problems: public health resources for veterans and those who care for them","volume":"4","author":"Owen","journal-title":"Mhealth"},{"issue":"4","key":"R44","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1176\/appi.ps.201600283","article-title":"A virtual hope box: randomized controlled trial of a smartphone app for emotional regulation and coping with distress","volume":"68","author":"Bush","journal-title":"Psychiatr Serv"},{"issue":"5","key":"R45","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1145\/1735223.1735255","article-title":"Number of people required for usability evaluation","volume":"53","author":"Hwang","journal-title":"Commun ACM"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:53:29Z","timestamp":1785527609000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e89994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":45,"URL":"https:\/\/doi.org\/10.2196\/89994","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"v10i12e89994"}}