The Stress Autism Mate app: a best practice for digitisation of care

Through digitisation, the healthcare sector is transforming and promising a healthier future. From virtual consultations to intelligent medical devices, digitisation has changed how we look at healthcare and the potential to improve quality of life.

Yvette Roke is a psychiatrist and has worked at GGZ Centraal since 2001. She started as an ANIOS (Arts Niet In Opleiding) and later trained as a psychiatrist. In 2013, Yvette obtained her PhD in research into the side effects of antipsychotics, mainly focusing on prolactin (a pregnancy hormone). Throughout her career, Yvette has been concerned with improving care.

Coen: What motivated you to develop an app for people with autism?
Yvette: Of course, there are therapies and medications available for this target group, but I realised that two crucial factors can worsen the situation: stress and sleep. By working on one of these factors, we can help people much more effectively than we do now.

I then sat down with 15 of my clients and their families. Topics were: how can we make sure clients understand themselves better? What do clients need to cope better with stressful situations? From there, a collaboration developed, and we developed a prototype of the SAM app.

Coen: Can you tell us more about the SAM app and its main goals in creating it?
Yvette: The main goal was to develop an app that supports people with autism in dealing with stress in everyday life. Stress doesn't always have to be negative. The app had to give people with autism an insight into their own 'instructions for use'. What goes well and what doesn't? And at what moments do things go less well? This is how you create insight into their well-being during the week and specific activities.
I believe that minor adjustments can lead to significant positive effects. One example is the time of shopping. The app shows that clients experience a lot of stress at certain times. Changing the time of shopping significantly reduced the client's stress. This gave the client a sense of control. The SAM app measures personal stress levels by asking about activities undertaken and experiences over the past four hours. With this, the app provides insight into emotional stress and how best to deal with it.

Coen: What makes the SAM app so innovative?
Yvette: What is revolutionary is that this app looks at patterns in stress levels. Instead of focusing on peak moments when stress is very high, the app analyses and concludes the practices. The app fits the user's needs well and gives the target group control. The power lies in discovering and controlling ways to lead to positive change—for example, shopping at a different time. Moreover, the app is scientifically validated and developed with professional expertise. Clients created it but within the context of a mental health institution.

Coen: How do users react to the app?
Yvette: Daily, we have about 2,500 active users. We get emails where people say the SAM app has changed their lives. People have gained insight into moments of stress and now understand where that stress comes from. Of course, it's not all positive: some people find the two daily notifications annoying, for example.
We also researched the effects of the app on the client. After one week of using the app, clients experience 30% less stress. In the process, self-efficacy doubled when more stressed. When users used the app for three months, the effects persisted for two months.

Coen: What were the most significant challenges during the app's development, and how did you overcome them?
Yvette: It wasn't easy to convince people to invest in developing the app. Many people were sceptical because so many apps already exist. I had to convince them that this was a worthwhile investment. We won an award with the app's prototype and received research grants. The award gave us recognition and built our credibility.

Coen: How can digital innovations further improve the quality of care in the healthcare sector?
Yvette: Digitalisation mainly offers clients more freedom of choice. With digital or hybrid care, they can receive care at a time and place that is most convenient for them. This can significantly benefit treatment. The possibilities are huge when you consider what digital tools can achieve. However, it depends on the clients whether digital care fits and whether they want it. Some clients avoid travelling and prefer digital care, while others value human contact. Moreover, the caregiver must have the right digital skills to deliver care effectively.

Coen: What are the biggest challenges and obstacles regarding digital innovations in healthcare?
Yvette: Realising the exchange of digital patient data is taking too long in the Netherlands. Surrounding countries are already further along with this. We all work with different systems, making integrating them complex. Naturally, privacy laws and regulations play a role in this. There are many obstacles and challenges.

Coen: Finally, how do you see the future of digital innovation, and what trends do you expect?
Yvette: Artificial intelligence has been around for a long time and is currently growing exponentially. We will have a lot to deal with this, including ethically. It brings significant challenges that need to be thought through carefully. Ultimately, we need to digitise mental healthcare, but the focus should be on the adaptation and implementation of these tools.