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Making Experience Sampling Work in Clinical Practice: a User Experience Approach

How do we design digital tools that people actually want to use to support their mental health? How do we ensure that they use these tools correctly, consistently, but also with a sense of value? These questions sit at the heart of User Experience (UX) research and design.

What is User Experience and why should we care about it?

The concept of User Experience was introduced by Don Norman in the 90’s. UX is used to describe all aspects of a person’s experience when interacting with a digital product. For instance, what people think before they use a digital product, how they feel when using it (e.g., is it easy or fun to do) and how they look back on their experiences afterwards (Nielsen Norman Group, 2024). Think back to the “unboxing videos” that dominated social media years ago, where influencers shared their first impressions while opening new products, like a brand-new iPhone. These videos perfectly illustrate the core elements of UX: anticipation, first impressions and emotional responses. A helpful way to understand and disentangle UX is to think about it through three pillars as described by Hartson & Pyla (2012):

• Usability is about how easy a tool is to use in practice. When usability is good, people can focus on what they want to do, rather than on how to use the system. For example, an app that opens quickly, is easy to navigate and works well on a smartphone, whereas with poor usability, screens are cluttered, loading times are slow, buttons hard to find and so on.
• Usefulness refers to whether users perceive the tool as valuable, and why it’s worth their time.
• Emotional impact includhes all emotional responses triggered before, during or after interacting with the tool. These emotions can range from frustration and annoyance, to pleasure and motivation to use the tool again.
  
  

Looking at digital tools through this UX lens helps explain why some interventions fail in practice, despite sounding promising on paper. Tools that feel confusing, irritating, or meaningless are unlikely to be used. In contrast, tools that are easy to use, feel relevant, and evoke positive emotions are more likely to support engagement. A well-known example is Duolingo, which combines simple interactions, clear goals, and playful elements and streaks to keep users motivated. So, a UX approach helps us to identify where and why engagement breaks down and how we can improve this.

Why UX matters for ESM-based digital tools in Mental Health Care?

Experience Sampling Methods (ESM) rely on repeated brief assessments throughout the day, often for several consecutive days (Myin-Germeys & Kuppens, 2021). Because these prompts appear in real-life contexts (e.g. when commuting, cooking, relaxing, going out for dinner), it needs to be easy to complete. If the assessment feels too burdensome, confusing or irrelevant, engagement can drop quickly. Those drops in engagement can be problematic because it will limit the insights that can be derived from the ESM data.

Importantly, UX also applies to clinicians. Given that ESM can generate large amount of data (often up to 70 data points per week), making sense of this data can be challenging. If the system and included visualizations feel overwhelming, difficult to navigate or to explain to your client, the added value of ESM can get lost, no matter how rich, interesting and clinically meaningful the data are. As one head of a clinical unit noted during the IMMERSE Phase I interviews: “People who work in mental health care are not always mathematically oriented.” This highlights the need for researchers to shift from a statistically oriented perspective to a more clinical mindset in order to develop tools that support intuitive sense-making, no matter what professional background you have.

The UX-project in IMMERSE

After implementing the ESM-based Digital Mobile Mental Health (DMMH) tool in IMMERSE, we conducted semi‑structured interviews with clients and clinicians to understand how they experienced the tool in practice. Across sites, 39 clients and 37 clinicians participated, including those who substantially engaged with it and those who discontinued earlier. We analyzed the interviews using a qualitative approach structured around the UX pillars from Hartson & Pyla (2012)

A first glimpse of the general UX findings

• Usability: Is the DMMH usable? Well ... both clinicians and clients needed some time to get to know the DMMH, but most reported improvements over time. Technical issues with the DMMH (e.g., not receiving the notifications) or having limited data to discuss during therapy sessions sometimes hindered meaningful interpretation of the ESM data.
• Usefulness: Do they find it useful? Yes! ESM was seen as valuable for stimulating self‑reflection, awareness, but also communication during sessions. It gave them something concrete to talk about. Clinicians noted that ESM can help to structure sessions and be more prepared. Importantly, clinicians also emphasized that it may not be equally useful for all clients, therapeutic stages, or contexts (e.g. when clients are fully hospitalized).
• Emotional impact: How do they feel about it? Positive emotions such as motivation, fascination were often tied to the perceived usefulness (e.g. when finding out more of their symptoms), while negative emotions (e.g., burden, stress from prompts) were mostly related to the design and ESM procedure, such as the number of beeps or the limited time to respond to a beep.
• Engagement: Client engagement was dynamic, influenced by fluctuations in mood and daily circumstances. Engagement tended to decrease during periods of symptom relapse, and clients were more likely to respond to prompts when alone at home than when at school or in social situations.

Our findings suggest that ESM holds value for clients and clinicians, but it also depends on how it is experienced in daily life. By also understanding where friction occurs, we can refine the DMMH so they better fit therapeutic routines.

More ongoing UX work

In addition to the general UX findings, three follow‑up subprojects are currently underway:

• The clinician-focused project aims to identify shared patterns of experience and contribute to the development of clinician user-types (also called personas in UX research and design), which can inform strategies that will help clinicians to use the DMMH in therapy.
• The client-focused projects aim to examine 1) the relationship between UX and engagement (van Lee et al., 2025), and 2) whether UX differs across individuals with different psychiatric diagnoses (Adriaensen et al., 2025).
  
  

Together, these projects reflect our assumption that not all users experience ESM or its relevance in mental health care in the same way.

References

Adriaensen, F., van Lee, M., Uyttebroek, L., Myin-Germeys & Beames, J. R. (2025). Does UX of an ESM Tool in Mental Healthcare Differ across Service Users. AsPredicted. https://aspredicted.org/g2z752.pdf

Hartson, R., & Pyla, P. S. (2012). The UX Book: Processes and Guidelines for Ensuring a quality user experience. Elsevier.

Myin-Germeys, I., & Kuppens, P. (2022). The open handbook of experience sampling methodology: A step-by-step guide to designing, conducting, and analyzing ESM studies (2 ed.).

Nielsen Norman Group (2024, November 15). What is User Experience (and What is it Not?). https://www.nngroup.com/articles/what-is-user-experience/ (Accessed on January 14^th 2026)

 ISO. (2019). Ergonomics of human-system interaction - Part 210: Human-centred design for interactive systems (2 ed.).

Uyttebroek, L., Beames, J. R., Dr, Wolters, M. K., Wensing, M., Schick, A., Schwannauer, M., & Myin-Germeys, I. (2025, February 25). User Experience during Deployment of a Digital Mobile Mental Health Intervention: Secondary Analysis of Process Evaluation data in Clinicians and Service Users in four European Countries. https://doi.org/10.17605/OSF.IO/45NMG

van Lee, M., Adriaensen, F., Uyttebroek, L., Myin-Germeys, I., & Beames, J. R. (2025). User Experience and Engagement with a Novel Digital Tool: A Qualitative Study. AsPredicted. https://aspredicted.org/g2z752.pdf