A mobile application to reduce death anxiety during the covid-19 pandemic: design of a high-fidelity prototype

A mobile application to reduce death anxiety during the covid-19 pandemic: design of a high-fidelity prototype | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A mobile application to reduce death anxiety during the covid-19 pandemic: design of a high-fidelity prototype Aliakbar Shakeri, Hamid Reza Saeidnia, Hamid Keshavarz, Afshin Babajani, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2012924/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Individuals, organizations and society were all affected during the COVID-19 pandemic, which increased the level of death anxiety among people and patients. In cases of anxiety disorders such as death anxiety, exposure therapy is an effective and basic treatment method for which developing mobile-based applications and contents would help medical practitioners significantly. The current research aimed at reducing the burden of COVID-19 death anxiety by developing a prototype for a proposed mobile application. Methods The current article presents findings from an early project stage namely Exposure Therapy in Iran in which multiple interviews were conducted with psychologists for identifying criteria for content production. Afterward, two online workshops were held to develop a prototype for the user interface of the proposed application. Result Based on the interviews, contents on subjects like near-death experiences, habit control, death imagery, self-confidence, and anxiety management are the most essential criteria to be included in the mobile application. The online workshops emphasized the ease of use and usefulness of the mobile application. Finally, a prototype was designed as an initial version with the Figma software through high-fidelity technique. Conclusions For designing and developing suitable applications to relieve the anxiety caused by COVID-19 death, the identified criteria for content production and the proposed prototype would help software designers to develop related applications in the current challenging time. prototyping mobile applications death anxiety COVID-19 pandemic exposure therapy mental health Figures Figure 1 Introduction The COVID-19 pandemic has affected human societies at individual, organizational and social levels. Psychological issues and disorders are considered significant consequences of this pandemic era ( 1 , 2 ). It is even predicted that the affective issues of this pandemic would not disappear until a long time after it's over ( 3 , 4 ). Psychologically, this pandemic involves more tangible conceptualizations of death than before ( 5 ). These consequences have manifested themselves in such cases as anxiety, fear of self-death or loved ones, missing opportunity to say farewell to the loved ones, limitations in mourning rituals, procrastination or limitation in consolation and even feeling guilty caused by not being able to act according to the deceased's will ( 5 , 6 ). Mobile health (mHealth) services like calls (audio, video), apps (WhatsApp, zoom, Instagram), messages (text, audio, picture, video) would be considered a significant way for reducing death anxiety of people and patients during this pandemic ( 7 – 9 ). Moreover, mHealth is the process of using remote communication tools to promote clinical and public health practices. Different findings suggest that death anxiety would trigger anxious behaviors for those who are vulnerable to health-related worries. Mobile applications for contact tracing, symptom monitoring and information provision are among the critical applications developed to manage the COVID-19 pandemic ( 10 ). The findings of these studies along with the results of a review in 2019 ( 11 ) show that applications play a key role in reducing the symptoms of depression ( 11 ). Besides the patients, physicians’ attitude toward the use of mobile-based interventions is positive and promising. Physicians’ and patients’ acceptance of mobile applications in this field contributes to the use of mobile-based devices for self-management in mental diseases. Due to the notable limitations of the pandemic (e.g., the quarantine, less social contact, and consequently less face-to-face referral to care-providing centers), attention has been drawn to telehealth approaches to facilitate mental health-related services ( 12 , 13 ). Due to the effectiveness of mobile-based interventions in the mental health domain, during the pandemic, mobile-based interventions can be used as non-drug interventions with almost no adverse effect on the COVID-19 patients. These can help reduce depression and anxiety ( 14 ). Nowadays, much research is considered on death anxiety and fear as well as its roots, consequences, and management strategies ( 15 , 16 ). This phenomenon is understood as endangering life in everyday interactions ( 17 ). Fear or anxiety of death is an important concept in a wide range of health-related communications like cancer screening, psychiatric care, acute and traumatic care, chronic and pediatric disease care, and care for people with life-threatening and chronic diseases ( 18 ). However, the COVID-19 pandemic appears to have caused anxiety and fear of death on a wider range and a new scale ( 19 , 20 ). Natural exposure to death can reduce the anxiety of death during accidents and disasters. In addition, numerous studies suggested that death threats have been replaced by feelings of aliveness and even belief in the afterlife during serious accidents and illnesses ( 21 , 22 ). A noteworthy fact about exposure therapy is that it is one of the fundamental treatments for anxiety disorders ( 23 , 24 ) such as death anxiety ( 25 ). In the current situation, media and software could play an important role in reducing panic situations, distributing appropriate services and information in the form of smart personal assistants that helps users manage such horrible situations ( 12 , 13 ). The current research aimed at developing a mobile application through which we can reduce death anxiety during the pandemic period of coronavirus. The project applies a user-centered design process and the outcome will be an exposure therapy tool for reducing the burden of COVID-19 death anxiety. This paper presents the results from an early project Exposure Therapy in Iran. We set out to respond to the following research questions (RQs): RQ1: In the mobile application exposure therapy, which applicable content should be to reduce the burden of COVID -19 death anxiety? RQ2: In the mobile application exposure therapy, which elements should be incorporated into the user interface? Literature review James, believed that death anxiety is ‘the worm at the core’ in the human psyche ( 26 ). The situation is being exacerbated by the outbreak of the coronavirus in the past 1.5 years. Early findings suggest that fears of death predict anxiety about the virus, which in turn is shown to predict broader psychological pressure ( 19 ). Several exposure therapy tasks could be considered to have been recommended to reduce the death anxiety like ‘illness story’ ( 27 ), which means writing a vivid description of the death of oneself or loved ones. Acceptance and commitment therapies are also useful, which involves imagining one’s funeral and writing one’s eulogy ( 28 ). As a transdiagnostic construct, death anxiety, is now more relevant because of the COVID-19 pandemic, which could result in some mental health disorders ( 29 ). Martínez-López, Lázaro-Pérez and Gómez-Galán (2021) explored recently the levels of anxiety about death among social workers in Spain. Using two valid questionnaires, they showed high values of death anxiety among social workers in a way Fear of Death of Others and Fear of the Process of Dying of Others were the most common ones ( 30 ). They mentioned a lack of personal protection equipment and a need for psychological or psychiatric support ( 30 ). Some activities driven by cognitive behavior therapy (CBT) could contribute more to the improvements in death fears compared with other treatment procedures ( 31 ). As Hanbehzadeh et al. (2020) mentioned, using information and monitoring systems and data management protocols between stakeholders in different sectors can reduce the burden of disease on society ( 32 ). Terror management theory (TMT), as a social psychological theory is a well-known framework for explaining death fears in human behavior ( 33 ), in a way we could develop two distinct buffers: cultural worldviews, and self-esteem. In a research, Ahorsu et al., the questionnaire item ‘I am afraid of losing my life because of coronavirus-19’ had the highest factor loading, indicating the severity of the problem ( 34 ). The results of a study by Meng et al, on 1556 elderly people showed that 37% of them suffered from depression and anxiety during the COVID-19 pandemic ( 35 ). Guner, Erdogan and Demir, explored 354 elderly who meet in Turkey. They found acceptable levels of loneliness and moderate death anxiety among elderly people. The scale scores were found to be statistically significant among the elderly who have increased worries, or have a hobby at home, or communicate with their relatives via social media/mobile phones ( 36 ). Rababa, Hayajneh and Bani‑Iss, found out that female older adults were found to have higher levels of religious coping and lower levels of death anxiety during the COVID-19 pandemic. They concluded that religious coping and spiritual well-being were found to be significant predictors of death anxiety in older adults ( 37 ). Methods And Materials The Exposure Therapy project employs a user-centered design approach for developing the user interface of the proposed application. The project will be conducted in five-stage: 1) identifying data requirements, 2) developing the application, 3) pre-implementation, 4) implementation and 5) usability and clinical evaluation among end-users. The project is in an early stage, and this paper reports on the first stage, where 14 psychologists and 18 experts helped us identify and collect the data required for the application. For the response to the first question, we focused on identifying appropriate content for reducing death anxiety during the pandemic. For doing so, semi-structured interviews were conducted with eight clinical psychologists and six general psychologists at Shiraz Medical Sciences University, Shiraz, Iran, who were assigned to the study randomly. The sampling process was not conducted because of the sample size limit, and they included all people in the investigation. The data was analyzed using a simple content analysis methodology. We analyzed the data into the primary codes, then into primary and secondary categories. Interviews were written verbatim and imported into the MAXQDA software in the order they were done. Subsequent interviews were arranged and conducted based on the analysis process. Data collection continued until no new primary code or category was obtained. The two last interviews were done to ensure data saturation. The mean duration of interviews was 73 minutes, with a range of 45–127 minutes. We tried to help the interviews become deeper by using probing questions. Some interview questions were as follows: What is the definition of death? Does the visualization of dying increase or decrease the fear of death? How typical is the stress of dying? Is it possible to reduce the fear of death by preparing yourself? What contexts are suitable for reducing the stress of death? As for the second question, experts were selected through purposive sampling. Based on previous research, we tried to recruit 15–24 experts ( 38 , 39 ). Our recruitment was advertised on social media including Instagram, Telegram and WhatsApp via online registration. During April - May 2021, 18 people, including six females and twelve men, aged 42 on average, participated in two co-creation online workshops. They have sufficient experience in human factors in developing mobile applications, psychology, health science, medical informatics, and user interface design. In the first workshop, we introduced the research team and project goals. We explained the user-centered design process and asked about their commitment to the project. The second online workshop addressed the RQ2. Experts were also asked to describe user needs and how the application should work via word format notes and tips. All participants then presented their suggestions to the research group. During the online workshops, which lasted on average about four hours, we collected video recordings and comments. Qualitative methods were used to analyze and categorize the user's needs and requirements. Figma is used to draw the user interface of the high-fidelity prototyping mobile application as a cloud-based design software. Following this step and after the experts agreed to the alpha version of the high-fidelity prototype of the mobile application, we tried to evaluate the high-fidelity prototype using the heuristic evaluation method regarding the alpha version to establish the final version. In doing so, we asked five experts in the field of user experience design for health applications. We provided the prototype to the experts and asked them to evaluate the prototype based on the heuristic method using Shneiderman’s eight golden rules ( 40 ) as well as Nielsen's five-point Severity Ranking Scale ( 41 ). The eight heuristics were: 1) strive for consistency, 2) seek universal usability, 3) offer informative feedback, 4) design dialogs to yield closure, 5) prevent errors, 6)permit easy reversal of actions, 7) keep users in control, and 8) reduce short-term memory load ( 40 ). Also, Nielsen's five-point Severity Ranking Scale is rated from 0 to 4, with 0 being the lowest severity, equivalent to "I do not think this is a usability issue", 1 equivalent "No need to fix unless the project can be extended", 2 equivalent "not a high priority", 3 equivalent "should be fixed as soon as possible" and rate 4 for the utmost severity as "Must be fixed before the product can be released." ( 41 ). Findings RQ1 As a result of the interviews, the specialists agreed on the following issues to be considered in developing the proposed application: near-death experiences, death imagery, control habit, anxiety management, fear management, self-confidence, emotion processing, and spirituality. In developing a mobile application, these topics should be considered as fundamental textual requirements as follows: Near-death experiences “ a vivid, realistic, and personal experience that is often triggered by life-threatening situations, such as cardiac arrest or respiratory arrest, head injury, or shock. A transcendental experience is usually characterized by an understanding of being separated from the physical body and being in a different spatial and temporal location. ” Death imagery “ a way of confronting a terrible phenomenon that can reduce fears of death. ” Control habit “ To control habits, or rather to manage habits, we must first have sufficient motivation to control that behavior. Changing a habit is easier when that change is valuable to the person. ” Anxiety management “ One of the problems of today's society is increasing stress and anxiety. To manage this issue, various methods such as cognitive therapy, behavioral therapy, and schema therapy are used. ” Fear management “ Fears are often normal but sometimes appear abnormal. Fear management helps a person avoid abnormal fears .” Self-confidence “ Self-confidence is the belief in one's abilities. ” Emotion processing “ Emotional processing is the process by which emotional disturbances are managed. Emotional processing plays an important role in managing anxiety .” Spirituality “ Spirituality includes the sacred or unseen, moral values, religion, mysticism, and all types of meaning to life. Spirituality is considered by many religions to be a true dimension of religion .” RQ2 Workshop participants agreed that an effective user interface should incorporate the following elements: The logo of the mobile application must be clear and unique; the application should always have a splash screen and in the first installation have an intro slider; feature showcase must be used to introduce the option mobile application so that different parts can be better introduced to users; the action bar of the mobile application should display their title clearly and include help and setting buttons; the application settings should include adjusting font size, line spacing, text color, and dark mode; users must be able to access their data like activity level and search history from a user account, to view trends and historical data, to use the simple and advanced search and always have an action bar to suggest relevant content. On-based benefiting from Figma, a prototype of the mobile application was created with suggestions for user interface design and preferred methods of interaction (Fig. 1 ). Evaluation of the high-fidelity prototype The results of a heuristic evaluation of the high-fidelity prototype showed that it is a well-designed user interface since it scored between 0 and 2 for most of Shneiderman's eight golden rules. Table 1 represents the results where ΣA refers to the total number of points scaled for each item in Shneiderman's eight golden rules. ΣB is the same as ΣA; however, it was classified by eliminating duplicate point scales, which finally resulted in a total ΣA 37 and ΣB 28 (Table 1 ). Table 1 Distribution of Frequency and Severity Scores by 8 golden rules Heuristic principle ΣA 1 ΣB 2 1 3 2 3 4 5 Strive for consistency 4 3 0 1 2 1 0 Seek universal usability 2 2 0 0 0 0 2 Offer informative feedback 4 3 1 1 0 2 0 Design dialogs to yield closure 2 1 0 1 0 0 1 Prevent errors 7 6 0 1 1 2 3 Permit easy reversal of actions 3 1 0 0 1 1 1 Keep users in control 8 6 1 2 1 1 3 Reduce short-term memory load 7 6 1 0 1 2 3 Total 37 28 3 6 6 9 13 1-A: number of point scale; 2-B: number of kinds of point scale (number of point scale with the removal of duplicates); 3: each expert's number. Discussion As a result of the psychologists' perspective on the proposed mobile application based on exposure therapy, they are on a set of criteria including near-death experiences, habit control, death imagery, life's final moments, anxiety management, and fear management. In a similar study, Saeidnia et al. (2020) Obtained the content used in a self-care mobile application during the coronavirus to prevent COVID-19, using a questionnaire and the opinions of self-care experts to find the appropriate content for the self-care mobile application ( 42 ). For this study, we also collected experts’ opinions and utilized an interview procedure. In many studies, literature reviews, questionnaire design, and opinion polls of experts are used to determine what content and technical features for mobile applications are appropriate ( 42 ). A second question explored the participants of the online workshop about the features of high significance in developing the interface of a mobile application based on exposure therapy. They emphasized the ease of usage and usefulness of the application as important considerations. Smaradottir et al. (2020) developed a mobile application to manage chronic pains through two workshops. They asked participants to eventually draw their prototypes on paper, thus gaining a prototype of the mobile application for chronic pains ( 43 ). During this study, we also conducted online workshops to determine the user interface features of the mobile application based on exposure therapy. After identifying the requirements, we asked participants to draw their desired prototype on paper. In this study, the prototype was finalized, which is essential for designing the following application stages. As prototypes would allow designers to talk to users, resolve disagreements, reduce poor communication, and test ideas without investing a ton of time and money in programming ( 44 , 45 ), the proposed prototype could shed light on research in this area. Finally, and it is crucial to note, maintaining mental health in the COVID-19 era is an important and necessary task; therefore, numerous recommendations have been made by the WHO and the Mental Health Foundation on different subjects and for different ages. Some limitations of this study include a small number of survey respondents. Despite this, the study participants were representative of the application's users. Conclusion We addressed both of the research questions relating to the first stage of the Exposure Therapy project in this study. We analyzed important contents from the perspective of psychologists as a response to the first question regarding content essential for the proposed mobile application. Concerning the second question, we focused on the features of the user interface. Moreover, we finalized the prototype, a key step in designing and developing the application. Mobile exposure therapy applications can use these contents as indicators and headings. Furthermore, these contents and user interface elements can also be utilized by exposure therapy providers for mental health purposes. Declarations Ethics approval and consent to participate: Participants in the semi-structured interview (psychologists and experts) provided informed consent. All participants' information was kept confidential, and we respected their privacy during the collection phase. There was full approval of the study protocol by the Ethics Committee of Tarbiat Modares University (IR. MODARES. REC.1399.142). In addition, we performed all methods according to the relevant guidelines and regulations, including the Declaration of Helsinki. Consent for publication: Not applicable. Availability of data and materials: Please contact the corresponding author if you would like access to the datasets used and/or analyzed during this study. Competing interests : Not applicable. Funding : Not applicable. 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Saeidnia H, Mohammadzadeh Z, Saeidnia M, Mahmoodzadeh A, Ghorbani N, Hasanzadeh M. Identifying Requirements of a Self-care System on smartphones for preventing coronavirus disease 2019 (COVID-19). Iran J Med Microbiol. 2020;14(3):241–6. Smaradottir B, Fagerlund AJ, Bellika JG. User-centred design of a mobile application for chronic pain management. 2020. Luchs MG. A brief introduction to design thinking. Design thinking: New product development essentials from the PDMA. 2015:1–12. Saeidnia HR, Karajizadeh M, Mohammadzadeh Z, Abdoli S, Hassanzadeh M. Usability Evaluation of the Mask Mobile Application: The Official Application of the Iranian Government. Iran J Med Microbiol. 2022;16(1):49–55. Additional Declarations No competing interests reported. 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Psychological issues and disorders are considered significant consequences of this pandemic era (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). It is even predicted that the affective issues of this pandemic would not disappear until a long time after it\u0026apos;s over (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Psychologically, this pandemic involves more tangible conceptualizations of death than before (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). These consequences have manifested themselves in such cases as anxiety, fear of self-death or loved ones, missing opportunity to say farewell to the loved ones, limitations in mourning rituals, procrastination or limitation in consolation and even feeling guilty caused by not being able to act according to the deceased\u0026apos;s will (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eMobile health (mHealth) services like calls (audio, video), apps (WhatsApp, zoom, Instagram), messages (text, audio, picture, video) would be considered a significant way for reducing death anxiety of people and patients during this pandemic (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). Moreover, mHealth is the process of using remote communication tools to promote clinical and public health practices. Different findings suggest that death anxiety would trigger anxious behaviors for those who are vulnerable to health-related worries.\u003c/p\u003e\n\u003cp\u003eMobile applications for contact tracing, symptom monitoring and information provision are among the critical applications developed to manage the COVID-19 pandemic (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). The findings of these studies along with the results of a review in 2019 (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e) show that applications play a key role in reducing the symptoms of depression (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). Besides the patients, physicians\u0026rsquo; attitude toward the use of mobile-based interventions is positive and promising. Physicians\u0026rsquo; and patients\u0026rsquo; acceptance of mobile applications in this field contributes to the use of mobile-based devices for self-management in mental diseases. Due to the notable limitations of the pandemic (e.g., the quarantine, less social contact, and consequently less face-to-face referral to care-providing centers), attention has been drawn to telehealth approaches to facilitate mental health-related services (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). Due to the effectiveness of mobile-based interventions in the mental health domain, during the pandemic, mobile-based interventions can be used as non-drug interventions with almost no adverse effect on the COVID-19 patients. These can help reduce depression and anxiety (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eNowadays, much research is considered on death anxiety and fear as well as its roots, consequences, and management strategies (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). This phenomenon is understood as endangering life in everyday interactions (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). Fear or anxiety of death is an important concept in a wide range of health-related communications like cancer screening, psychiatric care, acute and traumatic care, chronic and pediatric disease care, and care for people with life-threatening and chronic diseases (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). However, the COVID-19 pandemic appears to have caused anxiety and fear of death on a wider range and a new scale (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eNatural exposure to death can reduce the anxiety of death during accidents and disasters. In addition, numerous studies suggested that death threats have been replaced by feelings of aliveness and even belief in the afterlife during serious accidents and illnesses (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). A noteworthy fact about exposure therapy is that it is one of the fundamental treatments for anxiety disorders (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e) such as death anxiety (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn the current situation, media and software could play an important role in reducing panic situations, distributing appropriate services and information in the form of smart personal assistants that helps users manage such horrible situations (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). The current research aimed at developing a mobile application through which we can reduce death anxiety during the pandemic period of coronavirus. The project applies a user-centered design process and the outcome will be an exposure therapy tool for reducing the burden of COVID-19 death anxiety. This paper presents the results from an early project Exposure Therapy in Iran. We set out to respond to the following research questions (RQs):\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRQ1: \u003c/em\u003e\u003c/strong\u003e\u003cem\u003eIn the mobile application exposure therapy, which applicable content should be to reduce the burden of\u003c/em\u003e COVID\u003cem\u003e-19 death anxiety?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRQ2:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eIn the mobile application exposure therapy, which elements should be incorporated into the user interface?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJames, believed that death anxiety is \u0026lsquo;the worm at the core\u0026rsquo; in the human psyche (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). The situation is being exacerbated by the outbreak of the coronavirus in the past 1.5 years. Early findings suggest that fears of death predict anxiety about the virus, which in turn is shown to predict broader psychological pressure (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). Several exposure therapy tasks could be considered to have been recommended to reduce the death anxiety like \u0026lsquo;illness story\u0026rsquo; (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e), which means writing a vivid description of the death of oneself or loved ones. Acceptance and commitment therapies are also useful, which involves imagining one\u0026rsquo;s funeral and writing one\u0026rsquo;s eulogy (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAs a transdiagnostic construct, death anxiety, is now more relevant because of the COVID-19 pandemic, which could result in some mental health disorders (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). Mart\u0026iacute;nez-L\u0026oacute;pez, L\u0026aacute;zaro-P\u0026eacute;rez and G\u0026oacute;mez-Gal\u0026aacute;n (2021) explored recently the levels of anxiety about death among social workers in Spain. Using two valid questionnaires, they showed high values of death anxiety among social workers in a way Fear of Death of Others and Fear of the Process of Dying of Others were the most common ones (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). They mentioned a lack of personal protection equipment and a need for psychological or psychiatric support (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eSome activities driven by cognitive behavior therapy (CBT) could contribute more to the improvements in death fears compared with other treatment procedures (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e). As Hanbehzadeh et al. (2020) mentioned, using information and monitoring systems and data management protocols between stakeholders in different sectors can reduce the burden of disease on society (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTerror management theory (TMT), as a social psychological theory is a well-known framework for explaining death fears in human behavior (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e), in a way we could develop two distinct buffers: cultural worldviews, and self-esteem. In a research, Ahorsu et al., the questionnaire item \u0026lsquo;I am afraid of losing my life because of coronavirus-19\u0026rsquo; had the highest factor loading, indicating the severity of the problem (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe results of a study by Meng et al, on 1556 elderly people showed that 37% of them suffered from depression and anxiety during the COVID-19 pandemic (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). Guner, Erdogan and Demir, explored 354 elderly who meet in Turkey. They found acceptable levels of loneliness and moderate death anxiety among elderly people. The scale scores were found to be statistically significant among the elderly who have increased worries, or have a hobby at home, or communicate with their relatives via social media/mobile phones (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e). Rababa, Hayajneh and Bani‑Iss, found out that female older adults were found to have higher levels of religious coping and lower levels of death anxiety during the COVID-19 pandemic. They concluded that religious coping and spiritual well-being were found to be significant predictors of death anxiety in older adults (\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cp\u003eThe Exposure Therapy project employs a user-centered design approach for developing the user interface of the proposed application. The project will be conducted in five-stage: 1) identifying data requirements, 2) developing the application, 3) pre-implementation, 4) implementation and 5) usability and clinical evaluation among end-users. The project is in an early stage, and this paper reports on the first stage, where 14 psychologists and 18 experts helped us identify and collect the data required for the application.\u003c/p\u003e \u003cp\u003eFor the response to the first question, we focused on identifying appropriate content for reducing death anxiety during the pandemic. For doing so, semi-structured interviews were conducted with eight clinical psychologists and six general psychologists at Shiraz Medical Sciences University, Shiraz, Iran, who were assigned to the study randomly. The sampling process was not conducted because of the sample size limit, and they included all people in the investigation. The data was analyzed using a simple content analysis methodology. We analyzed the data into the primary codes, then into primary and secondary categories. Interviews were written verbatim and imported into the \u003cem\u003eMAXQDA\u003c/em\u003e software in the order they were done. Subsequent interviews were arranged and conducted based on the analysis process. Data collection continued until no new primary code or category was obtained. The two last interviews were done to ensure data saturation. The mean duration of interviews was 73 minutes, with a range of 45\u0026ndash;127 minutes.\u003c/p\u003e \u003cp\u003eWe tried to help the interviews become deeper by using probing questions. Some interview questions were as follows: What is the definition of death? Does the visualization of dying increase or decrease the fear of death? How typical is the stress of dying? Is it possible to reduce the fear of death by preparing yourself? What contexts are suitable for reducing the stress of death?\u003c/p\u003e \u003cp\u003eAs for the second question, experts were selected through purposive sampling. Based on previous research, we tried to recruit 15\u0026ndash;24 experts (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Our recruitment was advertised on social media including Instagram, Telegram and WhatsApp via online registration. During April - May 2021, 18 people, including six females and twelve men, aged 42 on average, participated in two co-creation online workshops. They have sufficient experience in human factors in developing mobile applications, psychology, health science, medical informatics, and user interface design.\u003c/p\u003e \u003cp\u003eIn the first workshop, we introduced the research team and project goals. We explained the user-centered design process and asked about their commitment to the project. The second online workshop addressed the RQ2. Experts were also asked to describe user needs and how the application should work via word format notes and tips. All participants then presented their suggestions to the research group. During the online workshops, which lasted on average about four hours, we collected video recordings and comments. Qualitative methods were used to analyze and categorize the user's needs and requirements. Figma is used to draw the user interface of the high-fidelity prototyping mobile application as a cloud-based design software.\u003c/p\u003e \u003cp\u003eFollowing this step and after the experts agreed to the alpha version of the high-fidelity prototype of the mobile application, we tried to evaluate the high-fidelity prototype using the heuristic evaluation method regarding the alpha version to establish the final version. In doing so, we asked five experts in the field of user experience design for health applications. We provided the prototype to the experts and asked them to evaluate the prototype based on the heuristic method using Shneiderman\u0026rsquo;s eight golden rules (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) as well as Nielsen's five-point Severity Ranking Scale (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The eight heuristics were: 1) strive for consistency, 2) seek universal usability, 3) offer informative feedback, 4) design dialogs to yield closure, 5) prevent errors, 6)permit easy reversal of actions, 7) keep users in control, and 8) reduce short-term memory load (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Also, Nielsen's five-point Severity Ranking Scale is rated from 0 to 4, with 0 being the lowest severity, equivalent to \"I do not think this is a usability issue\", 1 equivalent \"No need to fix unless the project can be extended\", 2 equivalent \"not a high priority\", 3 equivalent \"should be fixed as soon as possible\" and rate 4 for the utmost severity as \"Must be fixed before the product can be released.\" (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e"},{"header":"Findings","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eRQ1\u003c/h2\u003e\n\u003cp\u003eAs a result of the interviews, the specialists agreed on the following issues to be considered in developing the proposed application: near-death experiences, death imagery, control habit, anxiety management, fear management, self-confidence, emotion processing, and spirituality. In developing a mobile application, these topics should be considered as fundamental textual requirements as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNear-death experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003ea vivid, realistic, and personal experience that is often triggered by life-threatening situations, such as cardiac arrest or respiratory arrest, head injury, or shock. A transcendental experience is usually characterized by an understanding of being separated from the physical body and being in a different spatial and temporal location.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeath imagery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003ea way of confronting a terrible phenomenon that can reduce fears of death.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControl habit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eTo control habits, or rather to manage habits, we must first have sufficient motivation to control that behavior. Changing a habit is easier when that change is valuable to the person.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eOne of the problems of today's society is increasing stress and anxiety. To manage this issue, various methods such as cognitive therapy, behavioral therapy, and schema therapy are used.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eFears are often normal but sometimes appear abnormal. Fear management helps a person avoid abnormal fears\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-confidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eSelf-confidence is the belief in one's abilities.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmotion processing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eEmotional processing is the process by which emotional disturbances are managed. Emotional processing plays an important role in managing anxiety\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpirituality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eSpirituality includes the sacred or unseen, moral values, religion, mysticism, and all types of meaning to life. Spirituality is considered by many religions to be a true dimension of religion\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eRQ2\u003c/h2\u003e\n\u003cp\u003eWorkshop participants agreed that an effective user interface should incorporate the following elements: The logo of the mobile application must be clear and unique; the application should always have a splash screen and in the first installation have an intro slider; feature showcase must be used to introduce the option mobile application so that different parts can be better introduced to users; the action bar of the mobile application should display their title clearly and include help and setting buttons; the application settings should include adjusting font size, line spacing, text color, and dark mode; users must be able to access their data like activity level and search history from a user account, to view trends and historical data, to use the simple and advanced search and always have an action bar to suggest relevant content. On-based benefiting from Figma, a prototype of the mobile application was created with suggestions for user interface design and preferred methods of interaction (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003eEvaluation of the high-fidelity prototype\u003c/h2\u003e\n\u003cp\u003eThe results of a heuristic evaluation of the high-fidelity prototype showed that it is a well-designed user interface since it scored between 0 and 2 for most of Shneiderman's eight golden rules. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e represents the results where \u0026Sigma;A refers to the total number of points scaled for each item in Shneiderman's eight golden rules. \u0026Sigma;B is the same as \u0026Sigma;A; however, it was classified by eliminating duplicate point scales, which finally resulted in a total \u0026Sigma;A 37 and \u0026Sigma;B 28 (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of Frequency and Severity Scores by 8 golden rules\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHeuristic principle\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026Sigma;A\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026Sigma;B\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStrive for consistency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSeek universal usability\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOffer informative feedback\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDesign dialogs to yield closure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevent errors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePermit easy reversal of actions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKeep users in control\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduce short-term memory load\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e1-A: number of point scale; 2-B: number of kinds of point scale (number of point scale with the removal of duplicates); 3: each expert's number.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs a result of the psychologists' perspective on the proposed mobile application based on exposure therapy, they are on a set of criteria including near-death experiences, habit control, death imagery, life's final moments, anxiety management, and fear management. In a similar study, Saeidnia et al. (2020) Obtained the content used in a self-care mobile application during the coronavirus to prevent COVID-19, using a questionnaire and the opinions of self-care experts to find the appropriate content for the self-care mobile application (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). For this study, we also collected experts\u0026rsquo; opinions and utilized an interview procedure. In many studies, literature reviews, questionnaire design, and opinion polls of experts are used to determine what content and technical features for mobile applications are appropriate (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA second question explored the participants of the online workshop about the features of high significance in developing the interface of a mobile application based on exposure therapy. They emphasized the ease of usage and usefulness of the application as important considerations. Smaradottir et al. (2020) developed a mobile application to manage chronic pains through two workshops. They asked participants to eventually draw their prototypes on paper, thus gaining a prototype of the mobile application for chronic pains (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). During this study, we also conducted online workshops to determine the user interface features of the mobile application based on exposure therapy. After identifying the requirements, we asked participants to draw their desired prototype on paper. In this study, the prototype was finalized, which is essential for designing the following application stages. As prototypes would allow designers to talk to users, resolve disagreements, reduce poor communication, and test ideas without investing a ton of time and money in programming (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), the proposed prototype could shed light on research in this area.\u003c/p\u003e \u003cp\u003eFinally, and it is crucial to note, maintaining mental health in the COVID-19 era is an important and necessary task; therefore, numerous recommendations have been made by the WHO and the Mental Health Foundation on different subjects and for different ages. Some limitations of this study include a small number of survey respondents. Despite this, the study participants were representative of the application's users.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe addressed both of the research questions relating to the first stage of the Exposure Therapy project in this study. We analyzed important contents from the perspective of psychologists as a response to the first question regarding content essential for the proposed mobile application. Concerning the second question, we focused on the features of the user interface. Moreover, we finalized the prototype, a key step in designing and developing the application. Mobile exposure therapy applications can use these contents as indicators and headings. Furthermore, these contents and user interface elements can also be utilized by exposure therapy providers for mental health purposes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eParticipants in the semi-structured interview (psychologists and experts) provided informed consent. All participants\u0026apos; information was kept confidential, and we respected their privacy during the collection phase. There was full approval of the study protocol by the Ethics Committee of Tarbiat Modares University (IR. MODARES. REC.1399.142). In addition, we performed all methods according to the relevant guidelines and regulations, including the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003ePlease contact the corresponding author if you would like access to the datasets used and/or analyzed during this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution:\u0026nbsp;\u003c/strong\u003eA.Sh was responsible for the study\u0026apos;s conception and design. H.R.S and Z.M. did the interviews. At the same time, H.K supervised the whole thesis. Z.M. and A.B. Preparing the first draft of the manuscript and revising the manuscript. A.Sh and H.R.S. did the analysis of the results, made critical revisions to the paper for important intellectual content, and supervised the study. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSerafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of COVID-19 on the mental health in the general population. QJM: An International Journal of Medicine. 2020;113(8):531\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoseph R, Lucca JM, Alshayban D, Alshehry YA. The immediate psychological response of the general population in Saudi Arabia during COVID-19 pandemic: a cross-sectional study. J Infect Public Health. 2021;14(2):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEttman CK, Gradus JL, Galea S. Invited commentary: reckoning with the relationship between stressors and suicide attempts in a time of COVID-19. Am J Epidemiol. 2020;189(11):1275\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRansing R, Adiukwu F, Pereira-Sanchez V, Ramalho R, Orsolini L, Teixeira ALS, et al. Mental health interventions during the COVID-19 pandemic: a conceptual framework by early career psychiatrists. Asian J Psychiatry. 2020;51:102085.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallace CL, Wladkowski SP, Gibson A, White P. Grief during the COVID-19 pandemic: considerations for palliative care providers. J Pain Symptom Manag. 2020;60(1):e70-e6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguiar A, Pinto M, Duarte R. Grief and mourning during the COVID-19 pandemic in Portugal. Acta Med Port. 2020;33(9):543\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeidnia HR, Ghorbi A, Kozak M, Herteliu C. Smartphone-based healthcare apps for older adults in the COVID-19 Era: Heuristic Evaluation. Stud Health Technol Inform. 2022;289:128\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeidnia HR, Ausloos M, Mohammadzadeh Z, Babajani A, Hassanzadhh M. Mobile-based self-care application for COVID-19: Development process using the ADDIE model. Stud Health Technol Inform. 2022;289:110\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeidnia HR, Mohammadzadeh Z, Hassanzadeh M. Evaluation of Mobile Phone Healthcare Applications During the Covid-19 Pandemic. Public Health: IOS Press; 2021. pp.\u0026nbsp;1100\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh HJL, Couch D, Yap K. Mobile health apps that help with COVID-19 management: scoping review. JMIR Nurs. 2020;3(1):e20596.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerst A, Zielasek J, Gaebel W. Smartphone applications for depression: a systematic literature review and a survey of health care professionals\u0026rsquo; attitudes towards their use in clinical practice. Eur Arch Psychiatry Clin NeuroSci. 2020;270(2):139\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuli S, Tuli S, Tuli R, Gill SS. Predicting the growth and trend of COVID-19 pandemic using machine learning and cloud computing. Internet of Things. 2020;11:100222.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdnan M, Ali I, Derrar B, ur Rahman M. Role of psychology, social media, social norms and religious activity in the control of COVID-19 infection. J Clin Med Kaz. 2020;6(60):21\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing H, He F, Lu Y, Hao S, Fan X. Effects of non-drug interventions on depression, anxiety and sleep in COVID-19 patients: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021:1087\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArndt J, Routledge C, Cox CR, Goldenberg JL. The worm at the core: A terror management perspective on the roots of psychological dysfunction. Appl Prev Psychol. 2005;11(3):191\u0026ndash;213.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgnati LF, Marcoli M, Agnati U, Ferraro L, Guidolin D, Maura G. The mis-exaptation of the prediction capability of humans and emergence of intolerant religious beliefs. Neurol Psychiatry Brain Res. 2017;23:43\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLok GKI, Ng MWI, Zhu MMX, Chao SKK, Li SX. Mediating effect of religious belief on death anxiety in Chinese adolescents: a cross-sectional study. Int J School Health. 2019;6(4):14\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreyson B. Near-death experiences and spirituality. Zygon\u0026reg;. 2006;41(2):393\u0026ndash;414.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenzies RE, Menzies RG. Death anxiety in the time of COVID-19: Theoretical explanations and clinical implications. The Cognitive Behaviour Therapist. 2020;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurșeu PL, Coman AD, Panchenko A, Fodor OC, Rațiu L. Death anxiety, death reflection and interpersonal communication as predictors of social distance towards people infected with COVID 19. Current Psychology. 2021:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoyes R Jr. The human experience of death or, what can we learn from near-death experiences? 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Clin Psychol Rev. 2014;34(7):580\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026aacute;zaro-P\u0026eacute;rez C, Mart\u0026iacute;nez-L\u0026oacute;pez J, G\u0026oacute;mez-Gal\u0026aacute;n J, L\u0026oacute;pez-Meneses E. Anxiety about the risk of death of their patients in health professionals in Spain: Analysis at the peak of the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17(16):5938.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenzies RE, Zuccala M, Sharpe L, Dar-Nimrod I. The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. J Anxiety Disord. 2018;59:64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShanbehzadeh M. Design and Implementation of COVID-19 information management system and registry. 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A brief introduction to design thinking. Design thinking: New product development essentials from the PDMA. 2015:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeidnia HR, Karajizadeh M, Mohammadzadeh Z, Abdoli S, Hassanzadeh M. Usability Evaluation of the Mask Mobile Application: The Official Application of the Iranian Government. Iran J Med Microbiol. 2022;16(1):49\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"prototyping mobile applications, death anxiety, COVID-19 pandemic, exposure therapy, mental health","lastPublishedDoi":"10.21203/rs.3.rs-2012924/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2012924/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIndividuals, organizations and society were all affected during the COVID-19 pandemic, which increased the level of death anxiety among people and patients. In cases of anxiety disorders such as death anxiety, exposure therapy is an effective and basic treatment method for which developing mobile-based applications and contents would help medical practitioners significantly. The current research aimed at reducing the burden of COVID-19 death anxiety by developing a prototype for a proposed mobile application.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe current article presents findings from an early project stage namely Exposure Therapy in Iran in which multiple interviews were conducted with psychologists for identifying criteria for content production. Afterward, two online workshops were held to develop a prototype for the user interface of the proposed application.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eBased on the interviews, contents on subjects like near-death experiences, habit control, death imagery, self-confidence, and anxiety management are the most essential criteria to be included in the mobile application. The online workshops emphasized the ease of use and usefulness of the mobile application. Finally, a prototype was designed as an initial version with the Figma software through high-fidelity technique.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFor designing and developing suitable applications to relieve the anxiety caused by COVID-19 death, the identified criteria for content production and the proposed prototype would help software designers to develop related applications in the current challenging time.\u003c/p\u003e","manuscriptTitle":"A mobile application to reduce death anxiety during the covid-19 pandemic: design of a high-fidelity prototype","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-29 17:28:11","doi":"10.21203/rs.3.rs-2012924/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cc7c1ff-0cde-4927-b173-8b22f4571c4f","owner":[],"postedDate":"November 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-24T16:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-29 17:28:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2012924","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2012924","identity":"rs-2012924","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}