Compassion-Focused Implementation of Smartwatches in Acute Mental Health Care: Mixed Method Replicated Single-Case Study.

Authors

Charlotte M van Lotringen, Tessa Dekkers, Saskia M Kelders, Gerben J Westerhof, Matthijs L Noordzij

Published in

JMIR formative research. Volume 10. Pages e92279. Nov 04, 2026. Epub Nov 04, 2026.

Abstract

Smartwatches can support mental health care by providing insights into activity and sleep, which are closely linked to mental health and daily functioning. However, their implementation in mental health care practice remains limited. Professionals can feel resistance toward digital mental health interventions if they feel their use is not aligned with therapeutic values, and report a need for guidance on how to use technologies in ways that do align with such values. Compassion, a core value in mental health care, may offer a meaningful frame for implementation. Therefore, we previously co-designed compassion-focused implementation materials: a card set offering practical suggestions of how smartwatch data can support group treatments in ways that counter the self-optimization logic of commercial devices and instead align with compassion.
The current study evaluated the compassion-focused card set in practice, to explore whether the introduction of the card set influenced the use of smartwatches in treatment sessions, and mental health professionals' experienced compassion when working with smartwatches, the therapeutic alliance, and acceptance of smartwatches.
The card set was evaluated in a mixed methods replicated single-case design with 5 social psychiatric nurses from an acute mental health care team. Data collection included pre- and post-questionnaires, repeated measures, a focus group, and interviews.
For smartwatch use, no significant intervention effects were found, though several participants did report the start or increase of use of the smartwatch in sessions during the intervention phase. For compassion, only P2 showed a significant effect of the intervention on experienced compassion when using smartwatches (Tau-U=0.53, 95% CI -0.11 to 0.86; P=.02). This participant reported that the card set helped to make the use of smartwatches more concrete and insightful. For therapeutic alliance and acceptance of the smartwatches, no intervention effects were found. These scores were rather stable over time for most participants. The card set was experienced as flexible and easy to use, supporting session structure and enabling more in-depth, compassionate conversations. At the same time, barriers to sustained smartwatch integration included low patient uptake, challenges in mixed groups in which only some patients wore the smartwatch, and varying digital affinity among professionals.
These findings suggest that compassion-focused materials may trigger initial adoption and help reframe smartwatch use in line with therapeutic values. Broader implementation strategies, including further training and tailoring to patient readiness, are required for sustainable integration.

PMID:
43012861
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.

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