How patients’ experiences with mental health services are approached and evaluated varies both within research and within clinical practice. In some cases such evaluations are prioritized. In other cases such an approach is non-existent or fragmented.


So how can we better understand, evaluate and promote the service user experience within the mental health field – including in digital services?


Traditionally, there has neither been a big nor a systematic focus on patients’ experiences within the healthcare sector. There was often more focus on how a therapist or doctor experienced an intervention. The patient or service user was to a larger degree seen as a more or less passive receiver of a treatment or health service.


Except for a certain interest in the effect of the care provider’s competence and the therapeutic relationship, the outcome of the treatment was almost solely attributed to the intervention or modality that was used. This, despite the fact that the same type of interventions could bring very different results among patients with the same type of ailments – at the same time as different types of interventions could bring very similar results. 


However, during the last couple of decades there has been an increased focus on the patient- or user experience across health services. Within the mental health field there is also an increasing understanding that the patient’s experience is important and can affect the treatment results. Recent research on psychotherapy and on common factors in therapy, indicates that the patient’s experience can predict the outcome better than the therapist’s experience – and in some cases better than the specific intervention that is used.
Even if we have seen an increased interest and acknowledgement of the significance of the user experience – both within research and clinical practice  – it however varies if and how the user experience is evaluated and promoted within mental health services.


Different approaches to the service user experience


Digital health has been one of the areas which has been focusing most on the user experience (or ‘UX’) during the last decade. However, in the development of digital health services and interventions there has been a main focus on usability when it comes to design and technical functionality. Although this aspect of the user experience is important, it gives a relatively unidimensional and fragmented picture of the patient’s overall experience with a health service or intervention.
We have also seen an increasing tendency towards addressing the service user experience within traditional psychological services and mental health units. This is first and foremost done through assessments or digital clinical feedback systems evaluating the service user’s experiences of the therapist/care provider, the therapeutic relationship and/or specific treatment processes. This can bring valuable information to care providers; especially if the information collected leads to concrete changes which improves the patient’s experiences, and thereby also the outcome of the treatment. However, it varies which (and how many) aspects of the service user experience are approached and evaluated.

A new framework to approach and improve the user experience

Together with a colleague at the Institute of Psychology at the University of Oslo, I conducted a literature review of international research approaching the service user experience in both indirect and more direct ways. Our main focus was on psychotherapeutic interventions. This also included digital interventions in clinical contexts. The results of our review reflected a great variation in which aspects of the user experience were assessed in different research studies and contexts. Based on these findings we derived and published a new multifaceted framework to help better understand, evaluate and improve the service user experience in a more holistic and systematic way, across both traditional and digital health interventions and modalities.

This framework consists of five overarching factors/domains which involves:


  1. Perception of self as patient/user
  2. Perception of the therapist/intervention provider
  3. Perception of the therapeutic relationship/alliance
  4. Perception of the intervention/modality
  5. Perception of contextual factors

Several subordinate facets were also presented for each of the domains, based on our review and analysis, as well as clinical relevance.


Figure 1: The User Experience Framework for Health Interventions (Søvold & Solbakken, 2022)

The framework can be used for conducting a more systematic and multifaceted evaluation  of the user experience – both on individual and group level. When the user experience is evaluated through all of the five domains (and their subordinate facets), a pattern or picture of the overall experience of the service user will emerge. This will for example reveal that the patient is very happy with some aspects (e.g the therapeutic relationship and the intervention itself), and only somewhat satisfied or dissatisfied with other aspects (e.g their own participation in the therapeutic process or specific contextual factors). However this pattern looks, it gives a more holistic picture and understanding of the service user’s experiences, than by only evaluating one or two of these dimensions or domains of the user experience.

The framework can also be used to systematically promote or improve specific therapeutic factors, the user engagement, the therapeutic relationship and the outcome of the treatment or intervention. Moreover it can be used to compare the user experience in traditional and digital interventions, and/or in different therapeutic modalities. This can provide valuable information when it comes to important therapeutic mechanisms from the service users’ perspective. It also highlights factors which are important in the work to improve the quality of mental health services.
This kind of framework can therefore be useful in the development and implementation of both traditional and digital health services and interventions. It contributes to ensuring that service users’ experiences are taken into account, which again can bring increased quality and safety in such services. It can also be used together with existing tools (e.g clinical feedback systems or assessment inventories) to ensure that service users’ experiences are evaluated in an integrative and systematic way, both within qualitative and quantitative research, and in clinical practice.

From passive receiver to active co-creator

Today’s modern healthcare has an increasing focus on person-centered treatment, with the patient in the center. The patient has gone from being perceived as a passive receiver to becoming an active participant and co-creator in their own treatment. User engagement and collaboration with service users and/or people with lived experience of mental health conditions is becoming ever more important.
A holistic evaluating – which includes both quantitative and qualitative methodology – is needed in this context. This will not only contribute to more interdisciplinary collaboration and improved quality in health services, it will also strengthen the collaboration between providers and service users, and increase patients’ influence and ownership when it comes to their own health.

The full-text of the User Experience Framework paper is not currently open-access, but the abstract can be viewed by clicking here.


This blog article is an English adaptation of an article originally written for and published in the Norwegian e-health platform