Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Aug 21, 2020)
Date Submitted: Jan 30, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Design of an mHealth app to promote day-long physical activity in older adults with chronic pain: Phase 1 of the MORPH study
ABSTRACT
Background:
Participating in physical activity and minimizing time spent sitting is an effective strategy for managing pain in older adults. Theory-based mHealth tools are integral to effective day-long physical activity interventions, but it is vital that mHealth tools undergo an iterative development process alongside members of the target population to ensure their uptake and use.
Objective:
We subjected a preliminary social cognitive smartphone application (Companion App) designed to promote day-long movement to a user centered design process with the assistance of low-active older adults with chronic multisite pain. The Companion App integrates ecological momentary assessments of pain, Fitbit activity monitor data, and smart weight scale data to provide real-time feedback on the relationships between movement, sitting, and pain and to facilitate goal setting and achievement.
Methods:
We recruited participants (N=5; 71.8 5.54 years old) sequentially to participate in a three-phase iterative design study. First, each participant received a brief orientation to physical activity, was exposed to the application, and engaged in a Think Aloud protocol. Use and usability issues were noted by study staff. The participant then used the app for one week in their daily lives, and then returned to provide feedback. Issues were identified from participant feedback, discussed with the study team, and modified before the next participant began the study.
Results:
Participant interviews yielded feedback in areas related to technology selection and operation, app design/form, and intervention clarity. Regarding technology, the use of the Fitbit activity monitor revealed no issues, but there were barriers to the use of the Fitbit Aria 2 scale, including incompatibility with a widely used home internet router. Switching to a cellular enabled scale alleviated this issue. With regard to form, modifications were made to several key interface elements in response to participant feedback to aid in clarity. Finally, initial participant experiences revealed the need to separate the intervention orientation from the technology orientation to minimize informational load.
Conclusions:
Our brief user-centered design process produced key changes in our intervention orientation, the form and function of the Companion App, and the technologies that support the app. These are vital elements that are likely to hamper the perceived usefulness and utility of the Companion App in the context of a large trial and eventual public use. We recommend the conduct of such a process any time mHealth is used in research or medicine to account for changing populations and preferences. Moreover, publication of lessons learned can help to establish a foundation of knowledge for designing apps for underserved populations such as older adults. Clinical Trial: ClinicalTrials.gov Identifier: NCT03377634
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