JMIR Publications

ABSTRACT

Background:

Hospital-based violence intervention programs (HVIPs) reduce the long-term impacts of violence by linking survivors to resources that address social needs. However, HVIP effectiveness is often hindered by disorganized communication between Violence Prevention Professionals (VPPs) and their clients. Mobile health (mHealth) tools have the potential to improve communication, but none have been co-designed with survivors of violence to meet their unique needs. This study extends prior mHealth application (app) development aligned with VPP workflows by applying a Human-Centered Design (HCD) approach that centers the client-facing user experience, ensuring the app reflects clients' lived realities, preferences, and barriers to engagement.

Objective:

This study aims to design an mHealth app to improve communication and access to resources for survivors of violence using HCD and iterative prototyping methods.

Methods:

We developed the client-facing component using HCD and integrated three Ideation Phase methods: Participatory Design, Low-Fidelity Prototype Testing, and High-Fidelity Prototype Testing. Participatory Design included semi-structured interviews, co-design activities and card sorting activities with clients, followed by inductive qualitative analysis to inform the initial low-fidelity design. Low-Fidelity Prototype Testing included guided user-testing interviews about static wireframes, followed by inductive qualitative analysis to inform the high-fidelity design. High-Fidelity Prototype Testing utilized user-testing interviews and the Rapid Iterative Testing and Evaluation (RITE) method. An impact ratio was calculated to quantify the proportion of usability issues successfully addressed through iterative design changes.

Results:

Fifteen unique clients participated across 16 testing sessions. Participatory Design identified six key themes: (1) trust, (2) personal connection, (3) guidance in meaningful decision-making, (4) client empowerment, (5) intuitive and comprehensive design, and (6) dynamic journey and sense of progress. Low-Fidelity Testing reinforced these themes and identified two additional themes: (7) app personalization and (8) tailored resource curation. High-Fidelity Testing reinforced themes 1–8 and uncovered seven more: (9) celebration of client successes, (10) standardization of verbiage and design choices, (11) control over boundaries, (12) legitimization of experience, (13) accessibility of VPPs, (14) gratitude expression, and (15) integration with medical care. RITE identified 98 actionable usability issues, of which 89 were addressed, yielding a 91% impact ratio. The final app expanded from 12 initial low-fidelity wireframes to 32 refined high-fidelity wireframes.

Conclusions:

This study used HCD and RITE to develop a client-facing mHealth app tailored to survivors of violence receiving HVIP case management services. The 91% impact ratio demonstrates RITE's effectiveness in rapidly prioritizing and resolving usability issues. The final app integrates features that enhance usability, empowerment, connection, decision-making, and support while ensuring accessibility and consistency. This approach may be adaptable to other mHealth tools for specialized populations, though further research with larger samples and in other settings is needed to assess generalizability.