JMIR Publications

ABSTRACT

Background:

Breathing pattern disorder (BrPD) affects roughly 10% of the UK population with similar estimations worldwide. Symptoms include air hunger and hyperventilation. Breathing retraining has shown some promise but exercises are difficult to learn and sustain. This study describes the participatory design of a digital avatar prototype to support breathing retraining, using an integrated behavioral science and design approach.

Objective:

To understand the experiences of participants with BrPD in learning breathing retraining and their perceptions of how an avatar might assist this behavior change using participatory design and behavioral science.

Methods:

Participants diagnosed with BrPD (n = 10; group sizes ranged from 3–8) attended a series of 5 focus groups. Discussions explored experiences of breathing retraining, avatar visual design, and perceptions of using avatars as part of breathing retraining in a physiotherapy clinic. Data was analysed thematically drawing on the Theoretical Domains Framework (TDF) and affinity diagramming to design the theoretically informed digital intervention prototype.

Results:

All but three TDF domains were perceived to influence breathing retraining behavior. Identified barriers included low exercise self-efficacy [belief in capabilities, skills] and limited understanding [knowledge], difficulty recalling exercises outside of clinic sessions [memory, attention and decision-making processes], and scepticism about their effectiveness when distressed [emotion, beliefs about consequences]. Design recommendations integrated with TDF avatar barriers/facilitators produced a personalised prototype with features perceived to positively influence breathing retraining behavior: building understanding [knowledge], confidence [belief in capabilities]and motivation while acting as a visual aid strengthening post-clinic breathing-retraining recall [memory] and practice [skills/behavioral regulations].

Conclusions:

The multidisciplinary study was successful in producing an outline for an individualised digital avatar to assist breathing exercise capability and practice. The use of a theoretical framework integrated with participant views increases the viability and acceptability of the proposed prototype. Broader testing with participants and stakeholders will support further development and implementation.