JMIR Publications

ABSTRACT

Background:

Background:

Despite ubiquitous mobile technology, a doubling of osteoarthritis-targeted mobile health applications (mHealth apps), and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers have not met expectations. Most health and medical apps fail to retain users for longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication remains untapped. An important, recurrent criticism of app technology development is low user integration during design, which ensures user needs, desires, functional requirements, and app aesthetics are responsive and accurately reflect target user preferences.

Objective:

Objective:

To describe the co-design process for developing a knee osteoarthritis (KoA) minimum viable product (MVP) mHealth app with patients, family physicians and researchers that facilitates guided, evidence-based self-management and patient-physician communication.

Methods:

Methods:

A qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Co-design participants included family physicians, patient researchers and patients with KoA (including previous participants of related KoA collaborative research), researchers, key stakeholders, and Industry Partners. The study setting was an Academic Health Centre in Southern Alberta.

Results:

Results:

Distinct differences exist between what patients, physicians and researchers perceive are the most important, convenient, desirable, and/or actionable functional requirements of a KoA mHealth app. Despite these differences, study participants agreed the MVP should be electronic, track patient symptoms and activities, include features customized for patient- and physician-identified factors, and international guideline based self-management strategies. Through the research process, participants negotiated to consensus on their respective priority functional requirements. Highest priority requirements included a visual symptoms graph, setting goals, exercise planning and daily tracking, and self-management strategies. Structured co-design with patients, physicians and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning and respect for diversity and differing opinions., These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation and group reflection, aided by the provision of tangible and ongoing support throughout the research process, that encouraged team members to question conventional thinking. Group, subgroup and individual level data helped the team reveal how and for whom perspectives about individual functional requirements changed, or remained stable, over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization.

Conclusions:

Conclusions:

It is feasible to preserve diversity of perspectives while negotiating consensus on the core functional requirements of an mHealth prototype app for KoA management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between patient, physician and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus.