JMIR Publications

ABSTRACT

Background:

Obesity is a major global public health challenge. It has been associated with prolonged surgery and increases postoperative complications for many patients. Losing weight and improving fitness through lifestyle changes before elective surgery may help patients with obesity to reduce surgery cancellations and improve intra- and postoperative outcomes. Mobile health apps have the potential to assist obese patients with preoperative preparation via lifestyle changes; however, the development of many currently available apps lacks theoretical guidance. The utility of mobile apps in the prehabilitation period to assist in preparation for surgery has not yet been fully explored.

Objective:

This study aims to describe the development of a theory-based mobile app to encourage patients with obesity to change their lifestyles through multidisciplinary health coaching, thereby losing weight and improving their fitness for surgery.

Methods:

Guided by a framework for developing complex interventions to improve health and healthcare, a mobile app was developed by a multidisciplinary team and patients with obesity using an experience-based co-design approach. The development comprised four cyclic phases: understanding user needs, identifying applicable underlying theories, integrating theory into the prototype design and development, and evaluating and refining the prototype mobile app. Expert panel discussion, literature review, intervention mapping and focus group discussions were used in these four phases, respectively. The prototype mobile app was tested by two focus groups of patients with obesity in South Western Sydney, New South Wales.

Results:

Three common user needs were proposed by the expert panel: motivational needs, educational needs, and supportive needs. Based on these, Social Cognitive Theory was considered to be most appropriate to guide the app development. Seven key constructs guided the design of the conceptual intervention techniques as well as the functionalities to address the user needs. Our app, Fit4Surgery, includes automatic push notifications, online resources, goal setting and monitoring, and interactive health-related exchanges which encourages physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in accordance with a patient's risk level as determined by a baseline health assessment. Focus group participants affirmed the potential benefits of the app but also put forward more requirements for the function, presentation and personalisation needs, providing an objective and robust basis for the improvement of the app.

Conclusions:

The participation of a multidisciplinary team, the integration of underlying theory into functional module design, and end-user evaluation are in line with best practice guidelines for app development. Our research enriches the development methods of health apps and generates insight into the further application of mobile health in the prehabilitation period. It also sheds light on new approaches for community-based interventions for lifestyle management, leveraging the power of ubiquitous mobile technology. Clinical Trial: Australian New Zealand Clinical Trials Registry: ACTRN379452