Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 9, 2020
Date Accepted: Apr 13, 2021
Warning: This is an author submission that is not peer-reviewed or edited.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.
Combining User Centered Design And Crowdsourcing To Develop Messaging Content for a Physical Activity Smartphone Application Tailored to Low-income Patients
ABSTRACT
Background:
Text-messaging interventions can be effective and efficient ways to improve health behavioral change. However, most texting interventions are not tested and designed in real-word settings with diverse end users, which could reduce their impact.
Objective:
We combined participant feedback, crowdsourced data, and researcher expertise to develop motivational text-messages in English and Spanish to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms.
Methods:
First, we designed messages to increase physical activity based on behavior change theory and knowledge from the available evidence. Second, we refined these messages after a card sorting task and semi-structured interviews (n=10) and tested their likeability during a test phase of an app prototype (n=8). Third, the messages were tested by English and Spanish speaking participants in the Amazon Mechanical Turk (MTurk) crowdsourcing platform (n=134). Participants on MTurk were asked to categorize the messages into our overarching theoretical categories, which are based on the COM-B (capability, opportunity, motivation - behavior) framework. Finally, each coauthor also rated messages for their overall quality from 1 to 5.
Results:
200 messages were iteratively refined according to feedback from target users gathered through User Centered Design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged for discarding unappealing messages and for editing thematic aspects of messages that did not resonate well with target users. 54 messages out of 200 were sorted into the correct theoretical categories at least 50% of the time and rated at least 3.5 or higher. These were included in the final text message bank, resulting in 18 messages per motivational category.
Conclusions:
Using an iterative process of expert opinion, feedback from participants reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable input for the design of motivational text-messages to increase physical activity developed in English and Spanish with a low literacy level. We describe design considerations and lessons learned for the text-messaging development process and provide a novel framework for future developers of health text-messaging interventions. Clinical Trial: Registry: clinicaltrials.gov Registration Number: NCT 03490253 URL: https://clinicaltrials.gov/ct2/show/record/NCT03490253?view=record
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