JMIR Publications

ABSTRACT

Background:

Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) and game elements seem promising to support smoking cessation.

Objective:

This paper describes the user-centered design and usability evaluation of Kindle, a mHealth application with game elements to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation.

Methods:

Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to ISO 9241-11:2018: understanding the context of use through literature and secondary analysis of qualitative interview data (Phase 1), establishing the user and organizational requirements (Phase 2), production of design solution (Phase 3), usability inspection of the prototype through a heuristic evaluation (HE, 3 experts), and user testing by a think aloud (TA, 5 disadvantaged women, 5 nurses) (Phase 4). Usability problems were categorized according to Healthcare Information and Management Systems Society principles.

Results:

Phase 1 resulted in an understanding of the VoorZorg-program and needs of VoorZorg-nurses and –clients (e.g. focus on early stages of change and building new supportive networks for smoking cessation), where after we established requirements in Phase 2 (e.g. mHealth, secured communication between nurses and clients, adaptation to lower health literacy skills. Phase 3 resulted in Kindle, a prototype combining a nurses- and clients-interface, including the following functionalities: personal goal setting with earning points, secured chat function with nurse and other clients, tips, diary, and profile creation. The HE and TA in Phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned ‘simplicity’ (e.g. unclear clickable button) and ‘naturalness’ (e.g. unclear icon).

Conclusions:

The participative user-centered design and usability testing of a mHealth application yielded useful insights. The involvement of end-users, among which socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements regarding achieving readiness for smoking cessation. Moreover, the usability evaluation by end-users and experts revealed unique usability problems for this population. These insights allow a further optimization of Kindle and encourages future studies to engage disadvantaged populations in mHealth intervention design and usability testing.