JMIR Publications

ABSTRACT

Background:

Black people are disproportionally impacted by hypertension. New approaches for encouraging healthy lifestyles are needed to reduce hypertension and promote health equity in Black communities.

Objective:

In this report, we describe designing a Just-in-time-adaptive-intervention (JITAI) to increase physical activity in partnership with members of an underserved, predominately Black community.

Methods:

Our design process began with two user groups in communities with differing sociodemographic makeups in Michigan: Flint, predominately Black people and lower incomes, and Ann Arbor, predominately White people and higher income (as a comparison to Flint). After conducting (1) discovery interviews and (2) empathy mapping and analysis guided by the Behavior Change Wheel in both communities, we focused the remainder of the design activities on the Flint community because we found unique barriers between the communities and our prior design work was focused on predominately White populations. A Flint community-academic design team was then formed that partnered in the (3) design sprint, (4) storyboarding, and (5) paper prototyping.

Results:

We found that physical opportunity (i.e. physical environment and resources) was a strong barrier to physical activity in the Flint community while a facilitator in the Ann Arbor community. Thus, mobile app push notifications will be tailored based on participants’ community (e.g., Flint). Physical capability was a barrier to physical activity in both communities, but Flint participants noted more chronic physical impairments while Ann Arbor participants noted transient impairments. Accordingly, push notifications will be tailored to participants’ functional capacity at baseline. Other determinants were similar across the communities allowing for shared app features. Automatic motivation (i.e. impulses) was also identified as a barrier. Hence relying on data from smartphones and wearables, JITAIs will include mobile app push notifications tailored to the time of day, weather, and recent step count. Reflective motivation (i.e. planning) was a facilitator of physical activity which will be enhanced through social support. When participants do not meet their goals, we will provide acknowledgement and support as well as the ability to adapt their goals accordingly.

Conclusions:

We completed early-stage JITAI design in partnership with community participants and a community design team with limited tech literacy amid a global pandemic. We found that communities have unique needs and designing JITAIs with the community enables these interventions to address community-specific needs, and community partnership-based design helps these interventions address community-specific needs that, in turn, may lead to a more meaningful impact on users' health. Clinical Trial: NA