JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) apps for children are increasing in availability and scope. However, in the provision of therapy (physiotherapy, speech pathology, occupational therapy) for children with disabilities, there is no therapy prescription app specifically designed for the needs of children. Design processes which incorporate behavioral science and target engagement for children are essential for apps to be effective in improving adherence to home and school therapy programs.

Objective:

To describe the development of a consumer-informed therapy prescription app for children (6-12 years) with disabilities incorporating Intervention Mapping (IM) and gamified design.

Methods:

We utilized an iterative consumer-informed app development model, incorporating the first three steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence and relatedness identified in Self-determination theory (SDT). From these objectives we then selected behavior change techniques (BCTs), stipulating parameters for effectiveness and how each BCT would be operationalized. Gamification design was planned and implemented focusing on maximizing engagement with children. Two rounds of consultation groups with parents, teachers, and therapists, and one round of prototype app testing with children was conducted to inform app development, with a final iteration developed for further testing.

Results:

The IM process resulted in the specification of app elements, SDT-informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (n=4 therapists, n=3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and pragmatics of implementing an app-delivered therapy programs, that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale- user version) with the children yielded means (out of 5) of: 4.5 for engagement, 3.3 for function, 3.3 for aesthetics, and 4.3 for subjective quality.

Conclusions:

mHealth Apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with consumer-informed design, addressing the need for behavior change using IM process, and maximizing engagement with gamification and strong visual design. Clinical Trial: Australian New Zealand Clinical Trials Registry; ACTRN12619001356156