JMIR Publications

ABSTRACT

Background:

Smartphone ownership and mobile application use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions (DHI) to increase access to healthcare. To successfully implement DHIs and engage users, their development should be guided by user input, which is best achieved by the process of co-design. DHIs co-designed with active engagement of users have the potential to increase uptake of guideline recommendations which can reduce morbidity and mortality, and advance health equity.

Objective:

To co-design a DHI for atrial fibrillation (Afib), the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to develop a framework for inclusive design methodology for DHI development.

Methods:

We conducted virtual meetings with patients with Afib (n=8), their caregivers and clinicians (n=8), led by an expert designer and clinician trained in human centered design methodology. We developed the following steps of the co-design process. Step 1 – Virtual meeting focused on empathy generation and defining challenges that are faced in daily life by individuals with Afib and clinicians. Step 2 - Virtual meeting focused on brainstorming on top challenges identified during the first meeting. Step 3 - Individualized onboarding of patients with existing minimally viable version of the Afib app (Corrie Health platform). Step 4 - Virtual prototyping of the top three ideas generated during brainstorming. Step 5 - Further ranking of the ideas by the study investigators and engineers that were generated during brainstorming but were not chosen in top three solutions to be prototyped in step 4. Step 6 - Ongoing engineering work to incorporate top priority features in the app. Step 7 – Obtaining further feedback from patients and evaluating Afib DHI in a larger pilot clinical study.

Results:

Top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence and guidance during Afib episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable Afib risk factors and remote Afib episode management. Patients brainstormed more than thirty ideas to address the top challenges and clinicians generated more than twenty ideas. Solutions prototyped by patients included a feature with education on Afib triggers, alerting the clinician team and family during Afib episodes and a more robust medication reminder feature to promote adherence.

Conclusions:

We co-designed an Afib DHI together with patients, caregivers, and clinicians by virtually engaging in collaborative creativity through the design process. We then summarized our experience and developed a seven-step flexible framework for inclusive DHI design that can be tailored to for future DHI development to guide innovative teams working to advance health equity. Clinical Trial: N/A