JMIR Publications

ABSTRACT

Background:

To avoid low engagement and limited efficacy of digital behavioral health interventions, robust human-centered design (HCD) processes are needed. The primary objective of this paper is to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital sugar-sweetened beverage (SSB) reduction intervention comprised of six Internet-based Cores metered out over time to deliver the program content, an integrated short message service (SMS) strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. Secondary objectives are to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process.

Objective:

The primary objective of this paper is to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital sugar-sweetened beverage (SSB) reduction intervention comprised of six Internet-based Cores metered out over time to deliver the program content, an integrated short message service (SMS) strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. Secondary objectives are to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process.

Methods:

Methods were guided by the Model for Internet Interventions and by best-practices in HCD and instructional design processes (e.g., rapid prototype development, think aloud protocol). The 3-phased (i.e., contextual, prototype testing, end-user testing) process included a series of 13 semi-structured one-on-one interviews with 7 Advisory Team participants from the targeted Appalachian user group. Interviews were content coded by two researchers and then deductively coded to the suggested areas of digital behavioral health interventions.

Results:

Participants provided rich perspectives pertaining to iSIPsmarter’s appearance, behavioral prescriptions, burdens, content, delivery, message, participation, and assessment. Examples include 1) requests for built-in flexibility to account for varying Internet and SMS accessibility among users, 2) ideas to resolve issues and problems encountered when using the prototypes, including navigation and comprehension of content, 3) ideas to enhance personalized feedback to support motivation and goal setting for SSB and weight, and 4) feedback to refine the development of realistic and relatable vignettes. Participants were able to interact with multiple prototype drafts allowing researchers to capture and incorporate feedback related to the iSIPsmarter Dashboard, daily SSB and weight diaries, action planning, Core content, interactions, and vignettes.

Conclusions:

Using scientific models and established processes is critical to building robust and efficacious interventions. By applying an existing model and HCD and instructional design processes, we were able to identify assumptions and address key areas of the iSIPsmarter intervention that were hypothesized to support users’ engagement and promote behavior change. As evidenced by the rich feedback received from Advisory Team members and by the resulting iSIPsmarter product, the HCD methodology was instrumental in the development process. While the final iSIPsmarter content is specific to improving SSB behaviors among adults in rural areas, the intent is that this HCD process will have wide application to the development of digital behavioral health interventions across multiple geographical and behavioral contexts. Clinical Trial: NCT05030753