JMIR Publications

ABSTRACT

Background:

Just-in-time adaptive interventions (JITAIs) in mobile health (mHealth) are an intervention design that provide behavioral change support based on an individual’s changing and dynamic contextual state. However, few studies that document how end-users of JITAI technologies are involved in their development, particularly from historically marginalized families and children.

Objective:

We aim to broaden our understanding of how historically marginalized families are included in co-design from a public health perspective. The current work seeks to address research questions around JITAI, co-design, and working with historically marginalized families, including Black, Indigenous and People of Color (BIPOC) children and adults, regarding improving Sun protection behaviors.

Methods:

We examined two sets of co-design data (local and online) pertaining to a larger study on Mobile SunSmart JITAI technologies with families in Los Angeles, who were predominantly of Latinx and multi-racial backgrounds. In these co-design sessions, we conducted a stakeholder analysis through perceptions of harms and benefits and an assessment of stakeholder views and values. We open coded the data and compared the developed themes using a value-sensitive design framework by examining value tensions.

Results:

We present three major themes from our co-design data: 1) different experiences with the Sun and protection; 2) misconceptions around the Sun and Sun protection; and 3) technology design and expectations. We also provide a subtheme of Value Flow (opportunities for design), Value Dams (challenges to design), and Value Flow / Dam (a hybrid problem). For each subtheme, we provide a design decision and response we ended up making based on what was presented.

Conclusions:

We provide empirical data to show what it is like to work with multiple BIPOC stakeholders in the roles of families and children. We demonstrate the use of value tensions framework to explain different needs of multiple stakeholders and technology development. Lastly, we provide design implications and guidance around the development of JITAI mobile interventions for BIPOC families.