JMIR Publications

ABSTRACT

Background:

The prevalence of obesity among Canadian children is rising in part due to increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multi-sectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message: consume 5+ vegetables/fruits; have < 2 hours of recreational screen time; participate in 1+ hour of active play; and consume 0 sugary drinks, every day. A Live 5-2-1-0 Toolkit for healthcare providers (HCPs) was previously developed and piloted in two pediatric clinics at BC Children’s Hospital.

Objective:

To co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs.

Methods:

A series of three focus groups (FG) were conducted using human-centered design and a participatory approach. In FG #1 children (separately) and parents and HCP (together) participated in sessions that focused on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG #1 in an ideation session and key themes were subsequently presented separately to parents/children and HCP in FG #2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG #3 and provided feedback on usability and content, and also completed questionnaires. Thematic analysis and descriptive statistics were used for qualitative and quantitative data, respectively.

Results:

Fourteen children (mean age 10.2+/-1.3 years, SD = 1.3; five males), 12 parents (75% ages 40-49 years, n=9; two males), and 18 HCPs participated; most participated in two or more FGs. Parents wanted an app that empowers children to adopt healthy behaviors using internal motivation and accountability; children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted a baseline behavior assessment and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median [Q1,Q3] score of 7 [6,7] on a 7-point Likert scale (1=very difficult, 7=very easy). Children liked most suggested rewards (28/37) and found 76/96 suggested daily challenges (activities related to healthy behaviors that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change.

Conclusions:

Co-creating an mHealth app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 App.