Previously submitted to: JMIR Human Factors (no longer under consideration since Mar 03, 2025)
Date Submitted: Aug 18, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Design and Usability Evaluation of a Self-Care Application for Non-Alcoholic Fatty Liver Disease Patients with Overweight: Approach Leveraging Behavior Change Techniques
ABSTRACT
Background:
The prevalence of non-alcoholic fatty liver disease is increasing in parallel with the global increase in obesity, and it is predicted that non-alcoholic fatty liver disease will soon be the main reason for liver transplantation worldwide and requires new methods for The management of this disease. Today, the application of mobile-based software for the self-management of people suffering from Chronic diseases is one of the newest solutions for the management of these diseases. Adherence to treatment behavior is the most challenging aspect of self-management in chronic diseases such as non-alcoholic fatty liver disease, which can be optimized using behavior change techniques, and on the other hand, behavioral interventions are often complex and multifaceted.
Objective:
The current study aims to design and usability evaluation of a self-care application with the approach of using behavior change techniques for non-alcoholic fatty liver disease people with overweight.
Methods:
At first, the information needs of non-alcoholic fatty liver patients were extracted from clinical guidelines and reliable databases such as Up to Date. Effective intervention components to increase adherence of non-alcoholic fatty liver patients to treatment at the center and effective functions in the second layer of the wheel of behavior change were identified. Then it was mapped to the taxonomy of behavior change techniques and the most effective behavior change techniques in mobile application interventions for chronic diseases including non-alcoholic fatty liver were identified and applied to the content. Their face and content validity were evaluated at each stage by relevant experts. The defined intervention was implemented in the form of a personalized self-care application. Patients' messages were categorized into four structures, including nutritional motivation, physical activity motivation, non-alcoholic fatty liver treatment knowledge, and personalized messages in the knowledge base, and were triggered based on the personalization algorithm in the form of if-then rules for each patient. Think aloud method was used to evaluate its usability. The statistical population of the present study was people suffering from non-alcoholic fatty liver disease at the Persian Cohort Center in Mashhad, Iran.
Results:
Based on scientific evidence, the effective component of motivation in the center of the behavior change wheel (COM-B framework) and the functions of education, motivation, and persuasion were identified in the second layer of the behavior change wheel for interventions in the field of application for chronic patients including non-alcoholic fatty liver disease. Then, by mapping to the behavior change techniques taxonomy, the transtheoretical model and the elaboration likelihood model were selected and applied to the prepared content. Messages expected to have the greatest effect on patient’s adherence to treatment were prepared and sent to patients in the mobile application. 11 men (84.7%) and 2 women (15.3%) with an average age of 41 years participated in the usability evaluation with the think-aloud method. The average time of the evaluation process was 20:21 ± 23:01 minutes. 8 users (61.5%) provided 13 suggestions to improve the performance of the application, most of which were related to placing the communication with the physician on the home page and keeping the personalized message according to the patient's weekly performance on the screen. Overall, the usability results showed that users found the provided content useful. Features such as self-assessment charts, communication with a nutritionist, and knowledge about non-alcoholic fatty liver disease were liked by the participants. Important feedback for faster implementation of the clinical trial intervention was also obtained from the user test.
Conclusions:
To our knowledge, this is the first study to use the behavior change wheel to develop a digital intervention for the improvement of patients with nonalcoholic fatty liver disease. This study provides a complete example of evidence-based development of a mobile intervention with the approach of using behavior change techniques to increase nonalcoholic fatty liver patients' adherence to treatment by providing personalized information.
Citation
