JMIR Publications

ABSTRACT

Background:

As mobile health (mHealth) apps increase, theory-based, user-informed digital interventions affecting behavior change are critical for the improvement of health outcomes especially amongst adolescent and young adults (AYA). Such interventions are particularly important to implement where AYA can be found.

Objective:

To describe the development of the Dr. ERIC (Emergency Room Interventions to Improve Care), an interactive app focused on promoting condom use among sexually active AYA male emergency department (ED) patients.

Methods:

Our study methods followed five phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, Define, we explored our targeted health problem (infrequent condom use) by collecting key stakeholder input and conducting in-depth interviews with AYA males and ED medical providers. In phase 2, Discover, we partnered with a digital design agency to explore user experience and digital strategy. In phase 3, Design, we refined Dr. ERIC content, a 5-part sexual health educational module and a 10-week texting program. We conducted semi-structured interviews with male AYA ED patients and informatic experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis and informatic expert feedback was categorized by Neilson’s Heuristic Principles. In phase 4, Develop, we created the technical architecture and built a responsive web application. Lastly, in phase 5, Deploy, we conducted a pilot randomized controlled trial to evaluate the implementation and potential efficacy of Dr. ERIC.

Results:

Using the phase 1 and 2 data, we iteratively edited the prototype. Findings from 9 males suggested that users preferred: (1) straightforward information; (2) a clear vision of the purpose of Dr. ERIC; (3) open ended opportunities to explore family planning goals; (4) detailed birth control method information; and (5) interactive games presenting novel information with rewards. Five usability experts provided heuristic feedback. This led to the deployment of Dr. ERIC that was preliminarily evaluated in a pilot trial.

Conclusions:

Following these mHealth development phases, we created an interactive AYA sexual health mHealth intervention incorporating the principles of user experience and interface design to be implemented in the unique acute care setting. Researchers can use this framework in the formation of future digital health ED-based digital interventions.