JMIR Publications

ABSTRACT

Background:

The Person Based Approach is a method to incorporate users’ perspectives from the earliest stages of design for interactive digital health interventions (IDHIs). However, it does not explicitly describe the iterative stages of design and evaluation that are essential in moving from early planning to deployment. For this, we draw on methods from Human–Computer Interaction (HCI). Such methods have been developed for a variety of different contexts and drawing on different resources.

Objective:

To reflect on the adaptation and synthesis of the Person Based and HCI approaches to developing IDHIs. We describe a case study in which we used both approaches to develop EPIC-HIV1, an IDHI to support men living in a resource-constrained setting, rural KwaZulu-Natal, South Africa. EPIC-HIV was intended to support men to make an informed choice about whether to take an HIV testing and, if necessary, engage in the care process.

Methods:

We conducted a retrospective analysis of the documentation generated during the development of EPIC-HIV1 including findings about requirements, design representations and the results of iterative rounds of testing. The analysis sought to construct a narrative on the process, the outcomes, and the strengths and limitations of the design and evaluation methods applied. We also present the design of EPIC-HIV1 and an account of considerations when designing for hard-to-reach people in such settings.

Results:

The Person Based Approach was applied to deliver a first prototype. This was effective in identifying key messages to convey and how to manage issues such as user privacy, but the resulting prototype was judged by the team not to be engaging for potential users and there were concerns about whether the design was inclusive of people with low digital or health literacy. We therefore drew on methods from HCI to iteratively refine the app. Working with representatives of the local community, we conducted three cycles of refinement, adapting and retesting EPIC-HIV1 until no further changes were needed. Key changes included making it clearer what the consequences of selecting particular options in the app were and changing wording to minimize misconceptions (e.g., that the app would test for HIV).

Conclusions:

Techniques for developing IDHIs need to be situationally appropriate. The Person Based Approach enabled us to establish both empirical data and theory to design the content of EPIC-HIV1 but it did not directly address questions about interaction design that were necessary to make the app usable and effective for the intended users; HCI techniques that were tailored to the setting enabled us to refine the app to be easy for men with little familiarity with digital technologies to use within the constraints of the setting. Iterative testing ensured the app was engaging and that the intended clinical messages were communicated effectively.