JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) have the potential to extend the reach of disease prevention interventions; however, few are evidence-based, theoretically grounded, or developed for high-risk youth and families. Co-design approaches engage the end user in the design and development of the DHI by applying an equity lens that can lead to increased accessibility and engagement.

Objective:

The purpose of this manuscript is to describe the adaptation of an evidence-based diabetes prevention program for remote, digital delivery.

Methods:

The adaptation of the in-person intervention was guided by a modified Inclusive Digital Health Intervention Design to Promote Health Equity framework and conducted in collaboration with Hispanic adolescents (n=23) with obesity (BMI%≥95th) and parents (n=15). Initially, focus groups identified digital, health education, and support needs. Two panels, an expert and community panel, assisted in developing solutions based on these findings. A sample content session with a food tasting experience was created and reviewed by participants. The research team subsequently built a digital platform to host content. Participants assessed the usability of the platform including the ease of use, design components, and technical issues. A second meeting of the expert panel provided recommendations for further refinement and feedback.

Results:

Findings from focus groups indicated that most participants (83%) reported stable internet access and multiple digital devices. In regard to format, a few parents (10%) preferred synchronous content sessions, while most youth and parents favored asynchronous sessions (76%) lasting 40-60 minutes. Health education needs included interactive content, healthy recipes, and the ability to ask questions. Experts suggested offering asynchronous sessions with monthly synchronous meetings to meet both parent and youth needs. After viewing a sample session, families found the content easy to understand and mostly engaging, with 81% participating in the food tasting activity and all participants reporting that the activity was feasible. Experts recommended using a more conversational, interactive teaching style to improve content, and using a food box with non-perishable items to increase the ease of food tasting activities. While the digital platform was functional and easy to use, families highlighted the need for larger font and icon sizes, easier navigation, and better color contrasts. Based on this feedback, experts advised creating tutorial videos and an orientation session for platform training. The content and platform will continue to be refined before further evaluation in a 12-week feasibility pilot study.

Conclusions:

The use of a co-design approach provided opportunities to make content more interactive and engaging and to increase the ease of use of the digital platform. Describing the adaptation process using a guiding framework in collaboration with the focus population will inform future studies aiming to adapt evidence-based interventions to a digital platform.