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User-centered development of iCANSleep: A mobile app to treat insomnia in cancer survivors
ABSTRACT
Background:
Insomnia affects the quality of life and health outcomes of cancer survivors. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment for insomnia among cancer survivors, but is not readily accessible due to the limited number of trained providers and the difficulties providing care across wide geographical areas. Mobile health (mHealth) technologies are a promising solution; however, none are tailored to the unique needs of cancer survivors.
Objective:
To understand the needs and preferences of cancer survivors and test the usability of an evidence-based CBT-I smartphone app called iCANSleep that will be tailored and accessible to cancer survivors.
Methods:
A user centred design (UCD) was applied and cancer survivors were actively engaged in the app’s design, usability testing, and prototype refinement. In Phase 1, phone semi-structured interviews were conducted with a purposive sample of cancer survivors (n=20) to inform the design of the app and its content. In Phase 2, iterative low and high-fidelity usability testing was conducted with 7 participants until no further recommendations for change were suggested.
Results:
Users suggested several defining characteristics, features, and desired functionality, including being user friendly and evidence-based. They saw increased accessibility and simplicity as advantages of a mobile app but expressed some concerns about data security and losing the accountability that comes with in-person treatment. User-testing emphasized the desire for images of real people and diverse stories rather than graphics and animated videos and provided suggestions for improved navigation. The first iteration of the app has been developed using the information gained during the needs assessment and usability testing. Feedback was integrated into the final prototype of the iCANSleep app which will be tested for feasibility, acceptability, and efficacy.
Conclusions:
iCANSleep represents the merging of mHealth principles and best practices with evidence-based insomnia care, allowing for an intervention with minimal access barriers related to cost, geography, or provider availability. Feasibility, acceptability, and efficacy of the intervention will be maximized by following a UCD framework involving engagement of end-users at every design stage.
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