Applying User-Centered Design Methods to Understand Users' Day-to-Day Experiences Can Inform a Mobile Intervention for Binge Eating and Weight Management

Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study

BACKGROUND

Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe.

OBJECTIVE

This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement.

METHODS

The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics.

RESULTS

After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively).

CONCLUSIONS

The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention.

Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

BACKGROUND

App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials.

OBJECTIVE

To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding.

METHODS

In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified.

RESULTS

Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery.

CONCLUSIONS

Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.

Development and Initial Testing of a Personalized, Adaptive, and Socially Focused Web Tool to Support Physical Activity Among Women in Midlife: Multidisciplinary and User-Centered Design Approach

Background

Women in midlife are vulnerable to developing cardiovascular disease, particularly those who have conditions such as hypertension. Physical activity (PA) can reduce risk, but efforts to promote PA in this population have been only modestly effective. More attention to social influences on PA behavior may be useful, particularly social support and social comparison processes. Activating these processes with digital tools can provide easy access that is flexible to the needs of women in midlife.

Objective

This paper describes the user-centered design processes of developing and conducting initial evaluation of a personalized and adaptive web application, tailored to the social needs of women in midlife. The goal was to gather feedback from the population of interest, before and during the design process.

Methods

This study was conducted in 4 stages. The first and second authors (DA and AFL) developed technical specifications, informed by their experience with the population of interest. We collected feedback on potential content for the web application with women in midlife using both interviews (5/10, 50%; mean age 47.4, SD 6.66 years; mean BMI 35.3, SD 9.55 kg/m²) and surveys (5/10, 50%; mean age 51, SD 6.60 years; mean BMI 32.7, SD 8.39 kg/m²). We used their feedback to inform support messages and peer profiles (ie, sources of social comparison information). Nine members of the behavioral science team and 3 testers unfamiliar with the web application completed internal testing. We conducted naturalistic functionality testing with a different group of women in midlife (n=5; mean age 50, SD 6.26 years; mean BMI 30.1, SD 5.83 kg/m²), who used the web application as intended for 4 days and provided feedback at the end of this period.

Results

Iterative storyboard development resulted in programming specifications for a prototype of the web application. We used content feedback to select and refine the support messages and peer profiles to be added. The following 2 rounds of internal testing identified bugs and other problems regarding the web application’s functioning and full data collection procedure. Problems were addressed or logged for future consideration. Naturalistic functionality testing revealed minimal further problems; findings showed preliminary acceptability of the web application and suggested that women may select different social content across days.

Conclusions

A multidisciplinary and user-centered design approach led to a personalized and adaptive web application, tailored to the social needs of women in midlife. Findings from testing with this population demonstrated the feasibility and acceptability of the new application and supported further development toward its use in daily life. We describe several potential uses of the web application and next steps for its development. We also discuss the lessons learned and offer recommendations for future collaborations between behavioral and computer scientists to develop similar tools.

Understanding self-monitoring to inform a mobile intervention for binge eating and weight management: A proof-of-concept randomized trial

OBJECTIVE

This study explored consumers' perspectives on self-monitoring, a common feature in behavioral interventions that helps inform consumers' progress and answer their questions, to learn what outcome metrics matter to consumers and whether self-selection of these metrics leads to greater engagement (i.e., compliance, satisfaction) in self-monitoring than monitoring only default options.

METHODS

In a proof-of-concept randomized trial, 48 adult participants were randomly assigned to "clinician-determined monitoring" or "clinician + self-determined monitoring" conditions. Before starting monitoring, all participants shared outcomes that would matter to them in a mobile intervention for binge eating and weight management. Then, for 3 weeks, participants in the "clinician-determined" condition monitored their weight and binge-eating episodes, and participants in the "clinician + self-determined" condition monitored these and another metric of their choosing. After, satisfaction and compliance were assessed.

RESULTS

Participants identified 116 metrics, grouped into 12 themes, that mattered to them. During monitoring, participants in the "clinician + self-determined" condition monitored 41 metrics. Surprisingly, participants in the "clinician-determined" condition also monitored metrics besides weight and binge eating. This resulted in a failure of our experimental manipulation, which represents a significant limitation of this research. No significant differences emerged in satisfaction or compliance between conditions.

DISCUSSION

Although our proof-of-concept trial yielded null quantitative results, findings also suggested binge eating and weight management interventions may benefit from including an individually customizable monitoring option in addition to default metrics, warranting testing in future research.

PUBLIC SIGNIFICANCE

Examining consumers' self-monitoring preferences for a mobile intervention for binge eating and weight management revealed a variety of metrics that matter to consumers, although binge eating and weight were still most valued. Findings from our proof-of-concept trial suggest design implications of encouraging an individually customizable monitoring option, in addition to default metrics, which needs to be tested in future research over a longer period and during actual mobile intervention delivery.

Perceived Facilitators and Barriers to Engaging with a Digital Intervention among Those with Food Insecurity, Binge Eating, and Obesity

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.