Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach.

Hani Salim,Ping Yein Lee,Jasmine Wong,Hilary Pinnock,Ingrid Young,Sazlina Sharif-Ghazali,Ai Theng Cheong

doi:10.2196/26434

Abstract

BackgroundTechnology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic).ObjectiveThe aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop.MethodsWe recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues.ResultsThe stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout.ConclusionsThis study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Highlights

BackgroundSupported self-management for asthma is highly effective at improving control and reducing acute attacks [1,2,3]; globally, it is challenging to implement for 334 million people living with asthma [4,5,6,7]
Malaysia has a high burden of limited health literacy in the general population [11], and asthma control is challenged by a lack of patient education, overreliance on unscheduled visits, and lack of action plan ownership [12,13,14]
Health-related information-seeking behavior on the internet is greater in those with good health literacy [19], our previous qualitative work among people with limited health literacy suggests that a mobile app is a preferred medium to deliver supported self-management, including a pictogram-based asthma action plan and signposting to reliable asthma information sources

Summary

Introduction

BackgroundSupported self-management for asthma (written action plans and regular review) is highly effective at improving control and reducing acute attacks [1,2,3]; globally, it is challenging to implement for 334 million people living with asthma [4,5,6,7]. One of the challenges is the need to tailor support for people with limited health literacy. The use of digital technologies for internet-based information is more common in the younger age group than in the middle and older age groups [15]. Health-related information-seeking behavior on the internet is greater in those with good health literacy [19], our previous qualitative work among people with limited health literacy suggests that a mobile app is a preferred medium to deliver supported self-management, including a pictogram-based asthma action plan and signposting to reliable asthma information sources. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic)

Methods

Results

Discussion

Conclusion