Using co-design to develop INTERCEPT, a mobile health (mHealth) App, for the secondary prevention of cardiovascular disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Health Research Board, Ireland SOLVE CHD SYNERGY Grant, University of Sydney, Australia Background Co-design adopts a participatory, person-centred approach to the development of health interventions, which aims to maximise their acceptance and effectiveness. However, despite this many mobile applications are designed with little input from target end users, resulting in poor uptake and usage. Purpose The aim of our study was to optimize the evolution of the INTERCEPT (I-App) mHealth app by integrating target users’ (patients and healthcare professionals) perspectives into its design and development. Methods A core project team of health care professionals (nurse specialists, physicians, physiotherapists, dietitians, psychologists and a pharmacist), software developers and patients was established. A four phase iterative anrticipatory approach to the design process for I-App was adopted using online workshops conducted over a 12-month period. Phase one involved identification of the guiding principles, content and design features. In phase two, a working prototype of the I-App was developed and in phase three a beta version of this prototype was pilot tested among the project team and reviewed for clarity of language, ease of navigation and functionality. Phase four involved user acceptance testing of the I-App with patients who had a recent cardiac event (<2 years). Improvements in the usability of the app were assessed using the System Usability Scale (SUS), which was administered pre and post user acceptance testing. Results From target user insights and scientific literature five key design principles were identified: simplicity and ease of use; behavioural change through goal setting; self-monitoring and use of rewards; provision of credible information and data privacy. Medication adherence, psychosocial support and tracking physiologic parameters like blood pressure were considered important components. Usability testing of I-App resulted in 64 recommendations for the app and of these 51 were implemented. Significant improvements in SUS scores were observed from 61 to 82 (p<0.001) demonstrating the effectiveness of adopting a co-design apporach. Conclusion Using co-design methodology resulted in the INTERCEPT mHealth app responding to the end users’ needs and preferences including desired content and features. The next step in the development process is to trial the feasibility and usage of the I-App in the real-world clinical setting.