A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina

Abstract

Background Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.

Ten Steps to Design a Counseling App to Reduce the Psychosocial Impact of Human Papillomavirus Testing on the Basis of a User-Centered Design Approach in a Low- and Middle-Income Setting

“…A second activity, described elsewhere, 29 was aimed at understanding women's views on an app's model called mock-up. The mock-up consisted of seven screens that included labels of the content, menus of options, and draft illustrations.…”

“…The app design was based on formative research conducted among urban women living in the Metropolitan Area of Buenos Aires. The results showed that women reported unmet information needs regarding HPV and follow-up steps 29 and that is why for them the app's main objective should be to provide information on HPV, CC, and steps to follow after different HPV test results. This turned out to be the organizing axis of the design, and it became a prominent element in the different screens.…”

“…This turned out to be the organizing axis of the design, and it became a prominent element in the different screens. 29 Studies carried out in several rural and urban settings from Argentina 7,14,33 and Latin America and among Hispanic women from the United States [39][40][41] found similar information needs. Therefore, our IA on the basis of the information needs and psychosocial concerns of urban women from Argentina might be also usable in other regional contexts, whether rural or urban.…”

“…Formative research was a main activity of the IA design process (extensively described elsewhere). 29 We conducted online individual interviews (step 4), focus groups (FGs) (step 8), and design sessions (DSs) (step 9) with HPV-positive women age 30 years or older aimed at understanding their perceptions about the app and to investigating their preferences regarding the app design, content, and framing. All other steps shown in Figure 1 were used as additional inputs to the app's iterative design.…”

“…Thematic analysis 31 was used to analyze data described in steps 1, 5, and 8 (Fig 1 ), relying on the Health Belief Model and the Integrative Behavioral Model frameworks, which has been extensively described elsewhere. 29 The analysis allowed us to organize data into themes, detect emerging topics, and get richer data.…”