A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study

Abstract

Background Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.

A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App

“…Results from the SUS are displayed in Multimedia Appendix 2. However, similar scores have been reported for other mHealth apps with comparable features (eg, goal setting, rewards, and diaries for health behaviors) when reviewed by adolescents in several European countries [69]. It is also worth noting that the SUS score means that receiving all neutral responses will result in a score of 50 and fail grading.…”

Development and Evaluation of a Digital Health Intervention for Substance Use Reduction in Young Refugees With Problematic Use of Alcohol and/or Cannabis—Study Protocol for a Single-Armed Feasibility Trial

“…Concerning the development of the DHI, we did not have the resources to apply a fully iterative co-design [such as e.g., Martin et al ( 73 )] or community-driven adaptations of an existing intervention [such as e.g., ( 74 )]. Translating the application from German into Arabic, English, Pashto, and Persian and involving cultural mediators and refugees from a number of countries (Afghanistan, Iran, Iraq, and Syria) in the intervention development did not allow to limit cultural adaptations to one cultural group and may weaken the possible benefits of cultural adaptations compared to if done so.…”

Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews

“…Participating in challenges is a social activity that involves interactions with other participants. The evidence suggests that participation in the challenges might be more effective when friends are engaged because there is an abundance of evidence that both the motivation to be active and actual PA levels are increased when friends are involved [15,48,[67][68][69]. Moreover, it is more fun to be physically active together with friends [47], and peer involvement has been previously identified as a feature that adolescents like and use in ICT solutions [64].…”

“…To strengthen the effect of ICT solutions, attention should be paid to the user experience and the usefulness of the information provided, as both have been demonstrated to strengthen the effect of the solution [46,69,83]. The need for a positive user experience through a simple and well-ordered design that is pleasant to use has also been highlighted by the users involved in previous studies [43,46,54,60,69].…”

“…It has also been pointed out that rewards have the potential to foster motivation and increase self-efficacy [46]. However, the logic behind receiving award points must be clear to the participants [55,69], and the reward system should be carefully planned so that it would support intrinsic motivations because intrinsically motivated behaviors are derived from enjoyment and interest by the performer [64,84]. This, in turn, supports long-term behavior changes [85].…”