Co-Design in the Development of a Mobile Health App for the Management of Knee Osteoarthritis by Patients and Physicians: Qualitative Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Despite a doubling of osteoarthritis-targeted mobile health (mHealth) apps and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers has not met expectations. Most health and medical apps fail to retain users longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication is untapped. An important, recurrent criticism of app technology development is low user integration design. User integration ensures user needs, desires, functional requirements, and app aesthetics are responsive and reflect target user preferences.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aims to describe the co-design process for developing a knee osteoarthritis minimum viable product (MVP) mHealth app with patients, family physicians, and researchers that facilitates guided, evidence-based self-management and patient-physician communication.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Our qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Study participants included family physicians, patient researchers and patients with knee osteoarthritis (including previous participants of related collaborative research), researchers, key stakeholders, and industry partners. The study setting was an academic health center in Southern Alberta.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Distinct differences exist between what patients, physicians, and researchers perceive are the most important, convenient, desirable, and actionable app functional requirements. Despite differences, study participants agreed that the MVP should be electronic, should track patient symptoms and activities, and include features customized for patient- and physician-identified factors and international guideline-based self-management strategies. Through the research process, participants negotiated consensus on their respective priority functional requirements. The highest priorities were a visual symptom graph, setting goals, exercise planning and daily tracking, and self-management strategies. The structured co-design with patients, physicians, and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning, and respect for diversity and differing opinions. These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation, and group reflection, aided by the provision of tangible and ongoing support throughout the research process, which encouraged team members to question conventional thinking. Group-, subgroup-, and individual-level data helped the team reveal how and for whom perspectives about individual functional requirements changed or remained stable over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>It is feasible to preserve the diversity of perspectives while negotiating a consensus on the core functional requirements of an mHealth prototype app for knee osteoarthritis management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between the patient, physician, and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus.</jats:p> </jats:sec>

The use of patient-reported outcome measures in hip and knee arthroplasty in Alberta

“…An example is the development of a mobile health app for patients with knee osteoarthritis to guide self-management, provide evidence-based information to patients and physicians and facilitate communication that address patient needs and challenges in disease management. The co-design process with patients, family physicians and researchers, identified a visual symptom graph using PROMs to be amongst the highest priority for functional requirements of the app [ 17 ].…”

Health Apps Require Co-development to Be Acceptable and Effective

“…We acknowledge that the evaluation of an existing app is often appropriate (Boudreaux et al, 2014) and is both quicker and more cost-effective than designing an app from scratch, but wish to share the learning points from our experience. We believe HA can make a valuable contribution to health care delivery but "oven ready" solutions may not fit all and co-developing HA from the start with the envisaged service users (Mrklas et al, 2020) may lead to higher uptake. This requires creative strategies when including seldom heard service users, such as recruiting from a helpline providing help to those who struggle with virtual interventions.…”

Development of a mobile application to improve exercise accuracy and quality of life in knee osteoarthritis patients: a randomized controlled trial

“…Currently, approximately 20 health apps per year are evaluated for US Food and Drug Administration approval [ 7 ]. The continual innovation of health apps offers a broad range of tools to the user, such as disease tracking, treatment options, relevant medical information, and consistent encouragement [ 8 – 10 ]. In the context of physical therapy for OA, the use of a mobile app has been shown to improve pain control and decrease opiate usage for patients in the postoperative setting [ 11 ].…”