Lessons and reflections from an extended co-design process developing an mHealth app with, and for, older adults (Preprint)

Abstract

BACKGROUND There are many mHealth apps for older adult patients, but research has found that, broadly speaking, mHealth still fails to meet the specific needs of an older adult user. Others have highlighted the need for embedding the user in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps, and is described as involving stakeholders in each phase of the design/development process. Involvement of older adults in co-design processes has been variable. Co-design approaches to date have tended towards embedding the stakeholders in early phases (e.g., pre-design/generative) but not throughout. OBJECTIVE The aim of this paper is to provide reflections on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. The aim was to design an mHealth tool to assist older adults to coordinate their care with healthcare providers and caregivers. METHODS Our work to conceptualize, develop and test the mHealth app consisted of four phases: Phase 1- consulting stakeholders; Phase 2- app development and co-designing with older adults; Phase 3- field testing with a smaller sample of older adult volunteer testers; and Phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 12, using team-based thematic analysis. RESULTS In Phase 1, we identified key features that older adults and health care providers wanted in an app, and each user group identified different priority features (older adults principally sought supports to use the mHealth app, while providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what older adult users wanted, and what our developers were able and willing to deliver. In Phase 4 we reflected on our abilities to embed the voices and perspectives of older adults throughout the project, when working with a developer not familiar or committed to the core principles of co-design. CONCLUSIONS While our final mHealth app did not reflect all of the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. Furthermore, our reflective process identified important factors to consider when health researchers and gerontologists set into the app development sector.

The Impact of COVID-19 on Older Adults’ Perceptions of Virtual Care: Qualitative Study

“…Technology-based interventions can also improve access for marginalized groups with less technical experience by simplifying user interfaces and workflows on virtual care platforms to increase usability [40,41]. Efforts should be made to collaborate with older adults when designing and implementing such strategies in order to maximize their usefulness and relevance [40,42,43]. This can be accomplished by engaging older adults in designing technology and virtual care systems, training providers, and research/program evaluation (eg, through advisory committees, participatory research, codesign, etc) [40].…”