Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study

Abstract

Background There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective The aim of this study was to reflect 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. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods Our work to conceptualize, develop, and test the mHealth app consisted of 4 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 11, using team-based thematic analysis. Results In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. 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 with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions Although our final mHealth app did not reflect all 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.

Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey

“…These unsatisfying technology experiences can affect their motivation to engage in self-tracking health practices. This poor user experience for college students with disabilities represents a lack of inclusivity in the current distributed digital health technology, similar to how older adults may feel resistant toward new technology [ 36 ]. The fact that users with physical, sensory, and learning limitations cannot experience the same level of positive effectiveness and behavioral changes as common users can be understood as a paradoxical effect of technology that contributes to health inequality in the future [ 37 ].…”

Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis

“…These interventions do not include older adults. Future models of care may wish to engage older adults in co-design to conceptualize and brainstorm program delivery [ 80 , 81 ].…”

Toward Sustaining Web-Based Senior Center Programming Accessibility With and for Older Adult Immigrants: Community-Based Participatory Research Cross-Sectional Study

“…We recommend further studies for additional psychometric testing and continuing engagement of older Asian American immigrants in co-designing for adoption research and building upon a CBPR approach using both quantitative and qualitative methods. This may increase meaningful use and sustainability [9,13,39]. Further studies need to address continuing engagement of older immigrant clients in building and sustaining a senior center, completely web-based versus hybrid-combination of web-based and in-person services, and essential trust in web-based continuity of health care and social service.…”

“…Web-based care was a part of the pivot during the COVID-19 pandemic; however, this was isolating to many older Asian American immigrants [6]. Older adult users in the general population increasingly integrate technology and mobile devices into their daily lives [9], but this is not necessarily true for older Asian Americans. A study including older White Canadians showed that they were primarily concerned with avoiding the virus and with health care efficiencies [1] that web-based services can address, whereas older Korean immigrants were primarily worried about autonomy, technology dependence, and the burden of learning a new technology for engaging in social and health services [10].…”