Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study

Abstract

Background Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing.

Nurses’ Roles in mHealth App Development: Scoping Review

“…The characteristics of the included studies are summarized in Table 1 . Of the 157 included publications, 132 (84.1%) either described usability testing or were original research papers [ 32 - 49 , 51 , 52 , 55 , 56 , 58 - 65 , 67 - 75 , 77 - 81 , 83 , 85 - 87 , 89 - 107 , 110 , 112 - 117 , 119 - 124 , 126 , 129 , 130 , 132 - 134 , 136 , 138 , 140 - 145 , 147 - 160 , 162 - 169 , 171 - 173 , 175 - 187 ].…”

“…Nurses played a role in all the stages of development. Nurses were most represented in the design and prototyping phase (112/157, 71.3%) [ 32 - 37 , 39 , 41 - 43 , 45 , 46 , 49 , 51 - 53 , 55 - 58 , 60 , 63 - 65 , 67 - 70 , 73 - 79 , 81 , 84 - 88 , 90 - 93 , 96 , 99 - 102 , 104 , 106 , 107 , 110 - 118 , 121 - 129 , 131 - 136 , 138 , 139 , 141 , 142 , 144 - 146 , 148 , 149 , 151 - 153 , 155 , 157 , 158 , 160 - 165 , 167 , 169 , 171 , 173 - 177 , 180 , 182 , 184 - 186 , 188 ], followed by the requirements gathering phase (98/157, 62.4%) [ 32 - 37 , 39 - 41 , 43 ...…”

“…Nurses most frequently assumed the role of evaluator, with 123 (78.3%) of 157 publications indicating that nurses took on this role in at least 1 phase [ 32 - 37 , 39 - 49 , 51 - 53 , 55 , 56 , 58 , 60 - 65 , 67 , 68 , 70 , 72 - 75 , 77 , 79 , 80 , 82 - 88 , 90 - 94 , 96 - 107 , 110 - 123 , 127 - 131 , 133 - 135 , 138 - 143 , 145 - 152 , 155 , 157 - 160 , 162 , 164 , 165 , 167 - 169 , 171 , 172 , 175 - 180 , 182 - 186 ].…”

Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App

“…However, this study went further than others in applying health literacy principles at every step of the mHealth design process-from recruitment of participants to selection of app content, feature design, and the report-back process. Our study provides 4 key lessons and recommendations in mHealth Design for racial and ethnic groups with health disparities [37,38].…”

“…However, the multiple design sessions with the same participants performing concrete tasks allowed them to provide detailed information not available through other methods. As other researchers note, user-centered methods have high information yields and rich data [37].…”