Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study (Preprint)

Abstract

BACKGROUND Falls account for ~50% of infant injury hospitalisations and caretaker behaviour is central to preventing infant falls. Behaviour theory informed interventions for injury prevention have been suggested, but to date few have been reported. The potential of using smartphones for injury prevention intervention delivery is also under exploited. OBJECTIVE This study aims to develop a behaviour theory, evidence and user centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. METHODS Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In Phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components which were then implemented as a mobile application. In phase 2 following the person-based approach, user testing via think aloud interviews and comprehension assessments were used to refine content and implementation of the intervention. RESULTS Target behaviours identified in Phase 1 were adequate rest for the newborns mother and safe feeding practices defined as Prepare, Position and Place. From behavioural determinants and the Behaviour Change Wheel, behavior change functions selected to achieve these target behaviours were psychological capability, social opportunity and reflective motivation. Selected Behaviour Change Techniques aligned with these functions were providing information on health consequence, using a credible source, instruction on performing each behaviour and social support. The defined intervention was implemented in a draft Android application. In phase 2, four rounds of user testing were required to achieve the pre-defined target comprehension level. Results from think aloud interviews id were used to refine intervention content and application features. Overall, results from Phase 2 revealed users found the information provided helpful. Features such as self -racking and inclusion of social and environmental aspects of falls prevention were liked by the participants. Important feedback for successful implementation of the digital intervention was also obtained from the user -testing. CONCLUSIONS To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This work provides a detailed example of evidence-based development of a behaviour theory informed mobile intervention for injury prevention refined using the person-based approach.