The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care: a user-centered design

Abstract

Background: Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage.

Objective: The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback.

Methods: The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team.

Results: The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient.

Conclusions: This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial.

Keywords: accelerometry; physical activity; primary health care; remote sensing technology; self-management; user-centered design.

Figure 1

The It’s LiFe! user-centered design process. First the end-users and context were defined based on the literature. Second the conceptual idea of the tool was described in a use case, based on input from literature, an experts meeting and patient representatives. In stage 3 the use case was discussed with patients and health care professionals to elicit the user requirements for the tool. During the whole process the research team deliberated with the engineering team, to find out what was technically possible. After a detailed user requirements document was composed the engineering team translated the user requirements in technical solutions.

Figure 2

The monitoring and feedback tool that was developed, based on the requirements of the end-users. The tri-axial activity sensor is connected via Bluetooth to the smartphone. The smartphone gives directly visible feedback about the amount of activity in a bar chart, which dynamically fills up. When the goal (indicated by the red line) has been reached, a sun rises. In the app and on a secure webpage, people can see their activity history and answer dialogue sessions and read feedback messages generated by the system. The practice nurse can monitor the results of all patients on the secure web page to discuss during patient visits.

Figure 3

Activity menu on the smartphone app. The blue part of the bars indicates the moderately intense activity in minutes; the yellow part denotes the high-intensity activities. The red line indicates the daily goal.