Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype

Abstract

Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps.

Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD.

Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data.

Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001).

Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods.

Keywords: app design; chronic obstructive pulmonary disease; ecological momentary assessment; mHealth; mobile phone.

Figure 1

Screenshots of app: (left) home/landing page with the main menu and weather widget (center) graph showing ratings for breathlessness symptom and (right) self-reported impact of symptoms.

Figure 2

Screenshots of the app pages for medication questions and flare-up medications.

Figure 3

Homescreen mock-up.

Figure 4

Treemap depicting the number of references made to each coded theme.

Figure 5

Screenshots of the app pages using slider controls (left of the vertical bar) before they were replaced following user feedback by a more explicit list structure (right of the vertical bar).

Figure 6

Iterative design and development phases. COPD: chronic obstructive pulmonary disease.

Figure 7

Average score for all participants (N=37) per month for the impact of symptoms. Note that "how feeling" is rated on a 3-point scale (0=great, 1=so-so, and 3=bad), and the other symptoms are rated on a 4-point scale (0=none, 1=mild, 2=moderate, and 3=severe).

Figure 8

The number of times each participant submitted his or her self-reported symptom data per day per month.

Figure 9

Most common sequence of events within an episode between pages.

Figure 10

Recommended steps.