Translating Promoting Factors and Behavior Change Principles Into a Blended and Technology-Supported Intervention to Stimulate Physical Activity in Children With Asthma (Foxfit): Design Study

Abstract

Background: Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, health care providers lack interventions for children with asthma that effectively increase their PA levels and achieve behavior change. A technology-supported approach can positively influence PA and physical functioning in children.

Objective: The aims of this study were to develop a technology-supported intervention that facilitates health care providers in promoting PA for children (aged 8 to 12 years) with asthma and to systematically describe this developmental process.

Methods: Intervention mapping (IM) was applied to develop a blended and technology-supported intervention in cocreation with children with asthma, their parents, and health care providers. In accordance with the IM framework, the following steps were performed: conduct a needs assessment; define the intervention outcome, performance objectives, and change objectives; select theory-based intervention methods and strategies; create components of the intervention and conduct pilot tests; create an implementation plan; and create an evaluation plan.

Results: We developed the blended intervention Foxfit that consists of an app with a PA monitor for children (aged 8 to 12 years) with asthma and a web-based dashboard for their health care provider. The intervention focuses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification, including goal setting, rewards, action planning, monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. An evaluation plan was created to assess the intervention's usability and feasibility for both children and health care providers.

Conclusions: The IM framework was very useful for systematically developing a technology-supported intervention and for describing the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology-supported intervention Foxfit that facilitates health care providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention.

Trial registration: International Clinical Trial Registry Platform NTR6658; https://tinyurl.com/3rxejksf.

Keywords: chronic disease; cocreation; exercise; gamification; intervention mapping; mHealth; mobile app; mobile health; mobile phone; social participation; tailoring; technology-supported intervention; web-based dashboard.

Figure 1

Venn diagram in which the reported factors of all stakeholders are combined. The circles indicate the stakeholder groups. The factors are listed in random order (reprinted from Brons et al [44] with permission from the author). PA: physical activity.

Figure 2

Overview of all technical elements. The arrows indicate data traffic between elements. PA: physical activity; PAM: physical activity monitor.

Figure 3

Start pages of the health care providers' web-based dashboard. Log in to dashboard (top); select the ID of the child (bottom).

Figure 4

Visualization pages of the health care providers' web-based dashboard. Graphs regarding the physical activity (PA) behavior of the child are shown. From top to bottom: PA behavior of the baseline week (“Week 0”); PA behavior of the fifth week using the app (“Week 5”). In both graphs, the date is shown on the x-axis (“datum”), the y-axis represents the amount of PA minutes (“minuten”), and the intensity of PA (“intensiteit”) is represented by the color—low (“licht”); middle (“middel”); high (“zwaar”). In the bottom graph, the smiley faces indicate whether the child has achieved their daily goal, and the number between 1 and 10 indicates the experienced asthma symptoms in the morning (1=feeling very bad; 10=feeling very well).

Figure 5

Personalization pages of the health care providers' web-based dashboard. From top to bottom: personal goals and trophies; physical activity (PA) suggestions; scheduling PAs; choosing relevant tips.

Figure 6

Pages of the smartphone app for the children. From left to right and from top to bottom: home screen; starting the day and filling out symptoms experienced in the morning; filling out physical activity (PA); overview of PAs of the current week; ending the day and filling out symptoms experienced during the day; earned trophies.

Figure 7

Timeline of the Foxfit intervention in the daily practice of the health care providers. PA: physical activity; PAM: physical activity monitor.

Figure 8

Timeline of the Foxfit intervention in the everyday life of the children. The arrows indicate flows between elements. PA: physical activity; PAM: physical activity monitor.