Background
The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app.
Objective
The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product.
Methods
Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback.
Results
This co-design approach resulted in multiple patient and care partner–led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic.
Conclusions
We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing.
BACKGROUND
Older adults, and those living with physical and mental health conditions, may experience fluctuations in daily cognition that are linked to underlying changes in their health. Quantifying these fluctuations may help us to better understand the biological mechanisms underlying health and functional impairment, monitor health conditions more effectively and better tailor treatment to individual needs. However, current clinical practice does not provide convenient means of collecting repeated measures of cognitive fluctuations occurring across short time-periods, such as within a day.
OBJECTIVE
We aimed to address this gap in cognitive fluctuation measurement by developing a smartphone app to measure cognitive function on a more frequent basis in people with cognitive impairment.
METHODS
The app was developed using an Agile methodology, which allowed for end-user input to be incorporated at key points throughout the design and development process. Four co-design workshops, developed to consult end users (people living with a de-mentia diagnosis (PwD), care partners and advocates) about software implementations, were integrated alongside time-boxed software sprints that enabled user feedback to be fed into the next development iteration.
RESULTS
This co-design approach resulted in several user-led software alterations that had not been predicted by the development team. Importantly, the time-boxed approach to app development meant that the less user-friendly design elements were addressed early in the development process, before too much resource was committed to software development.
CONCLUSIONS
End-user input was important throughout the development process for early identification of usability issues. The benefits of this approach were, reduced costs, faster development and potentially a more user friendly app. Further research would be useful to better understand the benefits of this approach to developing health-related software. MyMindCheck is a customisable software platform, which could have further cognitive tests added and could be applied to other health conditions.
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