Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study

Abstract

Background Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.

Time to listen: a mixed-method study examining community-based views of mobile technology for interventions to promote physical activity

“…The data reported here are part of formative research to develop a PA intervention targeting African-American women at risk for cardiovascular disease. 40 The decision to develop a culturally tailored PA-promoting app arose from the community-based Washington, D.C. Cardiovascular Health and Needs Assessment. 6 41 Results presented in this paper represent the participants’ thoughts prior to engaging in the pilot PA intervention and using the study app.…”

“…Although use of NVivo software was considered, the research team elected to use a consensus-based approach that was achieved through multiple readings, discussions and coding sessions as this method is widely used by qualitative researchers in the literature. 40 43–46 …”

Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity

“…To optimise the app’s ability to facilitate improved health behaviours, end-user feedback was solicited from community focus groups (FGs) throughout the app development process. 38 We worked with an app-development organisation (CHAI Core: Interventions, Chapel Hill, North Carolina, USA) to design an app that tracks PA levels by logging step counts, and provides users with culturally tailored motivational messages created in partnership with DC CHOC. We named the app ‘Step It Up’, in reference to the desired outcome of increasing the number of daily steps among participants.…”

“…Subsequently, FGs were conducted at a local partnering church to understand participants’ experiences using the app to overcome PA barriers and increase PA, described in previous work. 38 These FG data were used to create a second iteration of the Step It Up app, subject to further user experience interviews and pilot testing. We learnt from one-on-one user experience interviews focused on wire-frame design that participants preferred bold colour schemes, audiovisual supplements such as instructional videos on stretching, and wanted an independent section for goal-setting and tracking progress.…”

“…Their suggestions were followed up with phone interviews to further clarify and tailor messaging to AA women (figure 4), as described previously. 38 Remote TPM Participants randomised to TPM will receive the same mHealth app, with different messaging based on the socioecological model (figure 1). This model considers each individual's behaviour to be influenced by a variety of interrelated institutional, environmental and community factors, thereby emphasising the importance of environmental context in behaviour change.…”