Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study

Abstract

Background Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods The WASABY app’s content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app’s 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app’s user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app’s content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app’s content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). Conclusions The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe’s Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention.

Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review

“…Children and adolescents were the main participants represented in the articles included in this review, which aligned with this study's purpose. The adolescents age group had the greatest representation in the included studies-all (8/8, 100%) cancer prevention serious game articles [7,34,[106][107][108][109][110][111] Cancer survivors [54,57,58,80,86,87,91] 0 (0) 7 ( 13) Health professionals [60,63,66,81,82,85,93,94,97] 0 (0) 9 ( 16)…”

“…Caregivers [60][61][62][63]66,79,81,82,92,95,97,99,[101][102][103] 0 (0) 15 (27) Healthy people [7,34,66,70,75,85,91,[106][107][108][109][110][111] 8 (100) 5 ( 9)…”

“…Serious game preference [7,55,56,62,63,67,68,70,75,79,[84][85][86]90,[92][93][94][95][96][97][98][101][102][103][104]108,110,111] 4 (50) 24 (44) Treatment adherence [69,95,101] 0 (0) 3 ( 6) Cancer education [34,55,56,80,95,101,105,106,109] 3 (38) 6 (11) Healthy behavior promotion [42,54,57,60,65,74,…”

“…the 63 articles included in this study, cancer care was the serious game objective with the most research (55/63, 87%)[35,42,52,, with cancer prevention only having 8 articles (8/63, 13%)[7,34,[106][107][108][109][110][111]. The majority of the included studies were published between 2019 and 2023.…”

“…The majority of the included studies were published between 2019 and 2023. To be specific, 5 out of 8 (63%) cancer prevention serious game articles[7,106,[109][110][111] and 35 out of 55 (64%) cancer care serious game articles[35,42,54,58,59,[61][62][63]65,66,71,72,74,75,[78][79][80][81][82]85,[91][92][93][94][95][96][97][98][99][100][101][102][103][104][105] were published between 2019 and 2023. The studies were conducted in Asia, Europe, North America, and Oceania, with the majority of the studies being conducted in Europe and North America.…”