Engaging users in the design of an mHealth, text message-based intervention to increase physical activity at a safety-net health care system

Abstract

Objectives Text-messaging interventions are a promising approach to increasing physical activity in vulnerable populations. To better inform the development of a text-messaging intervention, we sought to identify barriers and facilitators to using text messaging and engaging in physical activity among patients with diabetes and comorbid depression. Materials and Methods We conducted interviews with primary care patients at a safety-net health care system (N = 26). Data were collected at 3 stages, including a focus group (stage 1), and individual interviews (stage 2 and 3). Patients in stage 1 and 2 previously participated in a text-messaging intervention as part of depression treatment. Discussions focused on participant experience of previously using a text-messaging intervention, influences and perceptions of physical activity, and mobile phone use. We analyzed all transcripts for emerging themes. Results Participants were 56.2 years (±9.7); 69.2% were female, 65.4% identified as Hispanic/Latino(a), and 46.2% reported having less than a high school education. All had depression and 61.5% had diabetes. Specific barriers that emerged included low literacy and only basic use of mobile phones in everyday life, in combination with a high prevalence of comorbid health conditions and limited mobility. These were each addressed with a specific content or intervention delivery change in the overall intervention design. Conclusions Conducting a focus group and individual interviews with end users of an mHealth intervention under development has implications for tailoring and modifying components of the content and format to ensure that the final intervention will engage end users most effectively.

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

“…For example, mobile/virtual technology within safety-net health care settings may be tailored to patients at varying levels of literacy and different backgrounds. [50][51][52][53] In LA County, patient access to specialty services dramatically increased with the adoption of e-consult practices. 54 Similarly, using virtual care to address nonurgent primary care complaints may circumvent patient fears and improve access to care.…”

Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach

“…It consisted of a feasibility study phase with English-speaking (n=5) and Spanish-speaking (n=5) primary care adult patients recruited from a safety-net health care setting. All participants (10/10, 100%) were diagnosed with depression, and 90% (9/10) had diabetes [30,38]. A subset of messages (n=34) was tested using a mixed methods approach that included a card sorting task and individual semistructured interviews.…”

“…The individual semistructured interviews entailed a set of open-ended questions that ultimately informed the thematic content of messages and messaging characteristics [30]. Participants were also asked about their perceived barriers and facilitators of regular physical activity.…”

“…In the context of health text messaging development, a UCD approach consists of conducting preliminary research within the target population to inductively identify any barriers that they face and collect feedback about the content as it is being developed [21,29,30]. However, recruiting large groups of participants within patient populations to test the content is challenging.…”

Feasibility, Acceptability, and Influence of mHealth-Supported N-of-1 Trials for Enhanced Cognitive and Emotional Well-Being in US Volunteers

“…We used 5-day treatment periods as a compromise between the dictates of behavioral science (which would favor longer periods, to allow for adequate ramp-up and wash-out) ( 8 ) and statistical power (which would favor a greater number of switches between treatments). Participants received a text message through the HealthySMS system ( 25 – 27 ) each evening asking for ratings of stress, focus, and happiness for the day just finished and announcing tomorrow's activity.…”