Lost in Translation: Transforming Behaviour Change Techniques into Engaging Digital Content and Design for the StopApp

Abstract

Frameworks to support the application of behaviour change theory to the choice of behaviour change techniques (BCTs) in designing digital behaviour change interventions (DBCIs) are becoming well established, and have been employed by the authors in the development of StopApp. However, guidance on the next stage—effective operationalisation (translation) of these BCTs to a digital context, including the precise delivery and design of “behavioural intervention technology” (BIT) elements, is still in its infancy. This is despite growing recognition of the need to optimise engagement and usability, alongside a theoretical basis, for intervention effectiveness. The aim of this study was to explore methods to translate BCTs into digital content in an accurate and systematic manner. We describe the process of using co-creation (user-led) rather than expert-driven methods in the development of user-facing features and design in StopApp, including the iterative “bottom-up” and “top-down processes” necessary for accurate BCT translation. We found a small disparity between the intended and actual BCT content, reflecting the difficulties of translating BCTs into digital intervention content and the need for better guidance and methodical approaches to enhance this under-researched process. The involvement of our Patient and Public Involvement (PPI) group throughout these processes is described.

Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study

“…In general, health services have several specific characteristics that make cocreation particularly challenging. Analyses have both highlighted the theoretical benefits of involvement strategies to health care (eg, promoting equity and improvement) and identified numerous tensions and contradictions that play out in practice [ 17 , 23 , 51 - 54 ]. Nevertheless, within this project, particular emphasis was placed on improving each phase [ 55 ] of the process by harnessing the experiences of experts, citizens, and patients.…”

“…Its application in health services and prevention has been recommended [ 17 , 18 ], in particular when IT tools are proposed [ 19 - 22 ]. There are published case studies on the development of apps and other eHealth tools [ 19 , 23 - 30 ].…”

A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development

“…The combination of digital technologies and live coaching affords the most efficient support to engage the study participants and close the feedback loop while providing constant exposure to the intervention content [ 29 ]. Digital health interventions are promising, but sometimes demonstrate mixed effectiveness [ 6 , 57 ], often due to low participant engagement and high study attrition [ 27 , 57 ] and a lack of integration of BCTs into interventions [ 32 ]. To address these concerns, we designed the Healthy Frio RT intervention by considering both the behavioral and psychological theories as well as systems engineering models [ 31 , 58 ].…”

“…While the design of the content of digital health interventions has benefited from these theories and models, the design of delivery and feedback processes remains poorly guided. This weakness speaks about the lack of cooperation between computer system engineers and behavioral researchers [ 22 , 31 ] and the need to establish a model to guide the incorporation of BCTs into the content and functionality of digital health interventions [ 32 ].…”

An iterative, interdisciplinary, collaborative framework for developing and evaluating digital behavior change interventions

“…Beyond designers’ expertise, a close collaboration with behavior scientists ensures that the behavior science requirements are met in the design assets. As wireframes and prototypes are designed, testing with users and stakeholders should be an ongoing process [ 58 ]. Usability and feasibility testing should be performed by sharing prototypes with relevant stakeholders to receive feedback.…”