More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design

Abstract

Background: Multiple sclerosis (MS) is one of the world's most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users' needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen's heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-today life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it.

Design considerations for a multiple sclerosis fatigue mobile app MS Energize: A pragmatic iterative approach using usability testing and resonance checks

“…While there are fatigue management apps for other conditions such as cancer ( Spahrkäs et al, 2020 ), to our knowledge there is currently only one other mobile app (‘More Stamina’) that focuses on fatigue management in MS ( Giunti et al, 2018b ). ‘More Stamina’ is a task organisation tool that incorporates energy management and energy profiling, using the concept of “stamina credits”, to minimise the impact of fatigue in users' day-to-day lives.…”

e-Health and multiple sclerosis: An update

“…The costs for such a system would be contained, while improvements through immediate access to expert input may substantially improve the quality of care and of life for pwMS. 37 Not least, these platforms should be specifically designed to account for patients’ characteristics, not only in terms of MS-related disability but also for their literacy (traditional and computer specific) and propensity to digital media use. 38…”

The WOMEN-UP Solution, a Patient-Centered Innovative e-Health Tool for Pelvic Floor Muscle Training: Qualitative and Usability Study during Early-Stage Development

“…Computer-assisted qualitative analysis was performed using a thematic label framework based on the heuristics for medical device evaluation [21]. After data familiarization and iterative coding in data of two participants, the framework was complemented with additional relevant labels of the relevant themes from the model for user acceptance of technology [22] and serious gaming components [14,18].…”

“…Reliable and widely accepted usability testing methods, such as the think-aloud protocol and retrospective interviews, facilitate insight into usability issues (barriers) through observations of interface interaction [13]. Specifically, user-centered testing has been used for gamified health interventions [14] and biofeedback-assisted systems [15].…”