Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure (Preprint)

Abstract

BACKGROUND User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. OBJECTIVE This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. METHODS Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. RESULTS We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. CONCLUSIONS UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories.

Involving Older Users in Design of Patient Accessible Electronic Health Records: Exploring the Potential of Open‐Ended Questions

“…Users' concerns are not necessarily focused on mere usability issues and testing of existing features, often of a certain service or application, that is often the focus in user studies (e.g. Cornet et al, 2020;Gould & Lewis, 1985;Stojmenova, Imperl, Žohar & Dinevski, 2012). By using open-ended questions, respondents are allowed to innovate freely and propose ideas that go beyond specific services; hence, the answers can also be useful for informing the development of multiple types of services.…”

“…By using open-ended questions, respondents are allowed to innovate freely and propose ideas that go beyond specific services; hence, the answers can also be useful for informing the development of multiple types of services. As it has been found that lack of resources hinder cooperation between end-users and software developers (Rytkönen, Kinnunen & Martikainen, 2022), and usercentered design approaches usually include several phases such as planning, designing, testing and evaluating, requesting longer time spans and hence more resources (Cornet et al, 2020;Gould & Lewis, 1985;Stojmenova, Imperl, Žohar & Dinevski, 2012;van Velsen, Ludden, & Grünloh, 2022), the option of including open-ended questions in larger studies related to eHealth information behavior can be a cost-effective way to provide developers with useful feedback. The approach can be termed as a form of citizen science (van Velsen, Ludden, & Grünloh, 2022) with a major benefit of not requiring a recruiting of end-users at certain points of time at certain places, or the effort of testing existing services thoroughly multiple times (Cornet et al, 2020;Gould & Lewis, 1985).…”

Design Processes for User Engagement with Mobile Health: A Systematic Review

“…4. According to [81], mHealth projects frequently involve distinct stakeholders such as patient populations (e.g., older adults, patients with chronic conditions) and clinician experts, or both.…”

Supporting self-care with eHealth : Advancing theory-based research and development of interventions to support patients with a cardiovascular disease

“…However, the practical challenges and pitfalls of these approaches are seldomly reported in published literature (Cornet, Toscos, et al, 2020). Challenges can come in formative, design, and evaluation stages or as recurrent processes (Cornet, Toscos, et al, 2020).…”

“…However, the practical challenges and pitfalls of these approaches are seldomly reported in published literature (Cornet, Toscos, et al, 2020). Challenges can come in formative, design, and evaluation stages or as recurrent processes (Cornet, Toscos, et al, 2020). On top of that, to validate value sensitive eHealth, it will be necessary to test the differences in actual effectiveness trials.…”