User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness

Abstract

Background Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content.

Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration (Preprint)

“…In line with the literature [6,18,26], the success or failure of digital services such as a mobile phone app in encouraging a healthier lifestyle is highly dependent on the app's efficacy in achieving behavioral change. Based on research exploring game-based health interventions [13,15], as well as theories and practice of designing for change [20], our findings suggest that in the context of smoking cessation, psychological empowerment through the gamified design of a mHealth app significantly predicts users' ability to quit smoking successfully.…”

“…Tailoring motivational affordances or 'gamification tactics' to a task has been noted to be critical to successful gamification [5,6]. Goal-setting, for instance, has been noted as an effective tool for enhancing selfmotivation [7].…”

“…In turn, these may drive behavior change. Gamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain [6]. For instance, studies have shown that aspects of gamification can be twice as effective in frequency of self-monitored exercise for weight loss program compared to a standard paper diary [18].…”

“…challengeability balance, meaningful framing, personalization, fun or user-centered design [6,19]) affect behavior change by psychologically empowering users, enhancing their well-being, and giving them inspiration. Such gamification tactics, among others, have been identified to elicit behavior change within the health and healthcare settings, yet there is no clear pattern as to the type of behavior change strategy that is most effective [20].…”

Analysis and Development of a Platform for Generating Context-Aware Apps for Mental Health

“…Leveraging the improved connectivity and ubiquity of smartphones, some authors offer access to entire online libraries of learning materials [127,167]; others utilize in-app prompting as intervention techniques, e.g., sending reminders to use the app [87,103,104,118,159], motivational messages [70] or messages from the therapist [90,163]. Exploiting the improved interactivity of smartphones, we find interactive quizzes for training skills and improved learning [78,127], assessments for panic attacks [144], suicidal intentions [122], symptoms Chapter 2. Smartphone apps for the treatment of mental disorders: a systematic review.…”