Using codesign to develop a culturally tailored, behavior change mHealth intervention for indigenous and other priority communities: A case study in New Zealand

Abstract

The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Māori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Māori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Māori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Māori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whānau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Māori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.

A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting

“…Previous studies have stated that a co-productive and co-designed approach is necessary in the development of interventions that seek to improve community well-being outcomes. Examples of such interventions include healthy aging programs [19,20] nonmedical mental health interventions [21], community-based support for young onset dementia [19] and a mobile health programme to reduce obesity [22]. This statement is based on the perception that each community has unique socioeconomic and environmental features that influence the community's well-being [20].…”

“…This statement is based on the perception that each community has unique socioeconomic and environmental features that influence the community's well-being [20]. As a result, generic interventions will not lead to positive outcomes in every situation and engaging community members in the development of well-being interventions through co-production and co-design makes explicit the main priorities for well-being improvement, resulting in a practical and effective intervention [19,[21][22][23]. The evidence indicate that co-production and co-design can also empower communities [22,24] and enable them to have a sense of ownership of an intervention [23] consequently encouraging their participation in the delivered service [20].…”

Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process (Preprint)

“…This information increases transparency to users and offers protection for researchers. Finally, depending on the specific population and their needs, researchers may wish to adopt a co-design approach to designing and constructing their app interventions [39]. Specifically, to learn about the needs, attitudes, and preferences of their end users, health researchers may wish to conduct mixed method studies to understand how to best tailor an app intervention [40] to inform phase 1 (establishing a theoretical framework) or phase 2 (wireframe and content development) of the app building process [27][28][29][30][31].…”

Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design (Preprint)

“…Working in partnership with stakeholders in the design process can better serve app development. By doing so, developers can more easily identify desirable features for an app as well as obstacles hindering long-term usage; together, app developers and stakeholders could improve the viability, usability, and effectiveness of apps in health care services [28][29][30].…”