University of Manchester, Manchester, United Kingdom.
Manchester Academic Health Science Centre, Manchester, Manchester, United Kingdom.
JMIR Mhealth Uhealth. 2020 Sep 28;8(9):e15460. doi: 10.2196/15460.
Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction.
This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients.
There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach.
On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of "Motivate Me" and "My Activity Programme." Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within "Motivate Me." The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence.
The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable.
跌倒对老年人的健康和福祉有影响。力量和平衡干预措施显著降低了跌倒的风险。然而，患者并不总是执行减少跌倒所需的无人监督的家庭锻炼。
本研究旨在开发由健康专业人员和老年人共同设计的激励型智能手机应用程序，以支持患者进行已证明有助于减少跌倒的锻炼，并探索应用程序在健康专业人员和患者中的可用性和可接受性。
应用程序开发有 3 个阶段，包括分析、设计和实施。在分析阶段，我们查阅文献确定了关键的应用程序组件，并与参加力量和平衡课程的 12 名老年人、锻炼指导员以及 3 个跌倒服务机构进行了磋商。在设计阶段，我们创建了原型应用程序，并进行了 2 次患者和公众参与研讨会，一次有 5 名健康专业人员参加，另一次有 8 名来自锻炼小组的老年人参加。根据反馈对应用程序进行了修订。在实施阶段，我们对一个跌倒服务机构及其患者进行了为期 3 周的测试。通过测试、半结构化访谈和焦点小组探索了可接受性和可用性。与测试应用程序的服务机构以及另外两个服务机构进行了焦点小组讨论。使用框架方法分析定性数据。
基于文献研究和分析阶段磋商的结果，我们选择了行为改变技术，如目标设定、行动计划和行为反馈，作为应用程序的关键部分。我们使用熟悉的图标为患者选择和添加，同时自我报告锻炼情况，决定开发 2 个应用程序，一个供患者使用（我的活动计划），一个供健康专业人员使用（激励我）。这使健康专业人员能够指导患者完成目标设定过程，使非技术用户更容易使用。在设计阶段创建了故事板，最终形成了“激励我”和“我的活动计划”的原型。来自研讨会的关键变化包括能够在“激励我”中添加有关患者锻炼计划的更多详细信息以及更广泛的目标选择。总体应用程序设计得到了健康专业人员和老年人的认可。共有 7 名患者和 3 名健康专业人员参与了实施阶段的测试，对 6 名患者进行了访谈，并进行了焦点小组讨论，涉及 3 个团队（11 名健康专业人员）。确定了这两个应用程序的障碍、促进因素和进一步功能，有 2 个贯穿始终的主题是关于手机可用性和信心。
参与设计阶段的老年人以及在临床环境中测试应用程序的患者和健康专业人员发现激励型应用程序是可以接受的。用户主导的设计对于确保应用程序的可用性和可接受性非常重要。
