Johansen Simon Kristoffer, Kanstrup Anne Marie, Thomsen Janus Laust, Christensen Mads Norre, Rathleff Michael Skovdal
Center for General Practice (CAM-AAU), Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.
The Rectorate, Aalborg University, Northern Jutland, Denmark.
Digit Health. 2023 Oct 19;9:20552076231205750. doi: 10.1177/20552076231205750. eCollection 2023 Jan-Dec.
Mobile health (mHealth) applications have the potential to support adolescents' self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents.
This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles.
Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles.
The analysis based on user testing with adolescents with knee pain identified three themes: "user experience and feedback," "contextual challenges," and "new features" and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs.
Participants' motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents' cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.
移动健康（mHealth）应用程序有潜力支持青少年对膝关节疼痛的自我管理。然而，在为青少年设计移动健康概念时，确保其依从性仍然是一个障碍。
本研究旨在探索坚持移动健康干预措施的障碍和促进因素，以为设计原则提供参考。
使用低保真原型，对12名患有膝关节疼痛的青少年（中位年龄12.5岁）进行了出声思考测试。该原型是基于作者之前的工作、与7名健康专业人员的快速原型制作会议以及通过行为干预技术模型进行的综合分析而设计的。出声思考测试进行了视频录制，并进行主题分析以确定设计原则。
基于对患有膝关节疼痛青少年的用户测试分析，确定了三个主题：“用户体验与反馈”、“情境挑战”和“新功能”以及九个子主题。青少年能够使用移动健康行为功能，如自我跟踪、目标设定、教育和数据可视化，来记录和反思他们膝关节疼痛的发展情况，这促进了使用。然而，青少年在干预时机、分解管理行为方面存在困难，并且对干预措施的偏见被确定为依从性的内部威胁。竞争性活动、父母的干涉和隐私问题是外部依从性障碍。确定了12条设计原则，以将这些见解整合到移动健康设计中。
参与者坚持的动机受到内部和外部因素的影响。虽然青少年能够使用移动健康行为功能来记录和反思膝关节疼痛的发展情况，但了解如何适应青少年的认知能力、竞争性活动以及对独立性的需求，对于在日常情境中提高依从性至关重要。
