School of Medicine, University of Galway, Galway, Ireland.
National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
JMIR Hum Factors. 2024 Oct 23;11:e63707. doi: 10.2196/63707.
Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage.
This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users' perspectives throughout.
A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process.
Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02).
Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users' needs and preferences, thereby potentially improving future engagement.
二级预防是降低全球范围内主要致死病因心血管疾病（CVD）负担的重要策略。尽管数字健康干预（DHI）在 CVD 二级预防中的有效性证据不断增加，但大多数干预措施都是在极少考虑目标终端用户意见的情况下设计的，导致接受度和使用率都较低。
本研究旨在通过共同设计，将终端用户的观点贯穿始终，优化用于 CVD 二级预防的 DHI 的可接受性和有效性。
采用基于理论的、以人为中心的共同设计方法开发 DHI，称为 INTERCEPT。这涉及一个使用在线研讨会的 4 阶段迭代过程。在第 1 阶段，成立了一个由医疗保健专业人员、软件开发人员以及公众和患者参与成员组成的利益相关者团队。第 2 阶段涉及确定 DHI 的指导原则、内容和设计特征。在第 3 阶段，对 DHI 原型的语言清晰度、导航易用性和功能进行了审查。为了预测和解释 DHI 的使用情况，第 4 阶段对近期发生心脏事件（<2 年）的参与者进行了可用性测试。为了评估可用性测试的潜在影响，在测试前后使用系统可用性量表进行了评估。使用 GUIDED（健康研究中干预开发研究报告指南）清单报告了开发过程。
确定了 5 个关键设计原则：简单易用、通过设定目标和自我监测实现行为改变、个性化、系统可信度和社会支持。可用性测试产生了 64 项针对应用程序的建议，其中 51 项得到了实施。在实施建议前后，系统可用性量表的评分有所提高（61 分比 83 分；P=.02）。
将行为改变理论与以人为中心的共同设计方法相结合，有助于开发用于 CVD 二级预防的 DHI，从而优化对终端用户需求和偏好的响应能力，从而有可能提高未来的参与度。
