Frontiers in Public Health (Jan 2016)
The challenges of co-developing a behaviour change app that aimed to make physical activity a habit
Abstract
Background At least one third of adults are not meeting physical activity (PA) recommendations despite evidence of effectiveness of interventions to promote PA (including remote/web 2.0-based interventions). A key barrier to the uptake of any new behaviour, particularly one like a new PA regime requiring effort, is remembering, and finding time, to do it. A promising long-term solution is to make the behaviour habitual. Habit theory says that through repetition in a stable context, behaviours, which were initially the result of purposeful choice, can become automated, such that the behaviour is eventually initiated almost reflexively by external cues. Cognitive-experiential self-theory suggests that humans use an analytical-rational system (conscious, logical) to process information and an intuitive-experiential (unconscious, emotional) system, working independently but in parallel. Existing PA-focused mobile phone apps largely target analytical-rational processing. They allow users to quantify their PA and often have a competitive element (miles run, steps walked), but fail to target intuitive-experiential processing. We aimed to develop a behaviour change intervention (an app) that meets the needs of sedentary adults who are not ‘data-hungry’ by reinforcing the link between PA and positive mood, to increase the frequency of and habit strength for PA. We anticipated two main challenges to this project: developing an app which individuals would be motivated to use (90% of all downloaded apps are used once and eventually deleted) and designing content / functionality that will promote PA habit formation. Aim(s) To discuss the challenges of co-developing an app that aimed to make physical activity a habit. Method(s) The project team comprised qualitative and quantitative researchers, individuals working in marketing and social marketing and a public sector analyst. The team were brought together following a three-day intensive Cancer Research UK ‘sandpit’ event. A series of focus groups were conducted with users (round 1: two groups comprising 16 users; rounds 2 and 3: one group of 9 users) facilitated by two project team members. The aim of the focus groups was to establish users’ needs, their preferences for functionality, current behaviour and what PA they felt was feasible for them. Male and female users aged 35 to 55 were recruited from an existing market research panel and selected based on their current physical activity levels (sedentary), type of mobile phone (iPhone) and app use (downloads and uses apps). From round 2, users tested the app and provided feedback during focus groups and via email on their experiences of using the app in between focus groups. Qualitative data collected included spoken word during focus groups; free-text written feedback and photographs/posts uploaded to the app. Quantitative data included app use (number of posts, frequency of posts and other interactions with the app). The project team liaised with Chemical Wedding Heuristic Media who iteratively coded and designed the app for iOS, with user feedback integrated at each iteration. Results The app (‘Haptivity’): When users first open the app they are asked which specific PA behaviour they want to make a habit and when they would like to perform the behaviour. Users are encouraged to post a photograph that invokes positive emotions they experienced during PA (with a brief comments about why they feel good). At the time that users specified that they wanted to perform the behaviour, users are reminded to perform the behaviour, coupled with a previously posted photograph. Users’ posts can be seen publically and they can receive (a restricted range of) positive feedback provided by other app users. Challenges/benefits of the methods: Working with a diverse project team brought very different perspectives, expectations and priorities that needed to be balanced, but resulted in a product that was greater than the sum of its parts. The focus group context can result in users agreeing with others on matters which they would not do so if asked individually. Asking users to provide written feedback individually prior to group discussion allowed us access to both privately and publicly generated data. Challenges of the development: While users were not ‘data-hungry’ they still demanded rewards to motivate them to use the app. App development required careful designing of rewards that were concordant with the ethos of the app (i.e. non-numerical). Users expressed that it should be their decision if their content is private or publically available. Some wished to share their achievements with friends/family/strangers, while others did not. Users indicated that they wanted to personalise other functions of the app, such as reminders, which were active ingredients of the behaviour change intervention itself. Users expected the app to match the functionality of other apps/websites they used (such as Facebook and Google). Conclusions Developers of behaviour change apps must balance the demands of users that will make using the app a habit, while retaining the ingredients necessary for the app to achieve its purpose. Mixed methods provide a rich data set with which to base app development and greater confidence that the app will meet the needs of users in terms of social networking and privacy.
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