A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study.

BACKGROUND: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. OBJECTIVE: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. METHODS: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight-promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants' user experience feedback and development ideas were collected through focus groups and completion of questionnaires. RESULTS: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. CONCLUSIONS: Incorporating adolescents' preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.

Unilateral arm rehabilitation for persons with multiple sclerosis using serious games in a virtual reality approach: Bilateral treatment effect?

IMPAIRED: arm function and loss of manual dexterity can lead to decreased independence in activities of daily living in persons with Multiple Sclerosis (MS). In this study we verified the feasibility and efficacy of a serious games approach to supervised upper limb rehabilitation of the more affected arm in persons with MS and the cross-over effect to the nontreated arm. METHODS: Eighteen persons with moderate to severe MS symptoms participated (mean age 56.1 (range 28-73) years; mean disease duration 17.6 (4-35) years). Each participant received 12 supervised sessions of serious games (45 min, 12 sessions) aimed at improving the most affected upper limb. Primary outcomes were the Nine Hole Peg Test (9HPT) and the Box and Blocks Test (BBT). Perceived health was evaluated pre and post intervention with SF-12 and the VAS of the EuroQual-5DL. Non parametric tests were used and P was set at 0.05. RESULTS: After the serious games training participants improved dexterity and arm function bilaterally (10-18%), however, there was a statistically significant improvement only in the treated arm (P<0.05). Perceived menthal health improved follwing training (P<0.05) but not perceived physical health. CONCLUSION: An in clinic intervention with a serious-games virtual reality approach positively influenced arm recovery in persons moderately to severely affected by MS, improving mainly the treated arm but with positive effects on the nontreated arm. The persons were motivated during the intervention and expressed being willing to continue this kind of training at home as part of continuity of care.

Development and Evaluation of Cognitive Games to Promote Health and Wellbeing in Elderly People with Mild Cognitive Impairment.

BACKGROUND: In Europe the number of elderly people is increasing. This population growth has resulted in higher healthcare costs. The purpose of this project was to try to promote active ageing in people aged 65-80 with mild cognitive impairment through cognitive games delivered via a tablet computer. OBJECTIVES: Age-appropriate cognitive games were developed targeting different aspects of cognition and then experiences of elderly people using these games were evaluated. METHODS: The design of games was developed through iterative user-centered design focus groups with elderly people as participants. The experiences of participants playing the games over a 47 day period were explored through semi-structured interviews. RESULTS: Four games were developed that addressed a range of cognitive functions such as perception, attention, memory, language, comprehension and executive function. The participants were able to play these games without external intervention over an extended period and reported positively on their experiences. CONCLUSION: Cognitive games can be used successfully by people with mild cognitive impairment to promote active ageing.

User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach.

BACKGROUND: Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. OBJECTIVE: The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? METHODS: The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. RESULTS: The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. CONCLUSIONS: The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF.