Co-designing a mobile Internet service for self-management of physical activity in rheumatiod arthritis

Aim: The overall aim of the thesis was to describe and evaluate the content and outcome of co-designing a mobile Internet service for self-management of physical activity in rheumatoid arthritis (RA) with active lead user involvement, within the action research paradigm.

Context: Physical activity is known for its health benefits. However, maintaining a physically active lifestyle is a great challenge for most people, and maybe even more so for people living with RA. IT and mobile phones provide additional means to deliver health care services, i.e. mHealth, for physical activity self-management. Further, involvement of lead users in the development of services has been reported to improve their usability and effectiveness.

Process: In the first phase of the co-design process, six focus group interviews were performed with lead users (n=26) to explore their ideas on core features (Study I). In the next phase, four workshops were conducted, which included lead users, clinical and researcher physiotherapists, an eHealth strategist and an officer from the Swedish Rheumatism Association (n=10). The aim was to specify the system requirements of the future service (Study II and III). Video recordings, natural observations, prototypes of the future service and an online notice board were used to collect data on the requirements and challenges of co-design. In the third phase, the first test version of the service was produced and evaluate in terms of the participants’ utilization of and experiences with the service (Study IV). Log-data were collected during the six week test period. Web questionnaires were sent out to and telephone interviews were performed with the participants after the test period.

Content: Four core aspects that are important to consider in the development of the mHealth service were identified: features, customized options, user interface, and access and implementation (result Study I). To produce the requirements specification, the participants had to merge their different perspectives, which was the core challenge of codesign (Study II). The merging resulted in “tRAppen”, an mHealth service for maintenance of physical activity. tRAppen included two key components: 1) “My self-regulation features” and 2) “My peer support features” (result Study III). The first test version of tRAppen included 22 different behavior change techniques.

Outcome: Twenty-eight participants tested tRAppen (result Study IV). Most participants registered physical activity, sent likes and made an exercise plan. tRAppen was generally rated as easy and fun to use, and all participants would recommend it to other people. The results also described the experiences of using tRAppen as being influenced by physical and mental state and personal preferences.

Conclusions: The use of co-design in the development of the physical activity selfmanagement service tRAppen was successful. The first test version of tRAppen was perceived as feasible and to have the potential to support a physically active lifestyle in people with RA. Co-design in collaborative workshops was an extensive decision-making process that put high demands on the participants’ ability to find solutions, negotiate, come to agreements and reach final decisions.

List of scientific papers

I. Revenäs Å, Opava C, Åsenlöf P. Lead users’ ideas on core features to support physical activity in rheumatoid arthritis: a first step in the development of an Internet service using participatory design. BMC Med Inform Decis Mak 2014;14(21)
https://doi.org/10.1186/1472-6947-14-21

II. Revenäs Å, Martin C, Opava H. C, Bruzewitz M, Keller C, Åsenlöf P. A Mobile Internet Service for Self-Management of Physical Activity in People with Rheumatoid Arthritis: Challenges in Advancing the Co-Design Process During the Requirements Specification Phase. JMIR Res Protoc 2015; 4(3):e111
https://doi.org/10.2196/resprot.4824

III. Revenäs Å, Opava H. C, Martin C, Demmelmaier I, Keller C, Åsenlöf P. Development of a Web-Based and Mobile App to Support Self-management of Physical Activity in Individuals with Rheumatoid Arthritis: Results From the Second Step of a Co-Design Process. JMIR Res Protoc 2015;4(1):e22
https://doi.org/10.2196/resprot.3795

IV. Revenäs Å, Opava H. C, Ahlén H, Bruzewitz M, Pettersson S, Åsenlöf P. A mobile Internet service for self-management of physical activity in people with rheumatoid arthritis. Evaluation of a test version. [Submitted]