A Picture Instead of Words – Can a Visual MHealth App Promote Healthy Lifestyles in Low Health Literacy Populations?
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Abstract
Background
Hispanics make up 65% of American adults with low health literacy and bear the highest health risk (increased levels of obesity, diabetes, and cardiovascular disease) associated with inactivity. In primary care, recommendations for patient management include decreasing sedentary behavior (SB) and increasing physical activity (PA) . To date, there has been little uptake of evidence based PA guidelines by health care providers (HCP) and limited engagement in the topic during a primary care clinical encounter due to various perceived barriers. Mobile technology can be a viable tool to help HCP encourage PA in their patients and for consumers to take home individualized recommendations.
Objective
1. To develop, prototype and evaluate multiple design elements including non-textual representations such as pictograms, animation, and video, that represent critical health concepts (PA & SB)for active lifestyles.
2. To explore the adequacy of the visual images to capture sufficient dimensions of the constructs of interest in low health literacy Hispanic population.
3. To determine feasibility of the material for use in a mobile phone app that patients could use as a self-care adjunct to health care providers counseling.
Methods
Mixed methods, multistage, participatory design approach.
Focus groups were presented with visual images in two groups (PA & SB) and across five domains (icons, drawings, pictures, animates, and videos).
Results
Participants: reflected a low income, relatively sedentary, limited health literacy sample, with high mobile phone ownership (88%) and use. We ran 6 focus groups of consumers (16 men, 26 women) , 2 promotoras - community lay health providers groups (3 men, 13 women) and interviewed 6 HCP (all female).
Functional requirements results:
1.The mobile app must be simple, intuitive and easy to use; include mechanisms for personalization, the ability to tailor messages, activities and other content to end user’s preferences and characteristics.
2. Include an assessment function to reinforce activities that are already being done and attenuate or set limitations for activities within the realm for behavior change. The output for this assessment may be used as input for personalization. As a result, there are various types personalization: passive, active, and intuitive.
3. Visual mobile health content is both feasible and acceptable in conveying complex information about physical activity; but visual mobile health content must have a high sensitivity and specificity. Visual images must be identifiable, and clearly preemptive of an action in order to be motivating; be colorful, include realistic goal setting and a mixture of all types of visual content – icons, pictures, photos, and videos.
Conclusion
Our preliminary results emphasize the centrality of the user experience in the design of a visual-driven, physical activity, mHealth application for use among Spanish-speaking Latino adults with limited health literacy. Further results will be detailed during the presentation. These results will inform the functional requirements of a prototype mHealth application in the subsequent phases of design and testing where behavior change potential will be measured.
Hispanics make up 65% of American adults with low health literacy and bear the highest health risk (increased levels of obesity, diabetes, and cardiovascular disease) associated with inactivity. In primary care, recommendations for patient management include decreasing sedentary behavior (SB) and increasing physical activity (PA) . To date, there has been little uptake of evidence based PA guidelines by health care providers (HCP) and limited engagement in the topic during a primary care clinical encounter due to various perceived barriers. Mobile technology can be a viable tool to help HCP encourage PA in their patients and for consumers to take home individualized recommendations.
Objective
1. To develop, prototype and evaluate multiple design elements including non-textual representations such as pictograms, animation, and video, that represent critical health concepts (PA & SB)for active lifestyles.
2. To explore the adequacy of the visual images to capture sufficient dimensions of the constructs of interest in low health literacy Hispanic population.
3. To determine feasibility of the material for use in a mobile phone app that patients could use as a self-care adjunct to health care providers counseling.
Methods
Mixed methods, multistage, participatory design approach.
Focus groups were presented with visual images in two groups (PA & SB) and across five domains (icons, drawings, pictures, animates, and videos).
Results
Participants: reflected a low income, relatively sedentary, limited health literacy sample, with high mobile phone ownership (88%) and use. We ran 6 focus groups of consumers (16 men, 26 women) , 2 promotoras - community lay health providers groups (3 men, 13 women) and interviewed 6 HCP (all female).
Functional requirements results:
1.The mobile app must be simple, intuitive and easy to use; include mechanisms for personalization, the ability to tailor messages, activities and other content to end user’s preferences and characteristics.
2. Include an assessment function to reinforce activities that are already being done and attenuate or set limitations for activities within the realm for behavior change. The output for this assessment may be used as input for personalization. As a result, there are various types personalization: passive, active, and intuitive.
3. Visual mobile health content is both feasible and acceptable in conveying complex information about physical activity; but visual mobile health content must have a high sensitivity and specificity. Visual images must be identifiable, and clearly preemptive of an action in order to be motivating; be colorful, include realistic goal setting and a mixture of all types of visual content – icons, pictures, photos, and videos.
Conclusion
Our preliminary results emphasize the centrality of the user experience in the design of a visual-driven, physical activity, mHealth application for use among Spanish-speaking Latino adults with limited health literacy. Further results will be detailed during the presentation. These results will inform the functional requirements of a prototype mHealth application in the subsequent phases of design and testing where behavior change potential will be measured.
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