HCOM515 Mobile Health Design June 20, 2012, 5:30-8:30pm Lisa Gualtieri, PhD, ScM Assistant Professor Tufts University School of Medicine Elizabeth Comeau,

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HCOM515 Mobile Health Design

June 20, 2012, 5:30-8:30pm

Lisa Gualtieri, PhD, ScM Assistant Professor

Tufts University School of Medicine

Elizabeth Comeau, Boston Globe

Chelsea Conaboy, Boston Globe

Tara Montgomery, Director, Health Partnerships & ImpactConsumer Reports

Bradley Moore, MPH, Teaching Assistant

Agenda

• 5:30 Elizabeth Comeau and Chelsea Conaboy• Group presentations: 20 minutes with 10

minutes for questions. Use your rubric!– 6:15 Group 1– 6:45 Group 2– 7:15 Break– 7:25 Group 3– 7:55 Group 4

• 8:25-8:30 More to think about and survey

A Health and Weight Loss APP

for Caregivers

HCOM 515 Mobile Health DesignGROUP 1

Julie Berkley, Geetha Gopalan, Samantha Noderer and Lauren Parks

Target Audience

Incorporating fitness, nutrition, and

overall wellness to take care of those

who take care of others!

App Name?

You can help us vote later in the evaluation phase!!• A Helping Hand • A Healthy Dose  • The Good Life • Bene-Fit• Gather Around the Table• Sip n’ Saver (Savor—play on

words?)

Benefits and Supporting Research

Benefits:• Provides resources for caregivers to develop and

sustain a healthy lifestyle through healthy eating and active living

Supporting Research• Healthy People 2020– Promoting a healthy diet and individual behavior

change– "Consume a variety of nutrient dense foods

within and across the food groups" • USDA MyPlate

– "Cook more often at home" & "When eating out, make better choices"

Design Decisions

• Healthy recipe suggestions• Healthy menu options for restaurant

dining• Food shopping support and reference• Daily physical activity suggestions• "Local" features – geo-locating• Accessible to range of SES• Social networking through

community forum

A Review of Personas

MoniquePeter

Mitch & PriscillaBecky

Monique

• Single, working mother her late 30’s

• 3 kids: 10, 11, and 13

• Son has ADHD and frequently has difficulties in school

• Father visits with kids regularly

What Monique Needs in an App

• VERY user-friendly: an app that has a lot of video tutorials, as well as more images than words

• Geo-location features: an app that can help Monique find supermarkets and neighborhood gardens, free family outdoor activities, and related resources in nearby communities

• Reminders: an app that will remind her periodically throughout the day when and what to eat

• Flexible: because she does not yet have a smartphone, the app should be something that can be used via texting as well as through smartphone app technology

• Alternative choices: the app can provide her with healthier options (e.g., recipes, brands) for the foods that she loves

• Fitness planner and instruction: the app could suggest various ways she and her kids could exercise within the community, or in nearby areas that are safer

Peter

• 46 years old• Single father of

two teenage daughters, Kelsey 15 and Alexandra, 17

• Wife, Elaine, passed away 5 years ago from breast cancer

• Lives in a suburb of Boston

What Peter Needs in an App

• Not time consuming• Easy to learn• Healthy, fast recipes,

that are tailored to his tastes

• Support and guidance in sticking to an exercise plan

• Healthy suggestions for what to order out at restaurants

Mitch & Priscilla

• 67 and 63 years old• Parents of two twin

girls who are graduated from college and out of the house

• Married for 35 years, they moved to the beach in Naples, FL a few years ago to start a new chapter post-kids

What Mitch & Priscilla Need in an App

• Mitch - any app with cutting edge features

• Priscilla - needs something user-friendly that will not leave her flustered when Mitch is not around

• Need help making better choices while eating outside the home

• Suggestions for cooking and exercising together is welcome – good for health and marriage

• Suggestions to expand physical activity beyond Yoga

Becky• Married woman in

her 50s• 2 grown children• Helping care for her

mother, age 75, who has Multiple Sclerosis and is living in an assisted living facility right down the road

• Colitis• Very tech savvy,

has smart phone, iPad and new laptop computer

QUOTE

“Stuck in a rut”(Thinking: What

now?)

What Becky needs in an app• Geo-location features: an app that can help Becky find

healthy lunch and snaking options while on-the-go• Reminders: an app that will remind her periodically

throughout the day when and what to eat; also to keep hydrated

• Alternative Fitness planner and instruction: the app could suggest various ways she and her mom could exercise within the community (aquatic aerobics, yoga, etc.)– Tracking walks with her dog? Or finding groups to walk

with?• Quick Entry: constantly busy, she needs an app that

doesn’t require lots of typing and might be better suited for voice entry or choosing pictures of foods

• Website Connectivity: since she wants to share ideas with her mom or help her mom also better track, she would need some way of printing things off of the computer since her mom does not have any link to technology.

Design ImplicationsVery user-friendly

• Video tutorials• More images than words• Not time consuming - Quick entry--maybe by

voice?• Easy to learn, but still cutting edge!

Geo-location features• Find supermarkets and neighborhood gardens• Free family outdoor activities• Related resources in nearby communities• Healthy lunch and snacking on-the-go

Reminders and Personalization• Reminders of when and what to eat and stay

hydrated• Learn food and activity preferences

Design ImplicationsFlexibility

• For someone without a smartphone – texting options?Recipes and Restaurant Recommendations

• Alternative choices and healthier options• Cooking together or “cooking for two”• “Healthier” menu options for eating out

Fitness planner and instruction• Personalized, age appropriate suggestions for

exercising in the community (ex. seniors - aquatic aerobics)

• Safe areas for exercise outdoors• Support and guidance• Recommendations beyond yoga and outdoors

Website connectivity• A way to print things off to better show tracking

A Review of Competitive Analysis

FooducateSparkrecipes

Jenny Craig Dining OutNike Training Camp

FooducateBest: Simple, clean, friendlyUses icons, photos of

food and textLiteracy and numeracy

level is highWorst: Only works for items

with barcodeDoesn't provide

general guidance or tips

SparkRecipesBest features

Simple, user-friendly design and interfaceAccessible reading level Emphasizes low-cost ingredients

Worst featuresNo link between app and websiteLack of advanced features on app

Dining OutBest

Layout allows for quick and easy searchesQuizzes help create nutritional awarenessJenny Craig brand equity

WorstDatabase should cover more restaurantsPortion guide could be more readable

Nike Training Club

BEST• Personalized• Quick • Demonstrations,

music, and voice-over instructions

WORST• No baseline• Repetitive

Design Implications

• Easy ratings for “healthiness” of foods• Give alternative food choices or recipe

substitutions• Allow users to leave comments• Use icons and photos of food and text• Simple, clean, FAMILIAR• Accessible reading level--8th grade or

lower?• Emphasize LOW cost options (ingredients,

stores, restaurants)

Design Implications• Have apparent link between website and app• Potentially use quizzes to create nutritional

awareness• Need large database of restaurants• Readable and easy to understand portion

guide• Workout instruction that is easy to

incorporate in a busy, daily routine• Some way for people to baseline• Always have something new so the app does

not become repetitive with its suggestions

ApP Structure Map

Path Ex 1: Food Shopping

Path Ex 2: Cooking

Path Ex 3: fitness

Evaluation

Formative evaluation

Script sessions• Name and branding, usability, literacy levels,

design, and relevancy

Field evaluation• Trial users, real-life environments, return usage?• Summarizing and incorporate findings into

development

Ongoing evaluationUser surveys

Marketing and Promotion

Partnership• USDA/MyPlate & Consumer Reports

Promotion• App store & partner websites

Platform• Android? More users and SES accessibility• Preference – BOTH – difficulties in designing

Price• Free, plus additional community forum features

for $1.99

Limitations and Constraints

• Too many features?• Appeal to broad age range?• Which platform is best? Android

reaches a wider range of SES, but iPhone reaches the more tech savvy willing to pay for advanced features.

• Is this design actually feasible for a programmer?

Mobile Health DesignSlimSwap

Group 2Julie BrombergLinda DePoto Julie Gilliam Paula Power

SlimSwap Approach to Weight Loss

Weight loss should be:• Sustained behavior change• Not a chore, but a process of discovery• Long-term perspective• Realistic

Weight loss often is:• Viewed as temporary• Fad/extreme/yo yo dieting• Short-term success but long-term failure• Feeling helpless and out of control

Target Audience• Age: 18-50ish Sex: male and female Ethnicity: all ethnicities

• Economic situation: all SES groups

• Family Status: single or married; kids or no kids

• Health/nutrition literacy skills: low-mid health/nutrition literacy

• Health status: users who are overweight and seeking a weight loss app, but also for users who want to eat healthier

• Weight loss activities: users may not be as interested in exercise and may want to focus on diet/nutrition

• Technology skills: any level of mobile device skill

• Eating habits: users who are willing to purchase food at a grocery store and prepare it (not users who eat out for most their meals)

Evidence-Based GuidelinesCDC Healthy Weight Initiative1. Make commitment2. Define current health status and lifestyle3. Set goals4. Access resources for education and support5. Monitor progress

NHLBI Obesity Education Initiative Key Points• Targeted caloric reduction better than non-targeted• Maintenance of weight loss is difficult long-term; continued

monitoring is necessary

SlimSwap Key Features

• Provides healthier recipe alternatives (swaps)• Provides key comparison nutrition information

that is accessible to the layperson• Gets smarter the more you use it• Links to a calorie tracker app• Exports selected recipe to a grocery list• Allows linking to social networks• Meets you where you are in your weight loss

journey

How it Works Swap out … Cheeseburger

Calories: 1110 Saturated fat: 24g Sodium: 2250mg Fiber: 6g

Swap in … Turkey BurgerCalories: 278Saturated Fat: 1.2gSodium: 949mgFiber: 2.4gRecipeCalories saved with this swap: 832

Swap in … Red-Lentil BurgerCalories: 324Saturated Fat: 1.6gSodium: 688 mgFiber: 5.8gRecipeCalories saved with this swap: 786

Did you know?The American Heart Association recommends no more than 15g of saturated fat per day. High intake of saturated fat is linked to the development of heart disease.

Personas• Thomas, recently diagnosed with

diabetes 20 year old– Uses SlimSwap on-the-go to plan healthy

meals for the week and read nutrition tips

– Share with his friends

• Sarah, busy mom of three– Personalize information– Easy access to favorite recipes and

grocery list

Competitive Analysis: Comparison Apps DietPoint SparkRecipes ShopWell SportsTracker

Diet Plan/social networking

Large database of searchable healthy recipes

Grocery shopping weight loss aid

Workout analyzer/social networking

Simple, clean design

App design is simple but the website is cluttered

Peaceful colors, high quality pictures of food

Large font, user friendly interface

Free for basic content, monthly rate for premium content

Free Free Free

Unclear whether content is evidence-based

RDs are listed on the site but unclear if they approve recipes users submit

Experts evaluate based on IOM guidelines

Content based on the 3 founders’ experience with exercise

Competitive Analysis: Design Implications

• Easy to use, intuitive design• Professional look and feel, simple design• Personalization: tailoring the diet, having access

to favorites, etc.• Quick nutrition tips that appeal to a wide range of

health literacy (the “why” of eating this way)• Evidence-based

• Not a calorie tracker, but a nutrition educator

Evaluation Plan• Recruit smartphone users through grocery store• Give the participants time to explore the app on

their own and then provide them with tasks• Sample Questions– What do you like/dislike about the app?– Describe to me what this app is telling you about

nutrition/food options.– Does this seem like something you would download

and use? How often would you use it? – What features would you change or add to make this

something that you would use on a regular basis?• Adjust app design, and repeat

Marketing Plan

• Price: Free. We would like our app to start out with no price until it becomes more popular.

• Promotion: »Use of the grocery stores »Submission to an app review site»Use of Facebook or other social media sites

for advertisement• App Name: The name of our app will also help our app

get noticed, since it has a keyword of “slim.”• Video of App: Provide a video of an app on Google Play

Consumer Reports Role

• We will use the Consumer Reports website and magazine to advertise our app.

• The trust in the Consumer Reports brand will allow our app to get noticed more.

• Our app is congruent with the brand of Consumer Reports: helping people make informed decisions.

Limitations

• Utilization of another app’s calorie counter• Utilization of non-commercial recipe magazines• More designed for meals that you make, not prepared

foods/restaurant meals• Focused on healthy cooking techniques/healthy eating, but

not necessarily geared towards weight loss• Reviewed a limited amount of apps• No evidence that states people can learn from a mobile app

Conclusion

• Our different experiences have helped us develop a well-rounded app

» Julie Gilliam-Technology» Linda DePoto-Nutrition» Julie Bromberg-Health Communications Specialist» Paula Power-Clinical Psychology

• We have learned how mobile app design can be applied to all different areas of the health field.

Group 3

Charlene RyanNiranjan Karnik

Amy VazJeff Tingle

Find Me Food®Designed for

Concept Statement

Our app enables individuals with some degree of weight loss motivation to locate healthy food options when they are eating out. It is designed for individuals who travel but can also be used in a home area setting to obtain local nutrition and calories information for restaurants and eateries. The app will also allow for user content and contributions to dynamically update information for establishments.

Find Me Food®

Benefits

The application allows for rapid geo-location of establishments and ties this to nutrition content and information in an easy to read and rapid to access fashion. The app allows for personalization of nutritional and weight loss goals, and helps users match local food choices to their goals each day.

Find Me Food®

Find Me Food®

Target Audience

• Business travelers• Leisure travelers• Individuals with specific dietary needs (user content

driven)• People who move to a new location (students,

homeowners)• Individuals seeking to lose weight or maintain a healthy

eating pattern

Supporting Research and Justification of Design Decisions

• Healthy People 2020

1) Nutrition and Weight Status

2) Health Communication and Health Information Technology

• USDA Nutritional Standards - My Plate

1) http://www.choosemyplate.gov/

Find Me Food®

Supporting Research and Justification of Design Decisions

• Yelp-like app which had greater content from a nutritional aspect and allowed for both user content & weight loss goals

• Geo-location makes the app useful wherever the user is at the present moment

Find Me Food®

Personas/Scenarios and Their Design Implications

• Our persona development process highlighted several issues that we believe our app will help address:

1) Most individuals who travel and eat out routinely do so out of a sense of need and being too busy to do research on dietary choices.

2) Everyone has a different root for motivation but the common goal is to lose weight or eat better.

3) People eat out routinely, and therefore there is a need to have a centralized means of accessing nutritional data and information that leads to healthy eating choices.

Find Me Food®

Competitive Analysis and Design Implications

• No weight loss application has a sound geo-locating feature/system.

• The user experience needs to be smooth and inviting, and make the the app something that the user wants to use everyday.

• User content should be a part of the experience to facilitate continuous updating of database and app information.

Find Me Food®

Evaluation Plan

1) User feedback via App Store and email/Twitter/Facebook feedback

2) Weight loss data (aggregated data from users)

3) Food choice data (aggregated data from users)

4) Virtual focus group with invited user (using Google Hangouts)

Find Me Food®

Map of Structure (Information Architecture)

Find Me Food®

Find Me Food®

Marketing Plan

Platform: iPhone & Android

Price: Free app but $0.99/month subscription to service(free to current CR subscribers)

Promotion: New social media push. Restaurants have QR code on restaurant window if they meet the “healthy rating”

Find Me Food®

Marketing Plan

• Consumer reports will be essential to maintaining the quality of nutritional information on the website and assessing the accuracy of user contributed content. CR subscribers will have initial access to the app, and will get it as part of their online subscription. CR will create a companion website that mirrors the mobile app content and be dynamically linked to the app so that user profiles can be accessed through either system.

Find Me Food®

Limitations and Constraints

1) The app will have to start with content from municipalities that require posting of nutritional content

2) Voluntary restaurant participation outside of these areas may slow content generation

3) Individual restaurants may be slow to contribute to the database

4) User base will likely need to reach a critical mass before there is substantial participation

5) Start with chain restaurants and then add independents - possible encourage participation through Yelp partnership

Find Me Food®

FIT Teens

Follow, improve & track your health.

An app for teens.Meghan Hamrock, Dave Leader, Fuad

Abujarad, Kirby Lee

Introductory information

Target population• Ages 13-18 of healthy and

unhealthy weight

• Generation Z • 61% have televisions in

their rooms• 35% play video games• 4 million own a cell

phone• Do not know of a world

without cell phones or computers

Problem statement

• 33% of MA teens are overweight or obese

• Social Contagion factor

Personas

Covers everything and anything from popular, overweight, healthy weight, different ethnicity, sedentary, Smartphones, tablets, only child, working, medical problems, etc.

Amy 14, Carmen 16, Zack 15 & John 13

Competitive Analysis for Calorie Counter

Pros• Easy to use

• Food and exercise diaries

• Large food database

• Easy to identify foods by name, restaurant, brand or barcode

• Diet calendar

• Weight tracker

• Recipes and meal ideas

• Displays calories, fats, carbs and proteins

• Displays daily summary to show % of RDI for the day

Cons• No water intake log

• No customization or manual entry of calories of your own foods

• Does not track cholesterol, sodium, potassium, etc.

• No social networking

• Limited recipes

• Mostly diary and tracking tools with no evidence based recommendations for diet, weight and exercise

Competitive Analysis for Noom

Pros• Simple diet and exercise entry

• Prompts for activities

• Evidence base - two highly qualified advisers

• Easy to navigate

• Social networko Forao Facebook and Twitter

• Links: FitBit & Withings Scale

• Free version

• No ads for other products

• Free, optional water tracker

• Motivational

Cons• No connection with

parents

• Requires entry of data throughout day

• $9.99/month for full version

Competitive Analysis for Weight Watchers

Pros• Easy to navigate• Simple and intuitive• PointsPlus Tracker • High quality graphics• Sustainable • Geolocation in the meeting finder• Tracks diet and fitness• Latest recipes and the ability to

create a shopping list based on the featured recipes

• Interactive cheat sheet

Cons• Social network is limited to Weight

Watchers website (No Facebook)• The free version is limited; must be

a Weight Watchers member to use many tools and sections

• Rating 3/5• Monthly cost

Competitive analysis for MyPlate Calorie Tracker by LIVESTRONG.COM

Pros• Designed for the busy, hectic

lifestyle

• Simple

• Tracking availability; independent

• Evidence-based; credibility

• Branding; well-known

• Large food database

• Personalized with your information; search, edit & 1-click functions

• Fitness options

• Goals

• Website support & marketing

Cons• Uses BMI

• Not a ton of visuals

• No breakdown of macronutrients

• No recommendations when out to eat or

quick eat this, not that

Concept of FIT TEENS

• Obesity is a social contagion

• Need parental buy-in

• App must be easy for teen and parents

• Behavior modification

• Educational

• Increase activity

• Decrease calories

Concept of FIT TEENS

Teens• Want to lose weight

• Get to choose menus

Parents• Want to help child

• Self benefit

• Ease of useo Child chooses menuo App provides

shopping list• Aids communication with

child

Screenshots

Screenshots

Screenshots

Marketing plan

Schools, school nurses, parents, physicians/pediatricians, nutritionists...

• Market to professionals

• Professionals ID at risk teens

• Prescribe FIT Teens App

• Follow-up with teen and parents periodically

Evaluation

Limitations• No current teen weight

loss apps available

• Knowledge level of nutrition information

Assumptions• Teens will be intrigued to

use a healthy app throughout the day

• Teens will like not having to input tons of data

Consumer Report Values

• Evidence-basedo USDA databaseo CDCo Personas, competitive analysis

• Promoting physical activity & nutrition in a healthy manner

Thank you!Any questions?

Teamwork

• Worked mainly via

• Busy schedules, short amount of time

DRIVE

Legal issues• Key thing is to be sure that the app is not considered a “device”

– Draft FDA guidance : Products & Medical Procedures>Mobile Medical Applications http://vsb.li/4kVMmC

– See, e.g., Appendix A – Examples of mobile medical apps over which the FDA is asserting jurisdiction:• Mobile medical apps that allow the user to input patient-specific information and - using

formulae or a processing algorithm - output a patient-specific result, diagnosis, or treatment recommendation that is used in clinical practice or to assist in making clinical decisions: …

• Apps that act as calculators or utilize algorithms to produce an index, score, scale, or other similar calculations (e.g., Glasgow Coma Scale, pain index, Apgar score, NIH stroke scale, etc.); …

– May not apply to our apps not “used in clinical practice”• If it’s not covered by this guidance, use appropriate disclaimers

– See for example Fooducate terms of use • Issue may be appearance of trustworthiness

– Consider certifiion by TRUSTe – HON for apps– Or at least use a policy to give a sense of safety for anyone who “cares”– Use common sense – think about rules and why they exist and then follow rules even

when don’t have to• David C. Harlow Principal, THE HARLOW GROUP LLC∙ , HEALTH CARE LAW

More to think about

• Accessibility• Greater reach globally• Innovations to extend capabilities (and health

potential) of mobile devices• Innovations to reduce limitations of mobile

devices• Better segmentation (tablets etc) and integration• More for us to think about: survey