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Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study

Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study

Gabriela Constantinescu et al. JMIR Rehabil Assist Technol.

Abstract

Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions.

Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app.

Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs.

Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use.

Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development.

Keywords: app design; dysphagia; games for health; gamification; head and neck cancer; mHealth; mobile health; patient adherence; patient engagement.

Figures

Figure 1
Figure 1
Screenshots of design concepts for visual biofeedback, distinguished across 2 features: the type of visuals (simple, complex, abstract), and the presence or absence of a character. An example for each of the swallow exercises was created for all 6 categories and explained to patients in a video.
Figure 2
Figure 2
Fragment of notes taken during the analysis of convergent interviews. The following codes were used: (✓) participant agreed with issue; (✗) participant disagreed with issue; (-) participant did not raise this issue, or issue was not probed by clinician; (A) issue actively probed for by interviewer in subsequent set and participant agreed; (D) issue actively probed for by interviewer in subsequent set and participant disagreed; (U) issue actively probed for by interviewer in subsequent set and participant undecided or gave contradicting statements throughout the interview; (.) not a converging theme from previous set and not specifically probed for by interviewer. Highlighted issues were deemed convergent.

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