Mobilising Social Support: Insights from the Development of a Web and App based Intervention

Background: The internet and social media can be effective in influencing behaviour, and can reach large numbers of people. Previous research shows that setting goals, making plans and monitoring how well you are doing is important to facilitate behaviour change. The support of family, friends and others is also crucial in helping people to achieve and sustain behaviour change and healthier lifestyles. We aim to develop and test the feasibility of an intervention to promote health behaviour change employing three key facilitators: goal setting, monitoring, and social support. We will explore how web, app and text interventions might facilitate use of these techniques to enable individuals to identify and monitor goals and to enlist social support to help them to achieve their goals and change behaviours in relation to diet, physical activity and weight loss. The first stage of this work is user centred and involves co-design of the software with a panel of users. Objectives: To describe insights from focus groups and user testing which have informed the development of the app and website. Methods: Ten adults (BMI > 30) were recruited via online advertising and invited to three focus groups. In addition thirty other adults were recruited and one-to-one interviews were conducted with them. Think aloud methods were also used to assess acceptability, feasibility and usability. Participants were recruited to ensure a spread of different characteristics including age, gender and previous use of apps. Users in both the focus group and interviews were asked about their use of apps, design issues including features they liked/disliked, barriers to use and key features of the app and website including goal setting, self-monitoring and social support and how these might fit with their lifestyle and weight loss activities. Data were analysed using thematic analytic approaches. Results: Users preferred a friendly approachable design with simple uncluttered screens. Although initially there was discussion about the app monitoring diet and physical activity, the group agreed that the ‘unique selling point’ of the app was around the social support and that this should be the focus of the design and content. They thought that as well as being able to create their own goals that a ‘goal setting template’ was considered important to guide participants in setting SMART goals. Participants wanted to set more than one goal, with the option of ranking them. Participants generally preferred weekly to daily monitoring of weight but that the software should allow the users to choose daily or weekly. Progress graphs should display weight loss and % of goal completed. Participants requested a weekly email summary report also be sent to their ‘helper’. Participants also highlighted the important of gamification for engagement as well as some element of ‘competition’ even if this is with themselves. They also discussed the importance of ‘personalisation’ of things like notifications, feedback etc. Several strategies were identified for engaging helpers including: ‘app to app’ interaction; feedback to helpers on their performance; options for quick interaction e.g. thumbs up symbol; and an SOS button to request input from helpers in moments of potential relapse. They also felt that in-app rewards for progress were important to increase engagement and motivation. Rewards for helpers were also considered important for engagement. Conclusions: This detailed user-centred development process and feasibility testing will lead to an intervention, designed and tested by users, which will have the potential to change weight related behaviours