Developing the Live 5-2-1-0 mobile app using human-centered design and co-creation to promote healthy behaviours in children

Background: Live 5-2-1-0 is a community-based childhood obesity prevention initiative that promotes the message: 5+ vegetables/fruits; < 2 hours of screen time; 1+ hour of active play; and 0 sugary drinks, every day. A Live 5-2-1-0 Toolkit for healthcare providers (HCPs) was previously developed and piloted in two BC Children’s Hospital clinics. Objective: To co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behaviour change. Methods: Leveraging a systematic review of the literature on interventions utilizing mobile applications to promote healthy behaviour changes in children, a series of three focus groups (FG) were conducted using human-centered design and a participatory approach. FG #1 consisted of separate children and joint parents-HCPs sessions that focused on app conceptualization. Researchers and app developers participated in an ideation session to analyze qualitative data from FG #1. Key themes that emerged were presented in separate family and HCP FG #2 (co-creation) sessions to identify desired app features. Families tested a prototype in FG #3 and provided feedback on usability and content via questionnaires. Results: Fourteen children, 12 parents, and 18 HCPs participated; most participated in two or more FGs. Parents wanted an app that empowers children to adopt healthy behaviours using internal motivation and accountability; children described challenge-oriented goals and family-based activities as appealing. Families identified gamification, goal setting, daily steps, family-based rewards and daily notifications as desired features; HCPs wanted a baseline behaviour assessment and to see users’ behaviour change progress. After testing the prototype, families reported ease in completing tasks, with a median [Q1,Q3] score of 7 [6,7] on a 7-point Likert scale (1=very difficult, 7=very easy). Children liked most suggested rewards (28/37), and found 76/96 suggested daily steps realistic to achieve. Conclusion: Co-creating an ehealth app with children, parents, and HCPs was feasible. Stakeholders desired for an app that facilitated shared decision making with children as active agents in behaviour change. Future research will involve a quasi-experimental trial to assess the usability and effectiveness of the Live 5-2-1-0 App in achieving healthy behaviour change when used to support health behaviour counselling in a clinical setting.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat