Co-developing a multi-behavioural mobile phone app to enhance Social and Emotional Wellbeing and reduce health risks among Aboriginal and Torres Strait Islander women during pre-conception and pregnancy: development and usability study. (Preprint)
Authors: Bovill Michelle , Kumar Ratika , Ryan Nicole , Bennett Jessica , La Hera Fuentes Gina , Gould Gillian 
Published: July 2020

BACKGROUND

Improving the health and wellbeing of Aboriginal women and their babies is a primary focus to address health inequity in Australia. Interventions must be contextualised by the impacts on health that are a direct result of historical oppression, dispossession and ongoing racism since colonisation. Aboriginal women experience compromised social and emotional wellbeing including mental, cultural, spiritual wellbeing. Addressing social and emotional wellbeing coupled with behavioural risk factors would have a high potential to improve the health and wellbeing of mother and child. mHealth has been trialled in Aboriginal communities and appears to be a favourable method of intervention. Building on the requests from Aboriginal women we designed a multi-behavioural mobile phone app.

OBJECTIVE

This paper describes the development and pre-test of a prototype multi-behavioural change app MAMA-EMPOWER with Aboriginal women and communities in New South Wales, Australia.

METHODS

Mixed methods study design using the Center for eHealth Research and Disease Management Roadmap for designing eHealth technology’s three phases; phase one-contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, phase two- value specification included user-workshop with an Aboriginal researcher, community members and experts phase 3 co-design with Aboriginal researchers and community members, followed by a pre-test of the app with Aboriginal women, and feedback from qualitative interviews and the user-MARS survey tool.

RESULTS

Phase 1 conducted informal market interviews to establish community need. Engagement with stakeholders refined digital considerations and behaviour change wheel factors to embed in the app. Interviews with 8 Aboriginal women revealed 3 themes; current app use, desired app characteristics and implementation. Phase 2 workshop with 6 Aboriginal women raised 3 themes; engagement, caution with wording and visual content. Phase 3 engaged 16 Aboriginal women to trial the app on their phones, all content areas were accessed, u-MARS was completed by 5 women, the highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however functionality was problematic.

CONCLUSIONS

Developing a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behaviour change technique’s coupled with the consultative approach has added rigour to this process. The use of mobile phone apps to implement behavioural interventions in Aboriginal community settings is still a new area for investigation. In the next iteration of the app we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.