Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study
Authors: Giorgi Rossi Paolo , Ferrari Francesca , Amarri Sergio , Bassi Andrea , Bonvicini Laura , Dall'Aglio Luca , Della Giustina Claudia , Fabbri Alessandra , Ferrari Anna Maria , Ferrari Elena , Fontana Marta , Foracchia Marco , Gallelli Teresa , Ganugi Giulia , Ilari Barbara , Lo Scocco Sara , Maestri Gianluca , Moretti Veronica , Panza Costantino , Pinotti Mirco , Prandini Riccardo , Storani Simone , Street Maria Elisabeth , Tamelli Marco , Trowbridge Hayley , Venturelli Francesco , Volta Alessandro , Davoli Anna Maria ,   Childhood Obesity Prevention Working Group
Published: May 2020

Background
Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies.

Objective
The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity.

Methods
After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app.

Results
Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet.

Conclusions
The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.