Cocreating a Mobile Health App Providing Physical Activity Recommendations for Older People Living With Parkinson Disease or Dementia: User-Centered Pilot Study

Abstract Background The project “Personalized Integrated Care Promoting Quality of Life for Older People” aimed to develop an integrated care system based on information and communication technology to support older people living with Parkinson disease or dementia disease. One module focuses on physical activity (PA) recommendations. Objective The objective of the study is to describe the development process of the PA recommendation system from the behavior-change and technical perspective, followed by its content and satisfaction evaluation. Methods This study describes the development of the PA recommendations based on the Health Action Process Approach (HAPA). A first pilot assessed the feasibility of the overall PROCare4Life system (previously reported). In a second pilot, users evaluated the content of the PA recommendations during 40 intervention days. In a third pilot, users evaluated their satisfaction with a mobile health satisfaction questionnaire. Results The PA recommendations focused on different aspects of an adapted version of the HAPA model, while they simultaneously approached 3 activation factors: skills, knowledge, and motivation. The content was generally well-received, with most users rating key sections as excellent or good, particularly “benefits and consequences of PA” (34/43, 79%) and “five golden rules of PA” (34/41, 83%). However, less than a third gave high ratings to “PA guidelines of the WHO” (9/36, 25%) and “practical tips for PA” (10/35, 29%). Regarding satisfaction, at least half of the 237 participants found it easy and good to use, with acceptable time spent and clear instructions. Compared with agreement or neutral evaluations, most disagreed with negative statements about it being time-consuming (111/237, 47%) or boring (99/237, 42%). While 41% (97/237) recommended it and 44% (104/237) felt it helped them understand lifestyle benefits, fewer agreed the recommender system helped them set personal goals (78/237, 33%) or motivated change (88/237, 37%). Users found the recommendations understandable, engaging, and practical, though some aspects, such as motivation and goal setting, received criticism. Challenges in pilot 2, particularly related to setup difficulties and limited participation, led to system modifications in pilot 3 that improved usability and data collection. Conclusions It has been confirmed that cocreating and iteratively testing the contents on HAPA and approaching the activation factors contributed to increasing the acceptance of the PA. The intervention development was based on user needs and used comparable methodology across user profiles and pilot phases. All in all, users were positive about the content. The research team has identified that digital systems, that provide monitoring functions of the mobile health app and Fitbit wristband are considered advantageous by participants in the cocreation process. Addressing the activation factors can be recommended for researchers and technical developers of other projects. Future adjustments to the design should focus on personalization to encourage the adoption of a healthier lifestyle.

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