Edinburgh Napier University

  Background: Cardiovascular disease is the leading killer globally and secondary prevention substantiallyreduces risk. Uptake of, and adherence to, face-to-face preventive programs is often low. Alternativemodels of care are exploiting the prominence of technology in daily life to facilitate lifestyle behaviorchange.Objective: To inform the development of a web-based application integrated with the primary care electronic health record, we undertook a collaborative user-centered design process to develop aconsumer-focused e-health tool for cardiovascular disease risk reduction.Methods: A four-phase iterative process involved ten multidisciplinary clinicians and academics (primarycare physician, nurses and allied health professionals), two design consultants, one graphic designer, three software developers and fourteen proposed end-users. This 18-month process involved, (1) defining thetarget audience and needs, (2) pilot testing and refinement, (3) software development including valida-tion and testing the algorithm, (4) user acceptance testing and beta testing. From this process, researcherswere able to better understand end-user needs and preferences, thereby improving and enriching theincreasingly detailed system designs and prototypes for a mobile responsive web application.Results: We reviewed 14 relevant applications/websites and sixteen observational and interventionalstudies to derive a set of core components and ideal features for the system. These included the needfor interactivity, visual appeal, credible health information, virtual rewards, and emotional and phys-ical support. The features identified as essential were: (i) both mobile and web-enabled ‘apps’, (ii) anemphasis on medication management, (iii) a strong psychosocial support component. Subsequent work-shops (n = 6; 2 × 1.5 h) informed the development of functionality and lo-fidelity sketches of applicationinterfaces. These ideas were next tested in consumer focus groups (n = 9; 3 × 1.5 h). Specifications for theapplication were refined from this feedback and a graphic designer iteratively developed the interface.Concurrently, the electronic health record was linked to the consumer portal. A written description ofthe final algorithms for all decisions and outputs was provided to software programmers. These algorith-mic outputs to the app were first validated against those obtained from an independently programmedversion in STATA 11. User acceptance testing (n = 5, 2 × 1.0 h) and beta testing revealed technical bugsand interface concerns across commonly-used web browsers and smartphones. These were resolved andre-tested until functionality was optimized.Conclusion: End-users of a cardiovascular disease prevention program have complex needs. A user-centered design approach aided the integration of these needs into the concept, specifications,development and refinement of a responsive web application for risk factor reduction and diseaseprevention.