Research Output
A mobile phone intervention to improve obesity-related health behaviors of adolescents across Europe: An iterative co-design and feasibility study
Promotion of physical activity, healthy eating, adequate sleep and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of non-communicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mHealth technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology.

To describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future mHealth intervention for adolescents from different cultural backgrounds.

Seventy-four adolescents aged 13-16 years from Spain, Italy and the United Kingdom participated in the co-design of the PEGASO Fit for Future technology. In three iterative cycles over 12 months, participants were involved in the co-design, refinement and feasibility testing of a system consisting of diverse mobile applications with a variety of functions and facilities to encourage healthy weight promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for one week at home or school. In the third iteration, further developed prototypes were tested for two weeks. Participants’ use experience feedback and development ideas were collected from focus groups and completion of questionnaires.

For the PEGASO Fit for Future technology to be motivating and engaging, participants suggested that it should (i) allow personalization of the interface, (ii) have age-appropriate and easy to understand language (of icons, labels, instructions, notifications), (iii) provide easily accessible tutorials on how to use the app or navigate through a game, (iv) present a clear purpose and end goal, (v) have an appealing and self-explanatory reward systems, (vi) offer variation in gamified activities within apps and the serious game, and (vii) allow to seek peer-support and connect with peers for competitive activities within the technology.

Incorporating adolescents’ preferences, the PEGASO Fit for Future technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex smartphone-based technological system applying the principles of co-design to mHealth technology with adolescents across three countries. Findings of this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multi-national pilot trial.

  • Type:


  • Date:

    02 March 2020

  • Publication Status:


  • Publisher

    JMIR Publications Inc.

  • DOI:


  • Funders:

    EU Framework Programme 7 and FP6 and earlier programmes


Martin, A., Caon, M., Adorni, F., Andreoni, G., Ascolese, A., Atkinson, S., …McKinstry, B. (2020). A mobile phone intervention to improve obesity-related health behaviors of adolescents across Europe: An iterative co-design and feasibility study. JMIR mHealth and uHealth, 8(3),


Monthly Views:

Available Documents
  • pdf

    A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe


    ©Anne Martin, Maurizio Caon, Fulvio Adorni, Giuseppe Andreoni, Antonio Ascolese, Sarah Atkinson, Kim Bul, Carme Carrion,
    Conxa Castell, Valentina Ciociola, Laura Condon, Mireia Espallargues, Janet Hanley, Nithiya Jesuthasan, Claudio L Lafortuna,
    Alexandra Lang, Federica Prinelli, Elisa Puidomenech Puig, Sarah A Tabozzi, Brian McKinstry. Originally published in JMIR
    mHealth and uHealth (, 02.03.2020. This is an open-access article distributed under the terms of the
    Creative Commons Attribution License (, which permits unrestricted use, distribution,
    and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited.
    The complete bibliographic information, a link to the original publication on, as well as this copyright
    and license information must be included.

  • Downloadable citations