This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included.
Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care.
The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management.
A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0.
A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP.
This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.
Obesity in adolescents remains a major public health concern owing to its high prevalence and association with significant adverse health outcomes in adulthood [
Information and communication technologies have created opportunities to deliver accessible and cost-effective interventions for weight management that may help to sustain adolescents engaged in healthy lifestyle practices over the long-term. Mobile apps are being increasingly investigated for their potential to support long-term health management by providing more convenient and sustainable ways to implement health-related behavior change and access health care [
A number of systematic reviews of technology-based interventions for overweight and obesity in adolescents found significant short-term (less than 6 months) reductions in BMI and improvements in dietary behaviors, PA, and self-monitoring [
Despite advancements made, a number of gaps persist in the literature. Minimal research has been conducted toward the development and evaluation of mobile health (mhealth) technologies for weight management, specifically targeting adolescents with complex health needs that require more frequent contact with HCPs and more intensive engagement with services [
A descriptive qualitative research design, as described in the study by Sandelowski [
Purposive sampling of adolescents interested in weight management and healthy lifestyles was employed to collect information-rich cases that encompassed the diverse needs of a heterogeneous sample of adolescents with different health conditions and obesogenic risk factors. Participants in the age range of 12 to 18 years were recruited from two pediatric hospitals in Ontario, Canada. Participants at site 1 were recruited from a specialized tertiary care outpatient behavioral weight-management program for adolescents in the age range of 12 to 17 years with severe or complex obesity. Patients referred to this program have a BMI over the 99th percentile or a BMI over the 97th percentile and a significant obesity-related comorbidity requiring subspecialty care. Participants at site 2 were recruited from specialized inpatient units at a tertiary care pediatric rehabilitation hospital for adolescents in the age range of 12 to 18 years with disabilities, including acquired brain injury, neuromuscular, orthopedic and developmental disabilities. The study was approved by the Research Ethics Boards of both participating hospitals.
Eligible adolescents were introduced to the study by an HCP who was part of the client’s circle of care and could verify their capacity to consent. Adolescents were provided information letters describing the study and asked if they wanted their contact details passed onto the research team. Those interested were contacted by a research assistant who met with the adolescent to explain the study and obtain consent. Adolescents were deemed eligible to participate if they were receiving care at either recruitment site, were interested in weight and health management, and were able to speak and read English. Adolescents were excluded if they had severe cognitive impairments (eg, unable to take turns and consider other viewpoints), or a major comorbid psychiatric or medical illness that precluded their capacity to consent and ability to participate in a group discussion (eg, severe depression or anxiety), as identified by a member of their immediate clinical team.
Parents or caregivers of adolescents deemed eligible were also invited, though not required, to participate via the information letter. Parents or caregivers were required to speak and read English to participate. Parents were provided the option to participate with their spouse or on their own.
HCPs were introduced to the study by program managers and recruited from the respective clinical programs serving adolescent participants. No limitations were placed on health discipline or type of clinical service provided. Trainees were excluded from the study because of limited knowledge of the population.
Study consent was obtained before each focus group interview. Adolescent and parent or caregiver participants completed two questionnaires on demographic and health characteristics, as well as level of use and comfort with mobile apps. HCPs completed one questionnaire on demographic and occupational characteristics. All interviews were conducted at the two hospital sites by four research team members, two of whom facilitated group discussion and two who observed and took field notes capturing verbal and nonverbal behaviors.
Focus groups were semistructured in format and followed an interview guide created by experts in pediatric obesity and informed by current research and clinical experience. Guides for adolescents and parents or caregivers included topics regarding their general experiences with weight management in their clinical programs, school, and home, before moving into more specific questions regarding desired app features and design. Adolescent and parent or caregiver focus groups were conducted concurrently and separately. The HCP interview guide similarly started with general questions about their openness to a mobile app related to healthy lifestyles before moving into more specific questions regarding app features and integration within their clinical practice. Sample interview questions are provided in
Demographic data were coded and analyzed using Excel (Microsoft) to determine measures of central tendency and the distribution of values for the sample. All interviews were audiorecorded and transcribed verbatim, which were imported into NVivo 10.0 for data management. Qualitative content analysis was conducted using the approach described by Sandelowski, 2000 [
Three members of the research team coded the data (JR, TG, and MP). Study credibility and integrity were achieved using iterative questioning during interviews, frequent debriefing sessions with research team members, thick description, and prior examination of extant research in this area. Techniques were used to minimize the power differential between interviewer and respondents, including establishing rapport with ice-breaker questions using developmentally appropriate language, active listening, and relaxed body language. Data saturation was reached when no new codes were arising through iterative and open-ended questioning. The raw data were revisited regularly throughout the analytic process to ensure that the coding schemata reliably reflected the data. Discrepancies in coding were resolved with two senior members of the research team (JS and AM). Pseudonyms are used in place of participant names with quotes indicating the type of participant and the study site (site 1 or site 2).
Sample interview questions.
Group | Broad questions | Program-specific questions |
Adolescents | Can you tell me how long you have been working on healthy nutrition or physical activity goals and what it has been like for you? Why do you want to develop healthier lifestyle habits? Who do you feel should be involved with helping you to make and stick to healthy lifestyle changes? |
What do you think about having a website and smartphone app that could help you to better manage your weight and develop a healthy lifestyle? Would you be interested in tracking your weight, what you eat, and your physical activities on an app? How about your mood, stress, sleep quality, and medications? Would you want a function on the app to help you set healthy lifestyle goals? |
Caregivers | Can you tell me how long your child has been working on healthy nutrition or physical activity goals and what it has been like for him or her? Do you feel like your child has the tools or resources needed to manage and stick with their healthy lifestyle independently? Do you think your child wants to develop healthier lifestyle habits? Why or why not? |
What do you think about having a website and smartphone app that could help your child to better manage their weight and develop a healthy lifestyle? Does your child keep track of their weight, what they eat, and their physical activities on a regular basis (eg, paper or electronic diary)? Why or why not? What information about managing your weight and developing a healthy lifestyle would you or your child want to learn more about to feel comfortable managing a healthy lifestyle? |
Health care providers | What would you say are the patients’ and families’ biggest challenges and barriers to developing a healthier lifestyle? Do you feel like they have the tools or resources that they need to manage their healthy lifestyle independently? |
What do you think about having a website and smartphone app that could help them to better manage their weight and develop a healthy lifestyle? How do you see an app fitting in with their care plan? Are there any other important features that we didn’t talk about that could help them to become healthier? |
A total of 56 participants were included in the study. Three focus groups were conducted with adolescents (n=19), four with parents or caregivers (n=16), and three with HCPs (n=21). A total of 34 participants were interviewed at site 1 (adolescents: n=12, parents: n=10, and HCP: n=12), and 22 were interviewed at site 2 (adolescents: n=7, parents: n=6, and HCP: n=9). Demographic characteristics of adolescents, parents or caregivers, and HCPs are presented in
Thematic analysis revealed seven app functionalities of a mobile app for weight and health management, endorsed by adolescents, their parents, and HCPs. The seven desired app functionalities were as follows: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Similarities and differences in perspectives were compared between participant groups and outlined below. All participant groups felt that a weight and health management app that is geared toward the unique needs of adolescents receiving specialized health care services to promote healthy weight-related behaviors would be beneficial.
Adolescents identified a number of features that they felt were crucial to support healthy eating, including meal recommendations, recipes, nutrition information, and meal tracking. Adolescents desired meal suggestions to be personalized to factors such as mealtime patterns, social activities, and health conditions.
For example, one respondent proposed meal suggestions specific to popular restaurants or frequented eating locations, as illustrated in the following quote:
So like a list of the most popular restaurants...You could even have a section where it gives you options if you go to that place.
Adolescents also desired a variety of new healthy recipes, as exemplified by the following quote:
Maybe food recipes is a big one, because we can eat healthy all we want but if we continue to eat the same grilled chicken breast, it will get boring. So maybe it could update all the time with different food recipes.
Demographic characteristics of health care provider participants.
Characteristics | Health care providers (n=21) | |
Pediatrician | 2 (10) | |
Psychologist | 3 (14) | |
Social worker | 3 (14) | |
Registered nurse | 3 (14) | |
Dietitian | 2 (10) | |
Exercise counselor | 2 (10) | |
Occupational therapist | 6 (28) | |
Female | 21 (100) | |
Experience as a health professional (years), mean (SD) | 11.2 (8.0) | |
Experience working with children (years), mean (SD) | 8.21 (6.6) | |
Experience in obesity or weight management (years), mean (SD) | 5.23 (6.6) |
Demographic characteristics of teen participants.
Characteristics | Teens (n=19) | |
Female | 13 (68) | |
Male | 6 (32) | |
Average age (years), mean (SD) | 14.7 (2) | |
Grade 6 | 1 (5) | |
Grade 7 | 3 (16) | |
Grade 8 | 1 (5) | |
Grade 9 | 2 (11) | |
Grade 10 | 3 (16) | |
Grade 11 | 4 (21) | |
Grade 12 | 4 (21) | |
College | 1 (5) | |
Not working | 15 (79) | |
Part-time work | 4 (21) | |
None | 7 (37) | |
Not sure | 7 (37) | |
Asthma | 3 (16) | |
Autism | 1 (5) | |
Sickle cell | 1 (5) |
Demographic characteristics of parent participants.
Characteristics | Parents (n=16), n (%) | |
Biological mother | 14 (88) | |
Biological father | 1 (6) | |
Adopted father | 1 (6) | |
Unemployed | 2 (13) | |
Part-time | 2 (13) | |
Full-time | 11 (69) | |
Retired | 1 (6) | |
Less than 25,000 | 3 (19) | |
25,000-49,000 | 1 (6) | |
50,000-74,000 | 2 (13) | |
75,000-99,999 | 1 (6) | |
100,000-150,000 | 6 (38) | |
Above 150,000 | 2 (13) | |
Do not want to answer | 1 (6) | |
Some high school | 2 (13) | |
Graduated secondary school | 1 (6) | |
College or technical school | 5 (31) | |
Some graduate school | 2 (13) | |
Graduate degree | 6 (38) | |
Single | 2 (13) | |
Married or living common law | 12 (75) | |
Separated | 1 (6) | |
Divorced | 1 (6) | |
Aboriginal | 0 (0) | |
White | 9 (56) | |
South Asian | 0 (0) | |
Chinese | 0 (0) | |
Black | 1 (6) | |
Filipino | 0 (0) | |
Latin American | 0 (0) | |
Arab or West Asian | 0 (0) | |
Southeast Asian | 0 (0) | |
Korean | 0 (0) | |
Japanese | 0 (0) | |
Other (ie, Portuguese, Greek, or Italian) | 3 (19) | |
Do not want to answer | 3 (19) |
Related to this, nutrition information for specific foods was desired to facilitate more convenient grocery shopping. One adolescent stated the following:
You brought up using barcodes, maybe you could be able to go to the grocery store, scanning a barcode and the nutrition facts popping up and maybe give you more information than is on the package and see if that is in your list of things that you could have.
The feedback provided by the app would ideally reflect their individualized healthy eating plan established between the adolescent and their health care team.
Adolescents and parents felt a meal-tracking feature would be beneficial, as a strategy for health-related behavior change, exemplified by the following quote from one adolescent:
Say you go out and eat something for fast food and we put it in [the app] and it notices that we have had that [food] too many times that it gives us a tip saying be careful.
One parent provided a real-world example of how such a feature might provide guidance to their adolescent, as illustrated in the following quote:
A reminder...I’ve had hamburger and French fries, okay well then have a hamburger and French fries in 4-5 days but not tomorrow.
Parents’ priorities centered primarily on assistance with meal planning. Parents desired an app that would provide nutrition information and suggestions for healthy meals personalized to their child. One parent stated the following:
Yeah, I think [meal planning] is the biggest thing. Or on the app what are the good snacks and the ingredients and what they need to do, just so they have everyday planned out.
Another parent wanted greater variety with food selection, as illustrated in the following quote:
What things you’ve discovered that you can eat other than apple sauce.
HCP’s responses centered on meal tracking and emphasized identifying adolescents’ personal health goals and adapting self-monitoring practices appropriately to promote healthy eating. One HCP stated the following:
At least get a push notification saying we noticed your weight has gone up, try eating more fruit, based on if they were entering data regarding their diet, or depending on what their goal was...to help people make that connection between knowing and actually implementing what they know.
A key feature identified by the majority of adolescents was social support capabilities within the app. Social connection, or a way to maintain contact with peers, was frequently discussed as a critical feature for app use. One adolescent stated the following:
I think what you could actually have is something that could keep you connected to everyone else in the program...we have known each other for 10 weeks and it is kind of sad that we are not going to see each other anymore.
An app could be used to prolong connection with peer social supports.
Encouragement and coping support were also discussed as potential benefits to a social support feature, which would allow for adolescents to share encouraging messages with peers and to seek out or offer advice regarding healthy lifestyles. For example, one adolescent commented the following:
Every once and a while you click on someone’s name and send them a little private message or a little motivation thing.
To facilitate social support, adolescents suggested linking to other social media platforms that are already in popular use, while also providing ways to engage in more private conversations with peers in similar situations (eg, participating in a weight management program). One adolescent stated the following:
It would be cool if we could have a section we could log into and it would just be for your group and there you could have a chat to stay connected.
The importance of social support to adolescents’ motivation to adhere to healthy lifestyle change was reinforced by parents and HCPs who also identified social support frequently as a critical app feature. One HCP stated the following:
One thing we have heard back that people actually really like is the social [support].
Likewise, one parent commented the following:
Being here they’re with their own, at least I feel my daughter feels more herself. Being able to talk to people with the same issue.
HCPs and parents also endorsed using existing social media apps such as Instagram for motivation, entertainment, and encouragement, as illustrated in the following quote:
I’m really obsessed with the idea of having an Instagram with it...like look guys this is what [everyone] did today!
Adolescents supported tracking data such as meals, PA, sleep, mood, and general health and that tracking be made customizable and related to personal goals. For example, one adolescent stated the following:
You’re able to pick from a list of things, like say that there is a list of 20 different things that you can track, but you pick maybe 8 of them.
Adolescents also described how tracking would facilitate greater awareness of unhealthy lifestyle behaviors. One adolescent commented the following:
Maybe track how much sleep I need...When I’m feeling really tired I can’t [always] recognize it, it could tell me you need to go take a nap right now. Like when your body is really drained, go sit down.
HCPs similarly supported tracking as an appropriate technique for understanding lifestyle patterns and identifying areas for improvement. One HCP suggested the following:
Recording [and] tracking patterns, because lots of times our kids will say right after school [is when] they breakdown.
However, both parents and adolescents expressed concerns that tracking aspects of health over the long-term can be difficult to sustain. One youth stated the following:
Just some personal experience with apps like this. I find that you start off really well with tracking, but overtime you forget or you don’t put in accurate information. So it is really easy when it comes to tracking to lose focus.
Parents were particularly concerned that tracking all aspects of their life could be an emotional burden on adolescents, as was exemplified in the following quote:
[My daughter] tracked for a couple of years, and then she just had a meltdown. She refuses to track anything now. And my family doctor says she has every right not to want to track. Because they’re telling you not to eat and then to write down everything you did eat, like continuously in your face.
Finally, HCPs discussed the importance of setting realistic goals and considering the risk for unhealthy tracking, as demonstrated by the following quote by an HCP:
I think the danger is if they start using the app to expedite something. Their weight is going to be very tricky because we also want you to be comfortable with your weight. [Kathleen, HCP, site
Adolescents liked the idea of being able to keep in touch and communicate with their HCPs within the app. When considering the different features that could potentially be offered by the app, adolescents identified multiple ways that they would consider using to communicate with HCPs, such as video calling, SMS text messaging (short message service, SMS), and sharing health data. One adolescent stated the following:
Virtual check-ins would be pretty cool, almost if we could make our own little appointments...they could have a time slot and then we could be like “oh I’m free” so then we just add our own appointment. And then we just FaceTime.
Adolescents endorsed the utility and convenience offered by remote access to interprofessional health care supports. This is demonstrated by one adolescent who suggested the following:
[Having] professionals you could talk to in case you have a problem or you’re feeling down...At that moment in time, they could advise you and give you some strategies to help you.
Furthermore, adolescents endorsed greater comfort and more efficient care with greater access to familiar HCPs, with one adolescent stating the following:
I think it would be cool to be able to connect with [our HCP] and ask them for advice because we have known the people we have been working with for a while. So it’s more comfortable asking them.
Finally, data sharing with HCPs was suggested as many youths felt that this would provide a more accurate and up to date picture of their health, without constantly explaining what they were doing to maintain a healthy lifestyle. This was illustrated by a quote from an adolescent who stated the following:
Each time you go for your therapy, you wouldn’t have to explain how you’re feeling, or how you have been doing since the last time you saw them. You could just show them, or they could already have it written down.
However, adolescents still desired control over privacy in their communication, with one adolescent stating the following:
There could be an option to make it anonymous, or a direct message, or if you want you could put it to the group chat.
Parents also endorsed the benefits of having greater access to HCPs, whom many believed could provide needed emotional support to adolescents. One parent stated the following:
If they could talk with [a HCP], I think that would be the best thing, because sometimes [my daughter] just doesn’t want to talk to me, she gets all frazzled and then I start getting mad, and it’s just going to make it worse.
HCPs were also open to communication with adolescents using an app and acknowledged adolescents’ comfort and adeptness with mobile apps, particularly as a communication tool over more traditional platforms such as email. One HCP stated that using an app can be “a way to communicate with [youth] that they are tapped into [and] that’s groundbreaking. They are like, why do you want my email, what are you, 100 [years old]?” (Nadia, HCP, site 1). HCPs also described how sharing health data over the app would facilitate more personalized, targeted and consistent care, as illustrated in the following quote:
...with the app it’s a nice kind of consistency. If I don’t [see] you all the time but you wrote on the app “I’m sad today” then I can get you that support. So maybe I can get you someone from psychology or somebody from recreation that you have a good bond with to come talk to you.
However, HCPs still raised doubts about the practicality and enthusiasm held by adolescents for sharing their health data with their health care team, stating it would be “weird if you’re filling it out knowing a HCP is going to see it” (Tara, HCP, site 2).
Adolescents, parents, and HCPs all identified support for mental health as an important component of app function. Features that were suggested by adolescents included information about emotions, mood, and their impact on motivation, as well as healthy coping strategies such as relaxation, stress reduction, and building self-efficacy. Adolescents and HCPs both suggested inspirational messages, positive affirmations, reframing negative thoughts, and connecting with social supports as potential coping strategies facilitated by the app.
HCPs also viewed an app as an acceptable and useful tool for adolescents to self-monitor mental health, including mood and thought patterns, as exemplified by one HCP who stated the following:
You click on the app, first thing is “how are you feeling?”
HCPs also felt that the app would allow adolescents to more honestly report their mood and its impact on their lifestyle. One HCP stated the following:
I think they’d be more willing to say it on the app as opposed to telling us “I’m not having a good day today.” I think they’d be more open to doing it that way than verbally.
Finally, parents and HCPs found it important that support also be provided to parents to promote mental wellbeing and positive self-image in their adolescent. One parent (Eleanor, parent, site 2). in particular claimed that her daughter’s mental well-being and self-image were the “most important things” to her, even over her daughter’s weight or adherence to diet. Another HCP (Darlene, HCP, site 2) suggested the “model of giving parents the tools they need to be the therapist with their adolescent.
Adolescents proposed games and rewards-based incentives to help motivate continued use of the app. Suggestions included a point systems, monetary rewards, as well as multi-player gaming. HCPs also endorsed games and rewards, particularly group-based games as strong motivators for adolescents. One HCP stated the following:
I think that’s really motivating, when you have a goal in mind and you want to [improve] every single day. I think for kids that’s a good way to do it too. They’re always trying to compete against their classmates so I think having a goal oriented program would be good.
The most salient need in the UI design raised by adolescents was that it be attractive and entertaining to motivate its regular use. One adolescent’s quote encapsulates this notion, as stated in the following:
I feel like if we were to make an app, you have to make it entertaining...because even on the iPhone and the Android you automatically get a health app but almost no one ever touches it.
Some adolescents compared the need to design the app to be interesting and engaging in a similar fashion to popular social media apps such as Snapchat and Instagram, which are accessed frequently throughout the day by many teens. HCPs also stressed that the app be simple and easy to use, preferably with minimal reading. One HCP stated the following:
Simplicity, just keeping it simple, so no food entry or that kind of stuff. That is what drives people away from using it.
This qualitative study describes the perspectives of adolescents with severe or complex obesity or physical and developmental disabilities regarding the development of a mobile app to support weight and health management. Participants desired an app with features to enhance existing weight management practices and improve long-term maintenance of healthy behaviors. These features centered on healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and the UI design.
Healthy eating emerged across participant groups and included proposed features for meal planning, cooking, nutrition information, and more effective ways to self-monitor. The US Preventive Services Task Force considers a dietary component a critical aspect of comprehensive behavioral pediatric weight management programming [
Seventy-five percent of the top rated smartphone apps for weight loss are narrowly based on the energy-balance model of weight management and rely on a food database to track and control caloric intake [
Self-monitoring, which involves tracking relevant health data and analyzing trends, is argued to be a central strategy of effective weight management [
Studies of mobile device interventions in adults have demonstrated significant associations between frequency of dietary and PA self-monitoring and weight and health-related outcomes [
Social support was seen as an important app feature for adolescents to stay connected with peers they had met through their hospital. Peers were valued as major sources of motivation, confidence, and learning. Our findings reinforce the value of social support and relationships to adolescents’ adoption of health beliefs and behaviors [
Fostering supportive social relationships is a key strategy in pediatric clinic-based weight management programs, particularly in the maintenance phase of treatment [
Communication with HCPs using a mobile device has the potential to significantly expand access to professional support and reflects ongoing initiatives within telehealth to develop applications for remote health care delivery and monitoring. Although efforts to harness mobile technologies for remote health care delivery are growing rapidly [
Telehealth interventions to extend therapeutic contact for children and adolescents with overweight and obesity have incorporated telephone, email or Internet, and mobile device SMS [
The implication of our findings on future research and development of mobile device health provider communication suggests such a feature would be more effective when used by patients and their regular health providers with whom trust and a therapeutic alliance has been established. This way, more personalized and meaningful support can be provided, particularly for adolescents with complex health care needs. Furthermore, protecting privacy and ensuring security of personal health information is paramount to the utility, effectiveness, and safety of any mobile health intervention. Ultimately, our findings suggest that a mobile app can enhance or expand an existing health care service arrangement, rather than establish a new arrangement, and must be appropriately, safely, and securely implemented. Adolescents and parents view their HCPs as important sources of information and support and would benefit from easier access to them.
Support for mental health incorporated ways to feel motivated and increase self-efficacy. Adolescents, parents, and HCPs discussed the importance of emotion, motivation, and positive self-image for weight management success. Adolescents specifically touched on managing stress and mood as important components to making healthier lifestyle changes. Some specific strategies related to supporting mental health using the app included guided relaxation and mindfulness practices, access to personal supports, and speaking to an HCP. HCPs suggested storing affirmation statements, distraction techniques, and behavioral activation (eg, prompts) be incorporated into the app. Many of these strategies reflect components of emerging medical and commercial apps that have attempted to employ psychological theories into their design, mostly centered on cognitive behavioral therapy techniques such as mindfulness, relaxation, and emotional control, as well as providing tailored recommendations and information related to mental health and coping [
Finally, the app interface should be simple and interactive, enjoyable to use, and intuitive. HCPs stressed the importance of designing the app to be very simple to use, whereas adolescents highlighted the importance of designing the user experience to be interesting, fun, and entertaining. Turner et al [
This study presents preliminary findings toward the development of a mobile app for weight and health management using a qualitative research design. Hence, findings reflect the subjective perspectives of adolescents with complex health care needs in specialized clinical programs and should not be generalized to adolescents in the general population who are not as intensively engaged with the health care system and may not benefit from enhanced health care support through a mobile app. More research using quantitative and qualitative research designs should be used to substantiate these results and to evaluate and improve on proposed app designs. Second, it should be noted that the majority of adolescent participants in this study were girls, potentially limiting proper description of the unique needs of boys in a mobile app for weight and health management. Further work is needed to characterize the views of adolescent boys and actively involve boys and girls in the design and implementation of the tool.
The findings presented here describe the core functional components of a mobile app for weight and health management in adolescents with complex health needs. These findings highlight the lack of such a tool for adolescents in frequent contact with specialized health care services who could potentially benefit the most from more accessible health support through this technology. Remaining questions to be addressed center on how to best design these features into an app that is useful, interesting, as well as engaging for adolescents. Future directions for this research will be to develop the app and conduct iterative cycles of usability and feasibility testing before undergoing a pilot RCT to examine preliminary measures of effectiveness.
body mass index
health care provider
mobile health
physical activity
randomized controlled trial
short message service
user interface
The authors thank all the adolescents, parents or caregivers, and HCPs who participated in this study.
None declared.