Co-designing a mobile health application with breast cancer survivors: The MOSAIC study (Preprint)

BACKGROUND Background: Breast cancer is the world’s most prevalent cancer. Although 5-year survival rates for breast cancer in the United States are 91%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. OBJECTIVE Objective: The purpose of this study was to engage breast cancer survivors and acceptance and commitment therapy content experts in user-centered design to develop an mHealth application (app) employing stress intervention strategies. METHODS Methods: We held five user-centered design sessions with five breast cancer survivors, three acceptance and commitment therapy content experts, two user experience (UX) design experts, and one stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the five-step user-centered design process (e.g., problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the five breast cancer survivors and three acceptance and commitment therapy experts using the System Usability Scale (SUS), Acceptability E-scale, and a brief set of semi-structured interview questions. RESULTS Results: The 10 co-designers were present for each of the five co-design sessions. Co-designers identified five design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill building exercises, and social support. Four features were also identified as critical to use of the tool: an acceptance and commitment therapy and breast cancer specific onboarding process, clean navigation tools, clear organization of the interventions, and once per week behavioral nudges. These requirements created the foundation for the app prototype. The five breast cancer survivors and three acceptance and commitment therapy co-designers evaluated the app prototype for one week, using an Android smartphone. They rated the app as usable (M=79.29, SD=19.83) on the SUS scale (a priori mean cut-point score=68) and acceptable (M=24.28) on the Acceptability E-scale (a priori mean cut-point score=24). CONCLUSIONS Conclusions: Through the user-centered design process, we created an acceptance and commitment therapy app prototype with five breast cancer survivors, three acceptance and commitment therapy experts, and two UX designers. The next step in our research is to continue assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot test the app to examine the feasibility of a large scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings.