title: Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers' Perspectives.
abstract: BACKGROUND
  Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers' preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used.
  
  
  OBJECTIVE
  The aim of this study was to understand smokers' preferred design features of mHealth quit-smoking tools.
  
  
  METHODS
  We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a "blue-sky" brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important.
  
  
  RESULTS
  Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one's progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking.
  
  
  CONCLUSIONS
  Future mHealth cessation aids should be designed with an understanding of smokers' needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation.
authors: Group Health Research Institute, Seattle, WA, United States. hartzler.a@ghc.org.
authors: Andrea Lisabeth
authors: http://orcid.org/0000-0003-4932-7314
authors: AL
authors: Hartzler
authors: June
authors: http://orcid.org/0000-0002-1090-6100
authors: J
authors: BlueSpruce
authors: Sheryl L
authors: http://orcid.org/0000-0002-6325-9349
authors: SL
authors: Catz
authors: Jennifer B
authors: http://orcid.org/0000-0002-2094-9147
authors: JB
authors: McClure
keywords: human-centered design; human-computer interaction; mobile health; smartphone; smoking cessation; software design; telemedicine