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      Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach

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          Abstract

          Background

          Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process.

          Objective

          This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above.

          Methods

          We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app’s development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience.

          Results

          The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems.

          Conclusions

          Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients.

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          Most cited references47

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          Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study.

          Although tests for occult blood in the feces are widely used to screen for colorectal cancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness. We randomly assigned 46,551 participants 50 to 80 years of age to screening for colorectal cancer once a year, to screening every two years, or to a control group. Participants who were screened submitted six guaiac-impregnated paper slides with two smears from each of three consecutive stools. About 83 percent of the slides were rehydrated. Participants who tested positive underwent a diagnostic evaluation that included colonoscopy. Vital status was ascertained for all study participants during 13 years of follow-up. A committee determined causes of death. A single pathologist determined the stage of each tissue specimen. Differences in mortality from colorectal cancer, the primary study end point, were monitored with the sequential log-rank statistic. The 13-year cumulative mortality per 1000 from colorectal cancer was 5.88 in the annually screened group (95 percent confidence interval, 4.61 to 7.15), 8.33 in the biennially screened group (95 percent confidence interval, 6.82 to 9.84), and 8.83 in the control group (95 percent confidence interval, 7.26 to 10.40). The rate in the annually screened group, but not in the biennially screened group, was significantly lower than that in the control group. Reduced mortality in the annually screened group was accompanied by improved survival in those with colorectal cancer and a shift to detection at an earlier stage of cancer. Annual fecal occult-blood testing with rehydration of the samples decreased the 13-year cumulative mortality from colorectal cancer by 33 percent.
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            Long-Term Mortality after Screening for Colorectal Cancer

            In randomized trials, fecal occult-blood testing reduces mortality from colorectal cancer. However, the duration of the benefit is unknown, as are the effects specific to age and sex. In the Minnesota Colon Cancer Control Study, 46,551 participants, 50 to 80 years of age, were randomly assigned to usual care (control) or to annual or biennial screening with fecal occult-blood testing. Screening was performed from 1976 through 1982 and from 1986 through 1992. We used the National Death Index to obtain updated information on the vital status of participants and to determine causes of death through 2008. Through 30 years of follow-up, 33,020 participants (70.9%) died. A total of 732 deaths were attributed to colorectal cancer: 200 of the 11,072 deaths (1.8%) in the annual-screening group, 237 of the 11,004 deaths (2.2%) in the biennial-screening group, and 295 of the 10,944 deaths (2.7%) in the control group. Screening reduced colorectal-cancer mortality (relative risk with annual screening, 0.68; 95% confidence interval [CI], 0.56 to 0.82; relative risk with biennial screening, 0.78; 95% CI, 0.65 to 0.93) through 30 years of follow-up. No reduction was observed in all-cause mortality (relative risk with annual screening, 1.00; 95% CI, 0.99 to 1.01; relative risk with biennial screening, 0.99; 95% CI, 0.98 to 1.01). The reduction in colorectal-cancer mortality was larger for men than for women in the biennial-screening group (P=0.04 for interaction). The effect of screening with fecal occult-blood testing on colorectal-cancer mortality persists after 30 years but does not influence all-cause mortality. The sustained reduction in colorectal-cancer mortality supports the effect of polypectomy. (Funded by the Veterans Affairs Merit Review Award Program and others.).
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              Understanding tailoring in communicating about health.

              'Tailoring' refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 x 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.
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                Author and article information

                Contributors
                Journal
                JMIR Hum Factors
                JMIR Hum Factors
                JMIR Human Factors
                JMIR Human Factors
                JMIR Publications (Toronto, Canada )
                2292-9495
                Apr-Jun 2019
                08 May 2019
                : 6
                : 2
                : e12700
                Affiliations
                [1 ] STEM Translational Communication Center University of Florida Gainesville, FL United States
                [2 ] Department of Community Health and Family Medicine University of Florida Gainesville, FL United States
                [3 ] Division of Oncology College of Medicine University of Florida Gainesville, FL United States
                [4 ] Statistics Department North Carolina State University Raleigh, NC United States
                [5 ] Department of Computer and Information Science and Engineering University of Florida Gainesville, FL United States
                [6 ] Center for Health Outcomes and Informatics Research Loyola University Chicago Chicago, IL United States
                [7 ] Division of Cancer Prevention and Control Department of Internal Medicine The Ohio State University Columbus, OH United States
                Author notes
                Corresponding Author: Lauren Griffin lngriffin@ 123456ufl.edu
                Author information
                http://orcid.org/0000-0003-3129-7882
                http://orcid.org/0000-0002-9932-4376
                http://orcid.org/0000-0002-9848-5709
                http://orcid.org/0000-0003-3937-1733
                http://orcid.org/0000-0002-6249-9180
                http://orcid.org/0000-0003-2640-7696
                http://orcid.org/0000-0002-1190-3729
                http://orcid.org/0000-0003-4366-0757
                http://orcid.org/0000-0002-8247-8299
                http://orcid.org/0000-0001-9950-9170
                Article
                v6i2e12700
                10.2196/12700
                6530259
                31066688
                1bc7bb2f-7634-49a1-a66e-c185f5ba6b07
                ©Lauren Griffin, Donghee Lee, Alyssa Jaisle, Peter Carek, Thomas George, Eric Laber, Benjamin Lok, François Modave, Electra Paskett, Janice Krieger. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 08.05.2019.

                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 Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on http://humanfactors.jmir.org.as well as this copyright and license information must be included.

                History
                : 22 November 2018
                : 24 January 2019
                : 5 March 2019
                : 5 April 2019
                Categories
                Original Paper
                Original Paper

                communication,cell phone,mobile phone,culturally appropriate technology,interdisciplinary research,colon cancer,cancer screening

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