Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease
(COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related
self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is
limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as
useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was
developed to enhance exacerbation-related self-management in patients with COPD.
Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable
mHealth intervention to enhance exacerbation-related self-management in patients with COPD.
Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha
usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers,
COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development
process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing
behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention.
Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative
research methods were used throughout the design and development process.
Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention,
a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were
obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth
intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan.
Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of
patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation
impact. This extensive report of the intervention development process contributes to more transparency in the development of
complex interventions in health care and can be used by researchers and designers as guidance for the development of future
mHealth interventions.
