Usability testing of a mobile health physical activity application for people with an inflammatory bowel disease: Mixed methods study
Date
2025
Authors
Trim, Cameron
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Abstract
Background: Living with an Inflammatory bowel disease (IBD) implies a lifelong burden of physical and mental health complications to diagnosed individuals, even when in a quiescent disease state. The prevalence of IBD within industrialized nations is increasing worldwide, and the associated economic cost is substantial. Physical activity (PA) has the potential to improve systemic symptoms for people with an IBD without risk of exacerbating disease activity. Despite this, the recommended amount of PA is often not met within the IBD population. Fatigue is a common systemic symptom of IBD which can affect participation in PA. Just-in-time adaptive interventions (JITAI) can be delivered using mobile health (mHealth) apps and can provide tailored support for behaviour change. These types of interventions have the potential to offer a scalable solution to help increase PA levels for people with an IBD while tailoring to a person’s fatigue level. Using the IDEAS framework, a mHealth JITAI app with the aim of increasing PA levels of people with an IBD has been developed; however the usability and acceptability of the app remains unclear.
Objective: This study aims to evaluate the usability and acceptability of a JITAI app, IBD-Move, among individuals living with an IBD.
Methods: This mixed-methods study involved two cycles of 4 participants (n = 8) and was conducted at the University of Victoria. Participants were asked to complete five tasks, 1) login and read through the introductory module, 2) read through the Chapter 1 module, 3) add a PA goal, 4) complete a PA session, and 5) track the PA using the app. During the study, participants 1) completed the baseline questionnaire on demographics (e.g., age, sex, social economic status) and experience with smartphones, 2) attempted to complete the five goal-oriented tasks, listed above, while performing the Think-Aloud protocol, and 3) responded to the mHealth app usability questionnaire (MAUQ) and answered semi-structured interview questions. Usability measures included task completion rates, efficiency (i.e., completing a task with minimal steps), and qualitative use feedback. The framework analysis method and usability problem taxonomy were used to identify themes of usability problems, as identified from Think-Aloud task completion and interview.
Results: Quantitative results showed that task completion rates improved from Cycle 1 to Cycle 2, though Tasks 3 (Add Goal) and 4 (complete PA Session) sustained relatively lower rates of completion in Cycle 2 and demonstrated the highest inefficiencies of screen transitions. Usability scores improved in both Ease of Use (MAUQ) (Cycle 1 (M[SD]) = 1.93 [0.52], Cycle 2 (M[SD]) = 1.45 [0.21]) and Interface and Satisfaction (MAUQ: Cycle 1 (M[SD]) = 1.98 [0.42] to Cycle 2 (M[SD]) = 1.15 [0.14]). Usefulness scores, used to measure acceptability, also improved (MAUQ: Cycle 1 (M[SD]) = 2.88 [0.82] to Cycle 2 (M[SD]) = 1.67 [0.85]). Constructs of the Theoretical Framework of Acceptability were met with unanimous agreement in Cycle 1, however the constructs Perceived Effectiveness and Self-efficacy were not fully agreed during Cycle 2. Qualitative analysis identified 12 consolidated usability problems for Cycle 1 and 13 for Cycle 2, with the most severe problems in Task 2 (read Chapter 1), Task 3 (Add Goal), and Task 4 (Complete PA Session), primarily related to Visualness and Task-mapping classifications of UPT.
Conclusion: IBD-Move demonstrated high usability and acceptability, with its tailored approach to physical activity and content well-received. Key refinements were made from Cycle 1 to Cycle 2; text was adjusted, instructions were added, and technical errors were fixed, though challenges in Tasks 3 and 4 remained. Further adjustments to the app will be made in preparation for a future feasibility study, evaluating IBD-Move’s effectiveness for improving physical activity levels and health outcomes.
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Keywords
Inflammatory Bowel Disease, Physical Activity, mHealth, Usability, Acceptability