Subscribe to RSS
DOI: 10.1055/a-2267-1727
Human-Centered Design and Development of a Fall Prevention Exercise App for Older Adults in Primary Care Settings

Abstract
Background Falls in older adults are a serious public health problem that can lead to reduced quality of life or death. Patients often do not receive fall prevention guidance from primary care providers (PCPs), despite evidence that falls can be prevented. Mobile health technologies may help to address this disparity and promote evidence-based fall prevention.
Objective Our main objective was to use human-centered design to develop a user-friendly, fall prevention exercise app using validated user requirements. The app features evidence-based behavior change strategies and exercise content to support older people initiating and adhering to a progressive fall prevention exercise program.
Methods We organized our multistage, iterative design process into three phases: gathering user requirements, usability evaluation, and refining app features. Our methods include focus groups, usability testing, and subject-matter expert meetings.
Results Focus groups (total n = 6), usability testing (n = 30) including a posttest questionnaire [Health-ITUES score: mean (standard deviation [SD]) = 4.2 (0.9)], and subject-matter expert meetings demonstrate participant satisfaction with the app concept and design. Overall, participants saw value in receiving exercise prescriptions from the app that would be recommended by their PCP and reported satisfaction with the content of the app.
Conclusion This study demonstrates the development, refinement, and usability testing of a fall prevention exercise app and corresponding tools that PCPs may use to prescribe tailored exercise recommendations to their older patients as an evidence-based fall prevention strategy accessible in the context of busy clinical workflows.
Keywords
exercise - mobile apps - geriatrics - primary care - evidence-based behavior change strategiesProtection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Mass General Brigham Institutional Review Board.
Publication History
Received: 02 October 2023
Accepted: 22 January 2024
Accepted Manuscript online:
13 February 2024
Article published online:
10 July 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ≥65 years—United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65 (37) 993-998
- 2 Hartholt KA, Lee R, Burns ER, van Beeck EF. Mortality from falls among US adults aged 75 years or older, 2000-2016. JAMA 2019; 321 (21) 2131-2133
- 3 Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75 (01) 51-61
- 4 Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?. Clin Interv Aging 2019; 14: 701-719
- 5 Ganz DA, Latham NK. Prevention of falls in community-dwelling older adults. N Engl J Med 2020; 382 (08) 734-743
- 6 Sherrington C, Fairhall N, Wallbank G. et al. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med 2020; 54 (15) 885-891
- 7 Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018; 319 (16) 1705-1716
- 8 National Center for Health Statistics. Percentage of having a wellness visit in the past 12 months for adults aged 18 and over, United States, 2019–2022. National Health Interview Survey. Updated October 02, 2023. Accessed Oct 02, 2023. https://wwwn.cdc.gov/NHISDataQueryTool/SHS_adult/index.html
- 9 STEADI-Older Adult Fall Prevention. Centers for Disease Control and Prevention; 2021 Jul. Updated April 13, 2023. Accessed October 02, 2023. https://www.cdc.gov/steadi/index.html
- 10 Jones TS, Ghosh TS, Horn K, Smith J, Vogt RL. Primary care physicians perceptions and practices regarding fall prevention in adult's 65 years and over. Accid Anal Prev 2011; 43 (05) 1605-1609
- 11 McInnes E, Askie L. Evidence review on older people's views and experiences of falls prevention strategies. Worldviews Evid Based Nurs 2004; 1 (01) 20-37
- 12 Dickinson A, Machen I, Horton K, Jain D, Maddex T, Cove J. Fall prevention in the community: what older people say they need. Br J Community Nurs 2011; 16 (04) 174-180
- 13 Arkkukangas M. Keep on and keep up the fall prevention work: older adults need evidence-based fall prevention actions now more than ever. Eur J Physiother 2021; 23 (01) 1-2
- 14 Rowland SP, Fitzgerald JE, Holme T, Powell J, McGregor A. What is the clinical value of mHealth for patients?. NPJ Digit Med 2020; 3: 4
- 15 McGarrigle L, Boulton E, Todd C. Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises. BMC Geriatr 2020; 20 (01) 483
- 16 Hawley-Hague H, Tacconi C, Mellone S. et al. Smartphone apps to support falls rehabilitation exercise: app development and usability and acceptability study. JMIR Mhealth Uhealth 2020; 8 (09) e15460
- 17 Delbaere K, Valenzuela T, Lord SR. et al. E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ 2021; 373 (740) n740
- 18 Stanmore E. Developing, testing, and implementing a falls prevention and healthy aging app (keep-on-keep-up) for older adults. Innov Aging 2021; 5 (01) 514
- 19 Erfani S, Erfani SM, Ramin K. A Smartphone Health Application To Facilitate Falls Prevention Practices For Older Adults. Paper presented at: 27th European Conference on Information Systems (ECIS); June 8–14, 2019; Stockholm & Uppsala, Sweden
- 20 Rice H, Garabedian PM, Shear K. et al. Clinical decision support for fall prevention: defining end-user needs. Appl Clin Inform 2022; 13 (03) 647-655
- 21 Yang Y, Wang K, Liu H. et al. The impact of Otago exercise programme on the prevention of falls in older adult: a systematic review. Front Public Health 2022; 10: 953593
- 22 International Organization for Standardization (ISO). Ergonomics of human-system interaction—Part 210: human-centered design for interactive systems. Published July 2019. Accessed October 2, 2023. https://www.iso.org/standard/77520.html
- 23 Melles M, Albayrak A, Goossens R. Innovating health care: key characteristics of human-centered design. Int J Qual Health Care 2021; 33 (Supplement_1): 37-44
- 24 Toni E, Pirnejad H, Makhdoomi K, Mivefroshan A, Niazkhani Z. Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease. BMC Med Inform Decis Mak 2021; 21 (01) 329
- 25 Brunner J, Chuang E, Goldzweig C, Cain CL, Sugar C, Yano EM. User-centered design to improve clinical decision support in primary care. Int J Med Inform 2017; 104: 56-64
- 26 Garabedian PM, Gannon MP, Aaron S, Wu E, Burns Z, Samal L. Human-centered design of clinical decision support for management of hypertension with chronic kidney disease. BMC Med Inform Decis Mak 2022; 22 (01) 217
- 27 Burns ER, Kakara R, Moreland B. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 4th ed. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Atlanta, GA: 2022
- 28 Casey CM, Parker EM, Winkler G, Liu X, Lambert GH, Eckstrom E. Lessons learned from implementing CDC's STEADI falls prevention algorithm in primary care. Gerontologist 2017; 57 (04) 787-796
- 29 Kuniavsky M. Observing the user experience: a practitioner's guide to user research. Elsevier; 2003
- 30 Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research. 5th Ed.. Sage Publications; 2014: 280
- 31 van Leeuwen D, Mittelman M, Fabian L, Lomotan EA. Nothing for me or about me, without me: codesign of clinical decision support. Appl Clin Inform 2022; 13 (03) 641-646
- 32 Faulkner L. Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput 2003; 35 (03) 379-383
- 33 Schnall R, Cho H, Liu J. Health Information Technology Usability Evaluation Scale (Health-ITUES) for usability assessment of mobile health technology: validation study. JMIR Mhealth Uhealth 2018; 6 (01) e4
- 34 Yen PY, Sousa KH, Bakken S. Examining construct and predictive validity of the Health-IT usability evaluation scale: confirmatory factor analysis and structural equation modeling results. J Am Med Inform Assoc 2014; 21 (e2): e241-e248
- 35 Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011; 59 (01) 148-157
- 36 Nevedal AL, Reardon CM, Opra Widerquist MA. et al. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci 2021; 16 (01) 67
- 37 Holdsworth LM, Safaeinili N, Winget M. et al. Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU. Implement Sci 2020; 15 (01) 12
- 38 Glasgow RE, Chambers D. Developing robust, sustainable, implementation systems using rigorous, rapid and relevant science. Clin Transl Sci 2012; 5 (01) 48-55
- 39 Yang Y, Boulton E, Todd C. Measurement of adherence to mHealth physical activity interventions and exploration of the factors that affect the adherence: scoping review and proposed framework. J Med Internet Res 2022; 24 (06) e30817
- 40 Sun RT, Han W, Chang HL, Shaw MJ. Motivating adherence to exercise plans through a personalized mobile health app: enhanced action design research approach. JMIR Mhealth Uhealth 2021; 9 (06) e19941
- 41 Tejeda CJ, Garabedian PM, Rice H. et al. Development and usability testing of an exercise-based primary care fall prevention clinical decision support tool. . AMIA Annu Symp Proc 2023