Using Co-design Methods to Develop an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Pre-Teen Girls of Low Socioeconomic Position (Preprint)

Abstract

Pre-teen girls of lower socio-economic position are at increased risk of physical inactivity. Parental support, particularly mothers, is positively correlated with girls’ physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people’s physical activity. However, the effects of these interventions on girls’ physical activity are often inconsistent, with calls for more rigorous, theory-informed and co-designed family-based interventions to promote physical activity in this cohort.

Therefore, the aim of this study was to use co-design methods to develop an evidence and theory-informed mother daughter mHealth intervention prototype targeting physical activity in pre-teen girls.

The intervention prototype was developed in accordance with the UK Medical Research Council framework, the Behaviour Change Wheel (BCW), the Theoretical Domains Framework (TDF), and the Behaviour Change Techniques Ontology (BCTO). The Behaviour Change Intervention Ontology (BCIO) was also used to annotate the intervention characteristics. The co-design process incorporated three phases, (i) behavioral analysis, (ii) the selection of intervention components, and (iii) refinement of the intervention prototype. Across these phases, there were workshops with pre-teen girls (n = 10); mothers of pre-teen girls (n = 9), and primary school teachers (n = 6), with further input from an expert advisory group.

This three-phase co-design process resulted in the development of a theory-informed intervention which targeted two behaviors, (i) mothers’ engagement in a range of supportive behaviors for their daughters’ physical activity, and (ii) daughters’ physical activity behaviour. Formative research identified eleven theoretical domains to be targeted as part of the intervention (e.g., knowledge, skills, and beliefs about capabilities). These were to be targeted by six intervention functions (e.g., education, persuasion, modelling), and 27 behaviour change techniques (e.g., goal setting, self-monitoring). The co-design process resulted in a mobile application being chosen as the mode of delivery for the intervention.

This paper offers a rich description and analysis of using co-design methods to develop a mother-daughter mHealth intervention prototype that is ready for feasibility and acceptability testing. The BCW/TDF and BCTO provided a robust and transparent theoretical foundation on which to develop the prototype, by enabling the identification of potential pathways for behaviour change. Annotating the BCIO entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication and implementation of interventions.