A Development and Evaluation Process for mHealth Interventions: Examples From New Zealand

Abstract

The authors established a process for the development and testing of mobile phone-based health interventions that has been implemented in several mHealth interventions developed in New Zealand. This process involves a series of steps: conceptualization, formative research to inform the development, pretesting content, pilot study, pragmatic randomized controlled trial, and further qualitative research to inform improvement or implementation. Several themes underlie the entire process, including the integrity of the underlying behavior change theory, allowing for improvements on the basis of participant feedback, and a focus on implementation from the start. The strengths of this process are the involvement of the target audience in the development stages and the use of rigorous research methods to determine effectiveness. The limitations include the time required and potentially a less formalized and randomized approach than some other processes. This article aims to describe the steps and themes in the mHealth development process, using the examples of a mobile phone video messaging smoking cessation intervention and a mobile phone multimedia messaging depression prevention intervention, to stimulate discussion on these and other potential methods.

Acknowledgments

The authors acknowledge the investigators on the three mHealth intervention trials: A. Rodgers, R. B. Lin, M. Wills, M. Jones, T. Corbett, D. Bramley, T. Riddell, C. Bullen, H. McRobbie, S. Denny, V. Parag, P. Salmon, H. McDowell, I. Doherty, K. Stasiak, M. Shepherd, and S. Ameratunga. The authors also acknowledge the many others who were involved in the development process, including R. Smith, P. Wilson, M. Ellis Pegler, J. van Rooyen, J. Strydom, S. Chua, P. Chao, The Hyperfactory, V. Gaitan, G. Burt, D. Taylor, and the staff at the Clinical Trials Research Unit. The authors acknowledge the funders of these projects: the Health Research Council of New Zealand, Oakley Mental Health Foundation, University of Auckland, Digital Strategy Community Partnership Fund, Vodafone New Zealand Ltd, Auckland UniServices Ltd, National Heart Foundation, Cancer Society of New Zealand, Alcatel.

Notes

Note. RCT = randomized controlled trial. RR = relative risk.

¹Described in Bramley et al., 2005; Free, 2009; Free, in press; Rodgers et al., 2005.

²Maori are the indigenous population of New Zealand.

³Described in Whittaker et al., 2008; Whittaker et al., 2011.

⁴Described in Whittaker et al., 2012.