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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.

Feedback from digital technology has often been used to support people in changing undesired, unhealthy habits. As yet, there has been little research into the efficacy of these designs. In my PhD project, I evaluated the acceptance, sustained use, and effect of four designs that provide feedback on undesired habitual behaviour through digital technology. Findings are that the disruptive effect of feedback on undesired habits has been proven, and there is some evidence that feedback may have a lasting effect on behavioural change. (Sustained) use of digital designs that provide feedback is moderated by motivation, age, goal-related aspects, and user experience. The necessity of high motivation to use a device poses challenges for the acceptance of and sustained engagement with designs for behaviour change that rely on feedback. Further challenges concern privacy and the quality of the evaluations of our designs.

Habitual behavior is often hard to change because of a lack of self-monitoring skills. Digital technologies offer an unprecedented chance to facilitate self-monitoring by delivering feedback on undesired habitual behavior. This review analyzed the results of 72 studies in which feedback from digital technology attempted to disrupt and change undesired habits. A vast majority of these studies found that feedback through digital technology is an effective way to disrupt habits, regardless of target behavior or feedback technology used.Unfortunately, methodological issues limit our confidence in the findings of all but 14 of the 50 studies with quantitative measurements in this review. Furthermore, only 4 studies tested for (and only 3 of those 4 found) sustained habit change, and it remains unclear how feedback from digital technology is moderated by receiver states and traits, as well as feedback characteristics such as feedback sign, comparison, tailoring, modality, frequency, timing and duration. We conclude with recommendations for new research directions. Feedback through digital technology can disrupt undesirable habits.However, it remains unclear whether this disruption leads to durable habit change.The effect of feedback characteristics and user states and traits remain understudied.Findings from this review can be used to inform the development of feedback-based products.