This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete bibliographic information, a link to the original publication on https://pediatrics.jmir.org, as well as this copyright and license information must be included.
The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children’s Hospital.
This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs.
Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively.
In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change.
Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app.
In Canada, the number of children with obesity has more than doubled over the past 40 years [
Childhood represents a desirable time for chronic disease prevention interventions focused on regular monitoring of height and weight and healthy behavior counseling [
Mobile health use has experienced exponential growth over the years. The penetration rate (percentage of active users over the total number of potential users in the target market) of the Canadian mobile health market was 46.5% in 2021 and is expected to reach >53.7% by 2026 [
The use of participatory research methods, which involves direct collaboration between researchers and end users in a process of cocreation [
The Live 5-2-1-0 initiative works with community partners to create healthy environments for children via its message of consuming at least 5 servings of vegetables and fruits, engaging in <2 hours of recreational screen time, participating in at least 1 hour of active play, and drinking 0 sugary drinks per day [
In this paper, we described our approach to co-designing, with children, parents, and HCPs, the Live 5-2-1-0 mobile app (hereinafter referred to as
This study was approved by the University of BC and Children’s and Women’s Health Centre of BC Research Ethics Board (H18-00700; SA; August 16, 2018).
This study was conducted and reported using the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines [
The child and parent participants received a CAD $50 (US $37.35) gift card for their time and to offset the costs of participating; HCPs received a CAD $5 (US $3.73) Starbucks gift card.
Children aged 8 to 12 years and their parents were recruited via posters at BCCH, advertisements in a patient newsletter (Sunny Hill Connect), and announcements posted on BCCH and Live 5-2-1-0 social media channels (Facebook and Twitter). Recruitment material included the names of the principal investigators, eligibility criteria for participants, and a brief description of the goal of the research team to develop an app that supports healthy living habits. Interested participants contacted a research assistant via phone or email to receive additional study information and provide informed consent in writing. The eligibility criteria were (1) ability to read, speak, and understand English and (2) willingness to attend at least one FG session. A maximum of 1 child and 1 parent per family could participate. Participants with severe intellectual difficulties were excluded. BMI or other weight-related characteristics of children and parent participants were not part of the inclusion criteria as the aim of the study was to develop an app that could serve as a tool in primary prevention of childhood obesity and would apply to all children regardless of BMI. HCPs within the University of BC Department of Pediatrics at BCCH were invited to participate via an email containing study information and contact information for the research assistant. Given that the Live 5-2-1-0 initiative is multisectoral and cross-disciplinary, the representation of physicians and medical trainees, nursing staff, and allied health professionals was sought to capture a wide range of clinician perspectives in the app’s design.
Children and parents completed a sociodemographic questionnaire that included age, gender, and ethnic background of both the child and parent, as well as parents’ marital status, educational level, and annual household income. Parents completed an adapted version of the Healthy Habits Questionnaire (
A schematic outlining the sequence of research activities can be found in
Schematic of research activities for Live 5-2-1-0 app development.
The first FG (FG 1) aimed to inform the app’s conceptualization and consisted of separate child and adult (parents and HCPs) sessions. In total, 8 parents and 3 HCPs (2 dieticians and 1 physician) participated in the adult session, and 9 children participated in the child session. In the adult session (FG 1A), participants discussed the challenges in ensuring the adoption of healthy habits by their children, followed by an app feature prioritization activity. The children’s session (FG 1B) began with a discussion on their digital device and app use, followed by a drawing activity on how mobile devices played a role in their typical day. Facilitators then led a discussion where children reflected on what being healthy meant for them and their motivators for adopting healthy behaviors.
In total, 8 members of the research team, 1 health technology consultant, and 3 members of the app development team participated in an ideation session to generate insights from the qualitative data obtained from FG 1 and identify design opportunities. Participants were guided through three HCD inspiration rounds for themes uncovered in FG 1: (1) family habit tracking and accountability; (2) behavior change techniques; and (3) family, child, and HCP collaboration. Each round began with “How Might We” questions, an HCD technique where challenges are framed as questions to prompt innovative solutions [
Key themes that emerged from FG 1 and the ideation session were presented in the second set of FGs (FG 2). Separate sessions were held for families and HCPs 1 week after the ideation session. In total, 7 parents and 6 children participated in the family cocreation session (FG 2A), of whom 71% (5/7) of the parents and 67% (4/6) of the children had previously participated in FG 1. Parents and children were presented with wireframes (design layouts of requested features) and asked to rank features and daily challenge completion reward ideas by applying stickers that represented different ratings on printed wireframes. The HCP session (FG 2B) was attended by 15 HCPs from BCCH and facilitated by the health technology consultant. It aimed to gather feedback on questions that would help HCPs understand the baseline health behaviors of their patients, the design of the HCP dashboard wireframe, and the structure of the in-app daily challenges.
Agile development refers to the process of developing software that addresses stakeholders’ desires through short iterative cycles [
FG 3 was cofacilitated by the app development and research teams. A total of 11 parents and 14 children participated in FG 3. In total, 82% (9/11) of the parents and 77% (10/13) of the children had participated in at least one of the previous FGs. Each parent and child pair, or child only when a parent was not present, was given an iPad preloaded with the app prototype and asked to provide feedback on the prototype’s usability and content by completing and rating the difficulty of 5 tasks on a scale of 1 (very difficult) to 7 (very easy). FG facilitators minimized the guidance they provided on how to use the app to allow participants to independently explore the prototype. Next, participants were asked to brainstorm reward ideas as part of the app’s gamification feature and rate a list of predefined rewards generated by the research team. The FG ended with a brainstorming session of daily challenges and the categorization of these challenges into different levels of difficulty.
Descriptive statistics (means and SDs for continuous variables, counts and percentages for categorical variables, and medians and IQRs for ordinal variables) were generated to describe the sociodemographic characteristics of the participants, ease in completing tasks using the prototype, and ratings of rewards and daily challenges. Quantitative data were analyzed using SPSS (version 25.0; IBM Corp).
FG sessions were audio recorded and transcribed verbatim by KWY and reviewed by SK to ensure transcription accuracy. Transcripts were not returned to participants for comments or corrections given that our sessions were group sessions and not individual interviews. KWY and SP independently conducted a thematic analysis of all transcripts using NVivo (QSR International). Following the immersion-crystallization framework [
Most children (n=14; mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White participants) and parents (n=12; 9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White) participated in at least 1 of 3 FGs. The Live 5-2-1-0 behaviors of the FG child participants are summarized in
Live 5-2-1-0 behaviors of focus group child participants (n=14).
Live 5-2-1-0 behaviors | Values, median (IQR) |
Servings of fruits and vegetables per daya | 3.5 (2-6) |
Hours of screen time per day (excluding time for schoolwork) | 1 (1-2) |
Days per week physically active for at least 1 hour (n=13) | 5 (3-6) |
Cups of sugary drinks per day | 0.5 (0-1) |
a1 serving=half a cup.
Coding categories and themes that emerged from FG 1 are illustrated in
Concept map outlining themes that emerged from focus group 1 (app conceptualization). HCP: health care provider.
Parents described their children’s tendency to gravitate toward choices that were meaningful to them and that the empowerment of the child would lead to the establishment of long-term habits. Children’s self-discovery of health knowledge was thought to result in better adherence rather than a top-down approach in which parents instructed their children on what to do:
When kids feel empowered that they are making the decision...instead of being directive as parents, we would be non-directive and...coach them.
Both parents and HCPs agreed that an app that facilitates shared decision-making between children and parents would empower children to become actively involved in making healthy behavior changes. The importance of personal awareness was reflected in the child session, during which guilt was often discussed in association with knowledge of the optimal amount of screen time. Children expressed that guilt from excessive amounts of screen time discouraged them from playing with their electronic devices even when they had not exceeded their daily screen time limit. Education and awareness of the consequences of their actions played a role in their decision-making related to healthy behaviors:
I saw [a] fact on my agenda. It said if you play [on your device] four hours a day, it’s good to get out sometimes, so limit your time [to] two hours.
According to HCPs, and confirmed by children, children are more willing to engage with an app if it requires them to complete tasks cooperatively with or competing against their peers. Parents commented that children tended to gain awareness of healthy behaviors from their peers, which was far more effective than parental directives or encouragement. HCPs commented that, once children take ownership of their own health, they tend to develop a sense of responsibility for their family, and it may encourage them to adopt healthy behavior changes together. The sense of accountability and responsibility can also transform into a source of motivation:
Making it as a family activity that’s like “you need the physical activity but your parents also need it,” so going together and then doing some physical activity...making them (children) responsible for [their] parents’ health.
Parents believed that a blog or group chat for sharing healthy behavior tips would encourage children to mutually support each other as they make healthy behavior changes. However, both parents and HCPs agreed that any communication tool should be regulated by a moderator to ensure the accuracy and appropriateness of the information presented. Children identified connectivity with peers (ie, using digital messaging applications and social media platforms to communicate with their peers about play and engage in competition) and customizability (progressing through increasing levels of difficulty and selecting different modes of play) as key features they desired for the Live-5-2-1-0 app.
Parents and HCPs were supportive of the idea of the app tracking children’s daily Live 5-2-1-0 behaviors as the data collected could be summarized in a visual interface for the user to view their progress, which in turn could be a source of motivation. It could also be used by HCPs during clinical encounters to become aware of their patients’ progress since their last visit:
A graph when they come to see us...a snapshot picture...my physical activity is going up...going down. It...motivates them, they’re on the right track.
HCPs also explained how the availability of tracking data would serve as a conversation starter and enable them to further investigate the facilitators and barriers faced by the child. This would allow HCPs to build stronger relationships with children, who identified HCPs as individuals of authority and would be more likely to comply with their recommendations to improve their health behaviors.
A key discussion point during the ideation session was to identify ways for the app to facilitate collaborative decision-making, goal setting, and Live 5-2-1-0 behavior tracking among children, parents, and HCPs. A summary visual of the user’s progress was proposed to motivate users and guide HCPs in behavioral counseling. However, it was noted that the user may view the visual summary as discouraging if it reflects minimal progress. To address this, the idea of allowing for progressive changes in goal setting was proposed. For goal setting and progress data to be meaningful and comprehensible, it was agreed that the visual interface and user experience design had to be tailored to each stakeholder (child, parent, and HCP) while ensuring that the metrics were identical between different stakeholders.
Adaptive goals that were customizable based on the user’s preference and reflected progress in the behavior change journey were identified as essential. A suggestion was to include a baseline health assessment that would allow children, parents, and HCPs to set goals collaboratively based on current behavior and readiness to change via the app. Even though users may not choose to act on these behaviors immediately, it is still valuable for them to become aware of what behaviors can be improved upon. However, users should be able to choose which behavior to focus on regardless of the recommendations that arise from the baseline assessment. Finally, the choice to select “small steps” (daily challenges) toward achieving the Live 5-2-1-0 goals was proposed, addressing children’s desire for an app that allows for progression and choice of difficulty level.
Children suggested a progress bar for visualizing their healthy behavior change journey and progression through increasing levels of difficulty for their small steps to be completed toward achieving a health behavior goal. To do this, the decision was that users initially had to complete easier small steps before being allowed to attempt more difficult small steps toward their goal. In addition, given parents’ belief that intrinsic rewards are more likely to lead to sustained healthy behavior change, the inclusion of a mix of intrinsic and extrinsic rewards within the app was discussed. Intrinsic rewards may include creating an avatar of the user and their home and earning badges that recognize progress. Ideas proposed for external rewards included those that further encourage healthy behaviors; could easily be provided by parents; and promote family engagement, such as going to the local swimming pool, visiting a new playground, or going to a local park. To address parents’ desire for customizable external rewards, the option to manually enter a reward of their choice was suggested.
Information gathered in the app conceptualization FGs and the ideation session was used to create a pilot journey map (
Journey map presented to participants in focus group 2A (cocreation—family session). HCP: health care provider.
Coding categories and themes that emerged from FG 2 are illustrated in
Concept map outlining themes that emerged from focus group 2 (cocreation).
Completing challenges as a family on a weekly basis appealed to children and parents, with children indicating parental involvement as a key motivator for app use. Participants were enthusiastic about the idea of keeping participating family members accountable by having everyone set their own goals via individual user accounts but being able to achieve the family challenge only if everyone completed their respective individual goals:
Let’s say you all have the app...one of you would do five fruits, one does two hours of TV, one does one hour activity, and another does no sugary drinks...if one doesn’t do it...they all do not get a reward...all eyes are on each other.
Parents suggested that family challenges could be designated as rewards for children upon goal completion, such as a family bicycle ride or going on a camping trip.
Parents and children both pointed to the importance of novelty in promoting user retention and were supportive of a notification system that would remind users to record their daily challenge progress in the app. Suggestions for triggers included varied durations for goal completion and surprise rewards rather than user-selected rewards. Finally, an app that is regularly updated with new content and features was a suggested strategy to decrease attrition rates. Parents suggested the option for users to begin with an easier level to identify which of the 4 healthy behaviors to address before launching the rest of the app. Children added that rewards should be unlocked progressively such that users who achieve more difficult challenges would be awarded greater rewards.
Participants stated that the ability to personalize app content and customize settings within app features would enhance their experience. Parents stressed the importance of commitment to follow through with rewards and stressed that the option for parents to input their own reward ideas was essential:
Maybe going to a local lake...if there’s a movie your family really wants to see...you can customize to what’s happening to your life at that time.
The ability to customize the time and frequency of notification reminders for completing daily challenges was identified as a desired feature. Participants believed that reminders that could be customized to be sent at an ideal time and frequency would increase the chance that users would complete daily challenges and log their progress in the app. Discussion regarding rewards included in-app features that could themselves serve as rewards. Suggestions included badges and celebratory animations that are shown in the app when users accomplish a goal:
It (the badge) could have a picture of what you did and then it could have like rainbows and sparks coming out of it.
HCPs were enthusiastic about the app’s potential to support patient-centered care and shared decision-making with families. HCPs shared that, although collecting metrics and following the medical model of care are important, patient communication about their health priorities is also crucial to ensure patient- and family-centered care where HCPs are meeting the patient where they are at:
I’ve got my checklist of stuff that I want to get from my patient...the flipside of it is to help patients communicate what they want [us] to help them with, so that we can actually address their goals, not so much our goals.
HCPs believed that a visual summary of the user’s progress would allow them to easily pinpoint areas of opportunity and concern to address during clinical encounters. An app feature that provides users with the opportunity to input reasons for not completing a daily challenge was deemed to be useful for HCPs to identify barriers to successful goal completion. Given that users may not have the opportunity to visit an HCP frequently, participants agreed that the app should have educational content that parents can review with their children for extra support. The inclusion of a flagging system that would directly alert HCPs if users faced challenges with completing their goals was suggested.
HCPs stressed the importance for the app to be able to capture the child’s readiness to make changes in addition to their healthy behavior status. Specifically, HCPs called for capturing the child’s emotional feelings toward each healthy behavior and believed that children would be more likely to make changes if they felt positive toward the behavior and were motivated internally. Suggestions for facilitating this included allowing users to indicate how they feel (using child-friendly graphics such as emojis) related to the progress of their chosen goal and choose their own avatars with the option to customize their facial expressions to reflect their feelings on their goal progress.
On the basis of the feedback collected in the FGs and after rounds of iterative development, a prototype of the Live 5-2-1-0 app was created, which included seven main features: (1) a Healthy Habits Questionnaire to support a baseline assessment at the time of onboarding, (2) goal setting, (3) tiny steps (daily challenges), (4) rewards, (5) gamification, (6) daily notifications, and (7) a progress dashboard. During the FG, parent-child dyads were asked to complete five assigned tasks using the prototype, which included (1) completing the baseline assessment; (2) selecting a behavior to work on, a reward, and a tiny step; (3) responding to a daily notification for their current tiny step and reporting progress; (4) completing a further tiny step and receiving a reward for completing their goal; and (5) reviewing goal progress and changing their behavior goal. Families reported ease in completing the 5 assigned tasks, with a median score of 7 (IQR 6-7; range 2-7) on a 7-point Likert scale, where a score of 1 represented “very difficult” and 7 represented “very easy” (
Median scores for prototype testing during focus group 3 (user testing) on a 7-point rating scale (1=very difficult; 7=very easy).
Task | Values, median (IQR) |
Complete baseline assessment | 7 (6-7) |
Select a behavior to work on, a reward, and a tiny step | 6 (6-7) |
Respond to a daily notification for your current tiny step | 6 (5-7) |
Complete a tiny step and receive a reward for completing your goal | 7 (6-7) |
Review goal progress and change your behavior goal | 6 (6-7) |
Following prototype testing, families shared that they were pleased with the graphics and found the app easy to use overall. Most identified the rewards screen as their favorite but also found it the most challenging to navigate because of difficulty in scrolling through a long list of reward options. Parents also suggested a feature in which custom rewards entered by the user could be saved for future selection. Children desired more animation and sound effects as a reward for completing daily challenges and goals. A total of 64% (7/11) of the regular reward ideas and 81% (21/26) of the family challenge rewards proposed by the research team were “liked” by >50% (8/13, 62%) of the children who completed the scoring task.
After 8 months of app development, the Live 5-2-1-0 app was launched on both the Apple App Store and Google Play Store. The main app features, including the Healthy Habits Questionnaire, goal setting, reward selection, tiny step selection, goal wheel, goal completion, and assessment dashboard, are shown in
Screenshots of various app features. (A) Upon launching the app, users initially complete a Healthy Habits Questionnaire consisting of 8 questions about the user’s current practices for the Live 5-2-1-0 behaviors and readiness to make changes for each. (B) On the basis of the user’s response to the Healthy Habits Questionnaire, the app labels each behavior goal with either a green, yellow, or red tab representing meeting, almost meeting, and not meeting each behavior goal, respectively. The app also highlights a suggested goal for the user. (C) Users select a reward from a drop-down menu or input their own reward. (D) Users select a daily challenge (tiny step) related to their chosen behavior goal. Challenges are categorized into 3 levels of difficulty (easy, medium, and hard). (E) Visualization of the user’s progress toward achieving a goal. Completion of a tiny step earns users points that are used to fill the goal wheel. (F) Users are notified that they have earned their reward after the goal wheel is filled. (G) A visual summary of the user’s assessment response and goal completion progress.
Guided by cocreation and participatory design research principles, we developed a mobile app with features and content that are meaningful and relevant to the behaviors and lifestyles of children. Although other health behavior promotion apps for children have also used iterative design processes [
Several key themes emerged from the qualitative data gathered across the 3 sets of FGs. Children, parents, and HCPs desired an app that facilitated shared decision-making and empowerment of children to become active agents in behavior change. Desired app features that emerged included gamification, goal setting, daily challenges, family-based challenges, and an interface that illustrates behavior change progress. Previous studies describing the development of healthy behavior apps for children have also reported similar features, such as gamification [
A dominant theme that emerged from our research was the need for the app to support shared decision-making when making healthy behavior changes. By combining HCPs’ medical expertise with the children’s goals and preferences, shared decision-making facilitates patient-centered care [
Parents and children identified family connectedness as a key motivator, and children were enthusiastic about the idea of making healthy behavior changes through family challenges. However, results from studies that investigated the effectiveness of childhood obesity prevention and treatment interventions with parental involvement have been mixed [
Child-HCP connectivity, where the assessment dashboard allows users to keep track of their progress and facilitates better communication with their HCPs at clinical visits, was also identified as important and achievable. In an intervention that addressed childhood overweight via the 5-2-1-0 goals and included the use of paper-based goal trackers for children to record their behaviors, youth and parents reported increased self-perceived quality of care and counseling from their HCP, whereas HCPs felt better supported in providing medical evaluations and counseling on healthy behaviors [
Adults and HCPs explained that children would be more likely to adopt healthy behavior changes if the app meaningfully educated them about healthy behaviors. This contradicts evidence from the existing literature claiming that solely providing health knowledge is unlikely to lead to behavior change [
To allow children to act as active agents of their own behavior change, the app was designed such that users could select goals and rewards based on their perceived
A unique element of our study was the inclusion of stakeholders (children, parents, and HCPs) as research partners throughout the entire app development process. Researchers were able to seek input directly from stakeholders, analyze the ideas through a methodological lens, and relay the information to app developers such that the abstract ideas of stakeholders could be transformed into app design requirements that were then integrated into tangible features in the app.
This reflects the strengths of participatory research, including the focus on the everyday lives of stakeholders and the ability to address pressing issues via action and research [
The Live 5-2-1-0 app is one of the few mobile health apps aimed at promoting healthy behavior changes among children that used HCD and engaged stakeholders as collaborators throughout its development. The engagement of HCPs was particularly important to provide insight into how the app could best be incorporated into their clinical workflow to enhance patient care. Our approach, which included FGs and agile app development methodologies, can potentially be applied by others interested in developing a mobile app to support health interventions.
Despite these strengths, our development process also had several limitations, among them the inability to include all features discussed during the FGs owing to limited resources, such as 2-way communication between users and HCPs and remote monitoring of progress by HCPs. To create an app that closely resembled the overall vision of the participants, the research team, with guidance from the app development team, prioritized features that emerged from the FGs before the agile development phase. Although the app’s current version supports neither parental profiles nor multiple accounts, the app encourages parents to participate by including reward options and daily challenges that involve performing an activity with the family. Involving stakeholders in the feature prioritization activity and sprints during agile development would allow for their direct input on decisions regarding feature prioritization and resource allocation. Most participants in FG 3 (user testing; 19/24, 79%) also participated in at least 1 of the 2 previous FGs, which may have led to bias as the features tested were those that participants had suggested previously.
Selection bias from voluntary response sampling could have led to an overrepresentation of participants who were interested in mobile health and highly motivated to respond positively to the app, as well as those with higher socioeconomic status who had the ability to travel and the time to attend the FGs. To address this, we provided reimbursement for transportation and parking to families as well as scheduling FGs in the evenings to minimize conflict with work schedules. Finally, given that our study was conducted before the COVID-19 pandemic and the increasing use of telephone-based and internet-based care and digital health services since then, the perspectives we gathered may not truly reflect current stakeholder needs and desires.
A potential limitation of the app’s feasibility is its low compliance with health behavior tracking. However, previous studies that have investigated the feasibility of mobile health apps for children that were based on self-monitoring have shown promise. For example, a study investigating the feasibility of a handheld computer program with self-monitoring of fruit and vegetable intake and reminder systems to track behaviors among children reported high completion rates for fruit and vegetable goal reminders [
In a broader context, the success of childhood obesity prevention initiatives can also be influenced by socioecological factors surrounding those populations that an initiative aims to have an impact on [
We had initiated a pilot feasibility study in the General Pediatrics Clinic at BCCH intending to collect data to improve the app further, but it was later halted because of the COVID-19 pandemic. Despite this, we still gathered data from our partners at Shapedown BC, a weight management program at BCCH, and based on these data, a second iteration of the app was created. This new iteration includes some of the outstanding features not included in the app’s initial version, including the ability to build 1 weekly goal, input customized goals outside of the 5-2-1-0 habits (eg, mindfulness and sleep), and set the frequency of reminders. Using this new app iteration, another 1-group pretest-posttest quasi-experimental pilot feasibility study will be conducted in Shapedown BC to assess the app’s effectiveness. The results will inform the feasibility of using the app as a tool in behavioral weight management programs and primary care clinics and provide a basis for designing full-scale studies in the future. Concurrently, the app will also remain available to other HCPs at BCCH as an element of the Live 5-2-1-0 HCP Toolkit, with ad hoc feedback also helping inform future iterations.
We described the design and development process of the Live 5-2-1-0 app aimed at promoting healthy behavior change among children. This study demonstrated the feasibility of cocreating a mobile health app prototype with children, parents, and HCPs through participatory action research. Although further work is needed to investigate the effectiveness of the app in promoting health behavior change, our findings may serve as a reference for those who are interested in developing mobile apps that address behavior change in collaboration with stakeholders.
Focus group guiding questions.
Healthy Habits Questionnaire.
Focus group 2 (cocreation) materials.
British Columbia
British Columbia Children’s Hospital
Consolidated Criteria for Reporting Qualitative Research
focus group
human-centered design
health care provider
Research Electronic Data Capture
This study was part of KWY’s master’s thesis [
None declared.