Integrating top-down and bottom-up requirements in eHealth development: A case study of a mobile self-compassion intervention for people with newly diagnosed cancer (Preprint)

BACKGROUND Psychosocial eHealth interventions for people with cancer are promising in reducing distress, however their results in terms of effects and rates of adherence are quite mixed. To overcome this, developing interventions with a solid evidence base is recommended, while still ensuring adaptation to user wishes and needs. Since most models of eHealth development are based on examining user experiences only (bottom-up requirements), it is not clear how theory and evidence (top-down requirements) may best be integrated into this process. OBJECTIVE To investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications, by building on a case study of the development of a mobile self-compassion intervention for newly diagnosed cancer patients. METHODS Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: 1) explore bottom-up experiences, 2) reassess top-down content, 3) incorporate bottom-up and top-down into concrete features and design, 4) synergize bottom-up and top-down into intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 patients and 7 nurses (recruited via 2 hospitals) participated. Based on these sessions, a list of requirements, a final intervention design and an evaluation of the co-design tasks was yielded. RESULTS The final list of requirements included intervention content (e.g. main topics of Compassionate Mind Training such as psycho-education about three emotion systems, main issues that patients encounter post-diagnosis such as regulating information consumption), navigation, visual design, implementation strategies and persuasive elements. The final intervention ‘Compas-Y’ is a mobile self-compassion training that consists of six training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The four co-design tasks helped to overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements, and enabled the integration of all main requirements into the design. CONCLUSIONS Our study addresses the necessary integration of top-down and bottom-up requirements into eHealth development, by examining a preliminary model of four co-design tasks. Broader considerations regarding designing a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed.