Mobile app (WHEELS) to promote a healthy lifestyle in wheelchair users with spinal cord injury or lower limb amputation: Usability and feasibility study

Dirk Hoevenaars, Jasmijn F.M. Holla*, WHEELS Study Group, Leonie te Loo, Johan M. Koedijker, Sarah Dankers, Han Houdijk, Bart Visser, Thomas W.J. Janssen, Sonja de Groot, Marije Deutekom

*Corresponding author for this work

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Background: Maintaining a healthy lifestyle is important for wheelchair users’ well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale.

Original languageEnglish
Article numbere24909
JournalJMIR Formative Research
Issue number8
Publication statusPublished - Aug 2021

Bibliographical note

Funding Information:
This research is cofinanced by the National Taskforce for Applied Research SIA, part of the Netherlands Organisation for Scientific Research (NWO), under grant RAAK.PUB03.029. The members of the WHEELS Study Group are: LE van den Akker, L Alpay, H Bijwaard, M Deutekom, R Doms, JFM Holla (program coordination): Inholland University of Applied Sciences, Haarlem, The Netherlands.

Publisher Copyright:
©Dirk Hoevenaars, Jasmijn F M Holla, Leonie te Loo, Johan M Koedijker, Sarah Dankers, Han Houdijk, Bart Visser, Thomas W J Janssen, Sonja de Groot, Marije Deutekom, WHEELS Study Group.


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