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

Background:
Maintaining a healthy lifestyle is important for wheelchair users’ wellbeing, as it can have a major impact on their daily functioning. Mobile health (mHealth) applications can support a healthy lifestyle, however, are not suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth application (called WHEELS) was developed, to promote a healthy lifestyle.

Objective:
The objective of this paper was to describe the development of the WHEELS mHealth application and explore its usability, feasibility and effectiveness.

Methods:
The WHEELS application 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 application which was pre-tested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pilot study was performed to explore usability, feasibility and effectiveness of the application. Semi-structured interviews were thematically analyzed and questionnaires (System Usability Score [SUS] and Usefulness, Satisfaction, and Ease [USE]) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pitssburgh Sleep Quality Index [PSQI]), body composition and other secondary outcomes, pre and post intervention.

Results:
Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep and relaxation behavior of wheelchair users. Of the 21 participants included in the pilot study, fourteen participants completed the post measurements. The interviews and questionnaires showed a varied user experience. Participants scored 58.6 ± 25.2 on the SUS questionnaire and 5.4 ± 3.1 on ease of use, 5.2 ± 3.1 on satisfaction and 5.9 ± 3.7 on ease of learning. Positive developments in body composition were found on waist circumference (P = .015), fat mass percentage (P = .004) and fat free mass percentage (P = .004). Positive trends were found in body mass (P = .091), body mass index (P = .073), daily grams of fat consumed (P = .074) and sleep quality score (P = .063).

Conclusions:
The WHEELS mHealth application was successfully developed. The interview outcomes and usability scores are reasonable. Although, there is room for improvement, the current application showed promising results and seems feasible to deploy on a larger scale.