We approached our app development with a desire to look at both evidenced-based interventions,and a strong theoretical grounding. The elements of current health behavior and communication theories and framework such as social cognitive theory,health behavior change,and elaboration likelihood provided us with a strong theoretical background for many of the behavioral elements functionality and aspects of the Healthy Survivorship Act,including the assessment,the daily tips,and the provision of health education materials.
As we were developing this app,we really became aware that the current se tof theories don't quite support some of the behavioral aspects of the app design.
Mobile health or M-health as I'll refer to it,includes a range of functionalities and capabilities that didn't really exist when any of our theories were being developed. Functions like, individual tailoring,ecological momentary involvement,that means that they've got their phone in their hands,and their getting messages and acting on the min the moment, tailors feedback in their own time and sensitive interactive and adaptive aspects of mobile-enabled health behavior tools,suggest that there may be need for new theoretical paradigms,that our current set just aren't quite up to the task. That said, we did look at a lot of interventions and researching M-health from other chronic disease areas including cancer,asthma and diabetes.
Our development process is what I would consider extremely iterative. The initial funding for the project came as a grant from the Texas A&M School of Public Health, TTX cares,which is a CDC cancer prevention and control network project. The CTX cares PI, principal investigator The Dr. provided the funding, and was absolutely vital to the development of the project all the way along. We were able to leverage the initial 40K,40,000 with an additional 2,000in marketing funds from a health care facility grant for AYA professional and public education. Our technology decision to use IOS platform was based partially on the budget amount. We didn't have the funds to do both an iPhone and an Android app.
We knew we wanted to reach the largest possible audience. So this was two years ago,and at that point in time there were more iPhone apps than there were Android apps. Actually, that continues to be the place, the situation. We also wanted to make sure that some of our applications;our functionality was available to a broader audience at times when they might not have their phone. So we developed what we call a hybrid approach to native phone app. Native means that the application is native or lives on the phone,and most of the activities occur on the phone. We mixed it with a responsive Web site.
Responsive in a Web site means that the Web site can be seen and used by both mobile devices,using mobile browser,or a desktop or laptop. What the responsive Web site does is it actually tailors the size of the image to the device that you're using.
Most importantly we leveraged the professional and advocate and survivor AYA support groups from our grant,and they provided us guidance and insight into the design,and helped us as we developed our requirements and our use cases for the project. Our health care professionals included nationally recognized AYA cancer researchers and oncologists. Our advocates included AYA survivors and cancer advocates from groups like Live strong, Critical Mass, Komen,and I'm Too Young For This. I really cannot say enough about the value and the insights from these advisory groups in the development of the app.
So this is a screen shot of the Web site,healthy survivorship dot org. Dr. Ross Glasgow recently of NCI and now with the University of Colorado,I think considers projects like this as pragmatic research. We wanted to be able to quickly test whether and if cancer survivors were interested in using health behavior change apps. We wanted to explore how best to engage diverse groups of researchers, advocates, oncologists and technology professors in the creation of the app. Pragmatic research by its nature implies trade-offs, so you learn that some things--you learn some things,you can gather some data,some metrics, but it's notl ike a randomized and controlled trial.
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