# Designing a Case Management Mobile Health App for Violence Intervention Programs: Mixed Methods Human-Centered Design Study

## TL;DR

A mobile app was designed to help violence prevention professionals better support survivors through human-centered design methods.

## Contribution

A novel mHealth app tailored for violence intervention programs was developed using participatory design and iterative testing with VPPs.

## Key findings

- Nine VPPs identified key themes like trust, personal connection, and tailored resources during design phases.
- RITE testing resolved 133 of 181 issues, achieving a 73% impact ratio in usability improvements.
- The final app evolved from 3 low-fidelity to 25 high-fidelity designs based on iterative feedback.

## Abstract

Hospital-based violence intervention programs have shown promise in mitigating the effects of violence, but their impact is limited by time constraints and inefficient practices faced by the violence prevention professionals (VPPs) who function as case managers. Mobile health (mHealth) apps offer the potential to enhance communication and service delivery between VPPs and clients, but few have been specifically designed for vulnerable populations.

This study aims to design an mHealth app to improve communication and access to resources between survivors of violence and their VPPs using human-centered design (HCD) and iterative prototyping methods.

HCD methodology was used, including rounds of Participatory Design, Low-fidelity Prototype Testing, and High-fidelity Prototype Testing. The Participatory Design phase included in-depth interviews and co-design, followed by inductive qualitative analysis to inform the mHealth app’s initial low-fidelity design. The Low-fidelity Prototype Testing phase included in-depth interviews with probing questions about the low-fidelity design, followed by inductive qualitative analysis to inform the mHealth app’s initial high-fidelity design. The High-fidelity Prototype Testing phase used the Rapid Iterative Testing and Evaluation (RITE) method and inductive qualitative analysis to rapidly collect and integrate VPP feedback into the mHealth app’s final design approved for implementation.

Nine VPPs participated in 3 rounds of testing and feedback. Participatory Design identified four key themes: (1) trust, (2) personal connection, (3) tailored resource curation, and (4) management of administrative burdens. Low-fidelity Prototype Testing identified three additional key themes: (5) intuitive and comprehensive design, (6) dynamic journey and sense of progress, and (7) standardization of verbiage and design choices. High-fidelity Prototype Testing through RITE identified 181 actionable issues, with 133 addressed, achieving a 73% impact ratio (used to measure the effectiveness of usability improvements). High-fidelity Prototype Testing identified 9 key themes, reaffirming 5 themes from prior testing sessions (themes 2, 3, 5, 6, and 7) and uncovering four novel themes: (8) control over boundaries, (9) celebration of client successes, (10) client empowerment, and (11) warm handoff. The final mHealth app version adapted from 3 low-fidelity digital representations (wireframes) to 25 high-fidelity wireframes of a mHealth app to support case management.

The combination of HCD and RITE methodologies resulted in an mHealth app tailored to the needs of VPPs working with survivors of violence. This approach may be transferable to the development of other mHealth apps for specialized populations, although further research with larger samples would be needed to establish generalizability.