Mobile Health Intervention Development Principles: Lessons from an Adolescent Cyberbullying Intervention

Mobile health interventions are becoming increasingly popular, yet challenges in developing effective, user-friendly, evidence-based technologyaugmented interventions persist. In this paper, we describe the process of developing an acceptable, evidence-based text messaging program for adolescents experiencing cyberbullying in hopes of addressing some of the challenges encountered by many researchers and developers in this area of intervention development. Participants were 23 adolescents with past-year histories of cybervictimization and online conflict who enrolled in an hour long qualitative interview. Participants were asked to draw from personal experience to provide feedback on intervention content and design. Results focus on the main principles of intervention development for adolescents involved in cyberbullying: listening for the why in interviews, storyboarding to model abstract concepts, and strategies to develop acceptable theory and tone. Design process and final product design are described. The paper closes with final thoughts on the design process of mobile intervention development.

[1]  Justin W. Patchin,et al.  Bullying, Cyberbullying, and Suicide , 2010, Archives of suicide research : official journal of the International Academy for Suicide Research.

[2]  Ellen M. Selkie,et al.  Cyberbullying Prevalence Among US Middle and High School-Aged Adolescents: A Systematic Review and Quality Assessment. , 2016, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[3]  Yulong Gu,et al.  Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process , 2014, JMIR mHealth and uHealth.

[4]  R. Whittaker,et al.  A Multimedia Mobile Phone–Based Youth Smoking Cessation Intervention: Findings From Content Development and Piloting Studies , 2008, Journal of medical Internet research.

[5]  Caroline B R Evans,et al.  The Differential Impacts of Episodic, Chronic, and Cumulative Physical Bullying and Cyberbullying: The Effects of Victimization on the School Experiences, Social Support, and Mental Health of Rural Adolescents , 2014, Violence and Victims.

[6]  Robert W. S. Coulter,et al.  Cyberbullying, school bullying, and psychological distress: a regional census of high school students. , 2012, American journal of public health.

[7]  C. Bottino,et al.  Cyberbullying and adolescent mental health: systematic review , 2015 .

[8]  Gordon Parker,et al.  Therapeutic Alliance With a Fully Automated Mobile Phone and Web-Based Intervention: Secondary Analysis of a Randomized Controlled Trial , 2016, JMIR mental health.

[9]  David C. Mohr,et al.  Realizing the Potential of Behavioral Intervention Technologies , 2013 .

[10]  Seth M Noar,et al.  Efficacy of text messaging-based interventions for health promotion: a meta-analysis. , 2013, Social science & medicine.

[11]  N. Gale,et al.  Using the framework method for the analysis of qualitative data in multi-disciplinary health research , 2013, BMC Medical Research Methodology.

[12]  Elisheva F. Gross,et al.  Extending the school grounds?--Bullying experiences in cyberspace. , 2008, The Journal of school health.

[13]  Ross Shegog,et al.  Prevalence and Correlates of the Perpetration of Cyber Dating Abuse among Early Adolescents , 2016, Journal of Youth and Adolescence.

[14]  Margaret M. Thorsen,et al.  Acceptability, language, and structure of text message-based behavioral interventions for high-risk adolescent females: a qualitative study. , 2014, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[15]  Julie M. Skutch,et al.  A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. , 2011, Behavior therapy.

[16]  Megan L Ranney,et al.  Patient engagement and the design of digital health. , 2015, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[17]  A. Bandura.  Growing primacy of human agency in adaptation and change in the electronic era , 2002 .

[18]  Parisa Rashidi,et al.  The Behavioral Intervention Technology Model: An Integrated Conceptual and Technological Framework for eHealth and mHealth Interventions , 2014, Journal of medical Internet research.

[19]  G. Willis,et al.  Cognitive Interviewing: A Tool for Improving Questionnaire Design , 2004 .

[20]  Stephan Weibelzahl,et al.  Text messaging as a means to lowering barriers to help-seeking in students with depression , 2006 .

[21]  L Romo,et al.  [A cyberbullying study: Analysis of cyberbullying, comorbidities and coping mechanisms]. , 2015, L'Encephale.

[22]  Joanna Smith,et al.  Qualitative data analysis: the framework approach. , 2011, Nurse researcher.

[23]  Pamela Williamson,et al.  Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions , 2016, JMIR mHealth and uHealth.

[24]  A. Bandura.  Social cognitive theory: an agentic perspective. , 1999, Annual review of psychology.

[25]  Robin M. Kowalski,et al.  Bullying in the digital age: a critical review and meta-analysis of cyberbullying research among youth. , 2014, Psychological bulletin.

[26]  Deborah J Jones,et al.  Future Directions in the Design, Development, and Investigation of Technology as a Service Delivery Vehicle , 2014, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[27]  Lena Sanci,et al.  Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression: Randomized Controlled Trial , 2012, Journal of medical Internet research.

[28]  E. McColl.  Cognitive Interviewing. A Tool for Improving Questionnaire Design , 2006, Quality of Life Research.

[29]  Dinesh Bhugra,et al.  Interventions on Bullying and Cyberbullying in Schools: A Systematic Review , 2015, Clinical practice and epidemiology in mental health : CP & EMH.

[30]  Michele L. Ybarra,et al.  Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown) , 2016, JMIR mHealth and uHealth.

[31]  Abigail Sellen,et al.  Getting the right design and the design right , 2006, CHI.

[32]  Joshua Fogel,et al.  Randomized Clinical Trial of an Internet-Based Depression Prevention Program for Adolescents (Project CATCH-IT) in Primary Care: 12-Week Outcomes , 2009, Journal of developmental and behavioral pediatrics : JDBP.

[33]  Rochelle K. Rosen,et al.  Formative Research for Mhealth HIV Adherence: The iHAART App , 2015, 2015 48th Hawaii International Conference on System Sciences.

[34]  Heleen Riper,et al.  The Pace of Technologic Change: Implications for Digital Health Behavior Intervention Research. , 2016, American journal of preventive medicine.

[35]  Janis Wolak,et al.  The Role of Technology in Peer Harassment: Does It Amplify Harm for Youth? , 2015 .

[36]  Melissa K Holt,et al.  Cyberbullying victimization and mental health in adolescents and the moderating role of family dinners. , 2014, JAMA pediatrics.

[37]  John Young,et al.  The Development and Psychometric Investigation of the Cyberbullying Scale , 2014, Journal of interpersonal violence.

[38]  Megan L Ranney,et al.  Using High-Risk Adolescents′ Voices to Develop a Comprehensible Cognitive Behavioral Therapy–Based Text-Message Program , 2018, Behavioral medicine.

[39]  S. Bauman,et al.  Cyber and bias-based harassment: associations with academic, substance use, and mental health problems. , 2012, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[40]  E. Messias,et al.  School bullying, cyberbullying, or both: correlates of teen suicidality in the 2011 CDC Youth Risk Behavior Survey. , 2014, Comprehensive psychiatry.

[41]  S. Michie,et al.  What design features are used in effective e-health interventions? A review using techniques from Critical Interpretive Synthesis. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[42]  Elias Aboujaoude,et al.  Cyberbullying: Review of an Old Problem Gone Viral. , 2015, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[43]  Daniel E. Rivera,et al.  Agile science: creating useful products for behavior change in the real world , 2016, Translational behavioral medicine.

[44]  Wanda Pratt,et al.  Healthcare in the pocket: Mapping the space of mobile-phone health interventions , 2012, J. Biomed. Informatics.

[45]  G. Finnerty.  Qualitative Research Practice. A Guide for Social Science Students and Researchers , 2003 .

[46]  Nancy P Barnett,et al.  Translating Behavioral Interventions Onto mHealth Platforms: Developing Text Message Interventions for Smoking and Alcohol , 2015, JMIR mHealth and uHealth.

[47]  Charlene Cook,et al.  Cyber bullying behaviors among middle and high school students. , 2010, The American journal of orthopsychiatry.

[48]  L. Yardley,et al.  The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions , 2015, Journal of medical Internet research.

[49]  Michele L. Ybarra,et al.  Journal of Child Psychology and Psychiatry 45:7 (2004), pp 1308–1316 10.1111/j.1469-7610.2004.00328.x Online aggressor/targets, aggressors, and targets: a comparison of associated youth characteristics , 2022 .

[50]  Laurence Kern,et al.  Étude sur la « cyber-intimidation » : cyberbullying , comorbidités et mécanismes d’adaptations , 2015 .

[51]  Brianna S Fjeldsoe,et al.  Preventive Health Behavior Change Text Message Interventions: A Meta-analysis. , 2017, American journal of preventive medicine.

[52]  Edward W. Boyer,et al.  "You Need to Get Them Where They Feel it": Conflicting Perspectives on How to Maximize the Structure of Text-Message Psychological Interventions for Adolescents , 2015, 2015 48th Hawaii International Conference on System Sciences.

[53]  R. Cunningham,et al.  A Depression Prevention Intervention for Adolescents in the Emergency Department. , 2016, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[54]  Michele L. Ybarra,et al.  Examining Characteristics and Associated Distress Related to Internet Harassment: Findings From the Second Youth Internet Safety Survey , 2006, Pediatrics.

[55]  Frederick Muench,et al.  Understanding Messaging Preferences to Inform Development of Mobile Goal-Directed Behavioral Interventions , 2014, Journal of medical Internet research.