Accelerating Best Practices in Peer Support Around the World

An In-Depth Look at Peer Support App Development, Part 1

Clayton Velicer, MPH

Previously on this blog we have provided updates on mobile apps that incorporate peer and social support. Now, with the increasing number of apps coming onto the market, more transparency on the development and testing process may raise confidence in the effectiveness of these apps and lead to better refinements.

A recent article by Al Ayuba and colleagues provides an in-depth description of the development of a persuasive social mHealth application called PersonA designed to monitor and motivate users to increase physical activity.

The social support components are a central part of the app design. Users can communicate and compare their performance with that of their peers. According to the authors, the social component is important because published literature indicates that social support has the capacity to increase physical activity or at a minimum, reduce program attrition.

In Part 1 of this 2-part blog, we will provide background information on this project, discuss how the authors used health theory to inform development and explain how usability is tested. In Part 2 we will discuss the results of the usability and feasibility testing and how content for the app was developed.

Theoretical Foundation

It is sometimes unclear the extent to which app development is guided by health behavior theory. In the case of PersonA, however, the developers made sure to incorporate health behavior theories in the app. The technical characteristics of this app were developed from a review of health theories including the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Social Cognitive Theory (SCT), and the social support and health link theory.

Based on these theories and many others, the developers focused on characteristics for the program that:

  1. Have an apparent relationship with the success of the health behavior intervention
  2. Have the potential to be applied broadly across the health and wellness domain, especially PA (physical activity) promotion
  3. Have the potential to be leveraged in technologies currently available

From the article, the table below shows the seven key characteristics of the app and the health behavior theories from which they are drawn. For example the characteristic of making the app “Personal” is based on the theoretical construct of behavioral intention from Theory of Reasoned Action (TRA), the perceived behavioral control of the Theory of Planned Behavior (TPB), and of self-efficacy of the Social Cognitive Theory (SCT). Follow this link to the full article for a detailed discussion.


After deciding on the theoretical foundations to include in the app and evaluating the existing technologies on the marketplace, Al Ayuba and colleagues focused on testing the usability and of the app.

This papers outlines the five factors usually associated with usability testing:

  1. Learnability: how easy it is for the user to learn and start getting work done
  2. Efficiency: once users have learned, they are able to perform tasks, productively
  3. Memorability: so that the casual user can return to and remember how to use it
  4. Error rate: it should have low error rate so users make few errors and can easily recover when they do
  5. Satisfaction: the users are subjectively satisfied when using it

To test these factors the researchers used three methods common to the evaluation of new interventions in health behavior change. First, participants used “think-aloud assessment.” For this, users are asked to talk about what they are thinking and trying to do on the app. They are also encouraged to voice questions that come up as they work and ask about things that they read. The second form of assessment was a post-study questionnaire that was designed to evaluate the five usability factors quantitatively. Finally, usability is assessed with a semi-structured interview with the user.

Coming Up Next:

We hope you’ve enjoyed this unique look into the development of an app that can provide users with peer support for increasing physical activity. In Part 2 we will discuss the rest of this paper including the results of testing and how the users described the importance of different components, specifically focusing on the impact of social support.


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