The development process consisted of three main phases: (1) identifying intervention needs and planning (Steps 1-2 of IDEAS); (2) intervention development (Steps 3-5 of IDEAS); and (3) usability testing and refinement (Steps 6-7 of IDEAS).
2.1.1 Phase I: Identifying intervention needs and planning
2.1.1.1 Intervention needs
During this phase, we first conducted a systematic review of internet-based self-guided interventions aimed at increasing PA for depression to determine the intervention needs and potential intervention components and strategies (17). This review identified that few mobile apps designed to increase PA specifically target individuals with depression, highlighting the need for well-designed apps with enhanced engagement and efficacy. In response, we followed the IDEAS framework to design MoodMover. A multi-disciplinary team that consists of professionals in the field of depression and PA was involved in the entire development processes.
M-PAC Framework
Like other behavioural development frameworks, the IDEAS framework also emphasizes the importance of incorporating behaviour change theories into the development processes for identifying influential factors and potential explanations for the failure of interventions (23, 24, 25, 26). Instead of traditional social cognitive theories, such as the Theory of Planned Behaviour and the Social Cognitive Theory, the multi-disciplinary team selected the Multi-Process Action Control (M-PAC) framework (27, 28) with an acknowledgement of the intention-behaviour gap, where merely having an intention to engage in PA does not always lead to behaviour change (29).
In the M-PAC framework, intention is viewed as a decisional construct, with core determinants that include reflective processes (i.e., instrumental attitude, affective attitude, perceived capability, and perceived opportunity). Among these, two ongoing reflective constructs (perceived opportunity and affective attitude) along with regulatory processes (e.g., action/coping planning) collectively facilitate the intention-behaviour transition (action control). Further, the M-PAC framework emphasizes the importance of two reflexive processes, namely habit and identity, in sustaining effective action control. The M-PAC has been applied to understand and promote PA in various populations (30, 31, 32, 33, 34), and has been deemed suitable for informing PA promotion interventions among people with poor mental health (35). Moreover, the M-PAC framework includes a set of theory-driven behaviour change techniques (BCTs) (36), which guide intervention content development.
2.1.1.2 Target behaviour
We conducted an exploratory literature scan to determine the intervention target behaviour, i.e., what ‘dose’ of PA is needed for a clinically meaningful reduction in depressive symptoms. Various PA guidelines encourage the general population to engage in at least 150 minutes (30 min/day*5 days) of moderate PA per week for substantial health benefits (e.g., Ross et al (37) and Bull et al (38)). Walking is the primary form of PA behaviour targeted by MoodMover due to its accessibility, countability, and ability to be incorporated into the daily lives of all people without severe physical disabilities. A meta-analysis by Robertson et al (39) suggested that walking exhibits a similar effect size for treating depression or depressive symptoms compared to other types of exercise.
A 30-minute session of moderate-intensity walking is estimated to accumulate around 3000-4000 steps (40, 41, 42). As such, an increase of 3000 daily steps was deemed a clinically relevant behavioural goal for MoodMover. In addition, a commentary by Otto et al (43) on exercise for depression suggested adding steps to individuals’ baseline PA levels gradually. Similarly, previous web-based PA interventions proposed and applied ramped goals of 1000 extra steps above baseline every two weeks until achieving a total increment of 3000 steps (44, 45). Despite less than half of the participants achieving the ultimate goal, both studies indicated significant increases in step counts at post-intervention.
Given these, MoodMover adopted a similar graded approach by recommending participants to set their goals as increasing 1000 steps/day above baseline at week 2, followed by adding an additional 1000 daily steps every two weeks until meeting a total increase of 3000 steps/day (See Figure 2). This aligns with the findings of Sporrel et al (46), suggesting that assigning goals to users and using adaptively tailored goals may be more effective than user-set or generic goals. Moreover, MoodMover encourages end-users to gradually increase their daily goal achievement to 5 days/week, aligning with the potential importance of frequency in cultivating PA habits (43). This goal is likely to be both realistic and effective for individuals with depression.
Figure 2. Graded goal recommendations of MoodMover
Notably, while MoodMover emphasizes walking and targets steps, it is not solely a walking program. To allow flexibility and meet personal preferences, MoodMover encourages users to accumulate steps through any form of PA. A recent meta-analysis indicated that while aerobic exercise alone can significantly improve depressive symptoms, combining at least two types of exercise, such as aerobic and resistance exercise or aerobic and mind-body exercise, offers the greatest potential for maximizing the efficacy of exercise interventions (47). Therefore, MoodMover also encourages the combination of aerobic exercises with resistance exercise or mind-body exercises.
2.2.1 Phase II: Intervention development
During this phase, the multi-disciplinary team discussed content modifications, brainstormed potential app features and modes of delivery, and developed prototypes. This development process was highly iterative, being repeated until the research team reached consensus that the prototype was ready for usability testing.
2.2.1.1 Intervention content
The content of MoodMover was adapted from an existing web-based, 10-lesson M-PAC intervention designed to promote PA among young adults with low mood and/or depression engaged in community primary clinical care (48). This program was selected for adaption due to its good initial acceptability among a similar population of individuals with poor mental health, and its alignment with the M-PAC framework. The adaption of the content was guided by previous literature with consultations with the professionals in our multi-disciplinary team.
A recent study by Tang et al (35) underscored the potential significance of certain M-PAC constructs, namely capability, affective attitudes, intentions, and regulatory processes, in promoting PA among individuals with poor mental health. Conversely, perceived opportunity and instrumental attitudes were less pronounced in this population. In response, while the modified content retains all the constructs of the M-PAC framework, it places more emphasis on perceived capability, affective attitudes, regulatory processes, and reflexive processes but less emphasis on perceived opportunity, and instrumental attitudes. This focus on affective attitudes is consistent with evidence from other behaviour change frameworks, suggesting that emotion domains may be a crucial aspect that has been overlooked in previous interventions targeting changes in PA behaviour among individuals with depression (7). All theoretical constructs have been mapped to BCTs. Table 1 presents an overview of MoodMover's content of major lessons, targeted M-PAC constructs, and corresponding BCTs; a full version with complementary lessons is shown in Appendix 1.
Table 1.
Outline of the content of MoodMover’s major lessons and the corresponding M-PAC construct(s) and behaviour change technique(s)
|
Modules
|
Major topics covered
|
M-PAC construct(s) targeted
|
Behaviour change technique(s) used
|
|
1) Feeling better through daily activity
|
• Exercise as a treatment option for depression
• Mood and physical activity interaction
• Physical benefits of exercise
• Goal-setting
|
Affective attitudes, Instrumental attitude;
Behavioural regulation
|
Information about health consequences (5.1)*
Information about emotional consequences (5.6)*
Behavioural practice/rehearsal (8.1)*
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Credible source (9.1)*
|
|
2) Making physical activity enjoyable
|
• Introducing affect
• The importance of enjoying physical activity
• Strategies and activities to increase the enjoyment of physical activity
|
Affective attitudes;
Behavioural regulation
|
Information about emotional consequences (5.6)*
Behavioural practice/rehearsal (8.1)*
Self-monitoring of behaviour (2.3)*
|
|
3) Building your self-confidence
|
• Self-efficacy
• How to increase self-efficacy
• Exercise experiences shared by peers
|
Perceived capability
Behavioural regulation
|
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Information about others’ approval (6.3)*
Behavioural practice/rehearsal (8.1)*
|
|
4) Building your physical activity opportunity
|
• The influence of environment on behaviour
• How to build environment for physical activity
• Brainstorm physical activity opportunities
• Grab and go activities
|
Perceived opportunity
|
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Prompts/cues (7.1)*
Behavioural practice/rehearsal (8.1)*
Restructuring the physical environment (12.1)*
Adding objects to the environment (12.5)*
|
|
5) Developing self-regulatory skills
|
• Action planning
• Coping planning
|
Behavioural regulation
|
Goal setting of behaviour (1.1)*
Problem solving (1.2)*
Action planning (1.4)*
Self-monitoring of behaviour (2.3)*
Behavioural practice/rehearsal (8.1)*
|
|
6) Drawing on social support
|
• Introducing social support
• Building your social support
• Thinking strategies for exercise
• Positive self-talk
|
Perceived opportunity
Behavioural regulation
|
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Social support (practical) (3.2)*
Social support (emotional) (3.3)* Behavioural practice/rehearsal (8.1)*
Self-talk (15.4)*
|
|
7) Forming an exercise habit
|
• Introducing habit
• Relating habit to physical activity
• How to form a habit
|
Habit
|
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Behavioural practice/rehearsal (8.1)*
Habit formation (8.3)*
|
|
8) Building your exercise identity
|
• Introducing WHO guidelines
• Introducing exercise identity
• Ways to increase exercise identity
|
Identity
|
Goal setting (behaviour) (1.1)*
Self-monitoring of behaviour (2.3)*
Behavioural practice/rehearsal (8.1)*
Incompatible beliefs (13.3)*
Valued self-identity (13.4)*
|
Note. M-PAC = Multi-Process Action Control; WHO = World Health Organization.
*The numbers in the brackets refers to the behaviour change techniques in the “BCT taxonomy v1” by Michie et al (36)
Despite the original content of the web-based intervention being evaluated in collaboration with end-users and researchers, and incorporating various BCTs (48), we reassessed the alignment of targeted theoretical constructs with the taxonomy of BCTs (36) to identify additional intervention components that may be effective and preferred by end-users.
Overall, the revised program consists of eight major lessons accompanied by eight weekly complementary lessons. With an additional run-in period of one week (Week 1) for introducing the program and obtaining baseline step data, MoodMover results in a nine-week intervention. The major lessons generally follow the order of the three processes in the M-PAC framework, beginning with intention-formation (Lessons 1-4; 6), followed by action control adoption (Lessons 1-2; 4-6), and concluding with action control maintenance (Lessons 7-8). It is worth noting that constructs for intention-behaviour transition (i.e., perceived opportunity, affective attitudes, and regulatory processes) were emphasized early and integrated throughout the program, with the assumption that most individuals who volunteered to participate in a PA behavioural intervention already had intentions to be physically active (49). Several behavioural strategies, such as positive self-talk after exercising and increasing pleasant activities recommended by Otto and Smits (50), were incorporated. To match the temporal dynamics of symptom severity, especially for energy and motivation (51, 52), MoodMover added information about the fluctuating nature of depression and implemented strategies to emphasise engaging in PA when feeling more energetic and less fatigued.
2.2.1.2 Prototype development
The research team iteratively developed multiple prototypes on Pathverse, continuously refining the app’s content, features, navigation, layout, and aesthetic design. Pathverse is a "no code" mHealth intervention development platform (53) (see https://pathverse.ca/en/), which aligns with the M-PAC framework and enables the creation of tailored behavioural interventions. It supports rapid prototyping, allowing the customization of app content and features through a web portal. Three independent researchers (GF, MF, and MG) assessed the content and the design of the app, and provided feedback for making necessary modifications. Any discrepancies were addressed through discussions within the research team to reach a consensus. A computer programmer (HL) from Pathverse was engaged in this iterative process to provide technical support.
During this process, a few major modifications were implemented. For example, to further enhance engagement and increase PA, financial incentives (BCT: “10.1 Material incentive (behaviour)”) were incorporated into the gamification feature that Pathverse has enabled. Gamification features are associated with increased engagement in PA apps and increased PA levels (54). MoodMover incentivizes lesson completion, allowing participants to earn 20 points for each major lesson and 10 points for each complementary lesson. Every 60 points earned are equal to a CAD $5 e-gift card.
In addition, inspired by Webb et al (55) to enhance practical applications, two modes of delivery— “automated tailored feedback” and “enriched information environment”— associated with higher effects on behaviour change were considered. Unfortunately, due to limited resources and time constraints, “automated tailored feedback” was not incorporated. Instead, the prototype of MoodMover included an enriched information environment (i.e., images, videos, and short podcasts), along with automated follow-up messages (e.g., reminders/notifications), and peer-to-peer access (i.e., community forum). Furthermore, the prototype incorporated a mood tracking feature by adapting the existing exercise logging feature, potentially reinforcing the sense of connection between PA and mood enhancement.
Overall, the refined prototype contains various features (e.g., step tracker and community forum) and lessons with content framed within the M-PAC framework (one major/week and one complementary/week). Figure 3 illustrates a workflow of the refined prototype of MoodMover. Each lesson, except for the Week 1 introduction module, includes educational content presented on lesson cards in a variety of formats (e.g., texts, images, GIFs, and podcasts), along with surveys and/or quizzes. Figure 4 displays screenshots of a major lesson as an example.
2.3.1 Phase III: Usability test
After the research team was satisfied with the modified intervention package, a usability test of the MoodMover prototype was conducted to receive user feedback. This phase aims to explore users' general interest in the app and their willingness to integrate it into their regular routines. It also sought to identify any potential barriers to consistent usage, gather suggestions for improvement, and capture unexpected innovative ideas or opportunities that might arise. To comprehensively analyze MoodMover from end-users’ perspectives, we replicated a prior usability study of a Pathverse app (56) in employing a formative mixed methods approach. Ethics approval to conduct this study was received by the Research Ethics Board at the University of British Columbia (#H24-00047).
Participants were recruited through REACH BC (https://reachbc.ca/), an initiative in British Columbia, Canada, that facilitates participant recruitment for health research. Potential participants who expressed interest were contacted by one researcher (YT) via email and invited to complete a screening questionnaire (Appendix 2) online to confirm their eligibility. All eligible patients received further information about the study via email, and completed a demographic survey (Appendix 3; e.g., gender) after confirming their participation prior to the meeting. All participants provided verbal consent at the beginning of the Zoom meeting on the recording. Inclusion criteria for participants include: (1) outpatients aged 18–64 years who self-report a current diagnosis of major depressive disorder, irrespective of its severity, and/or at least mild depressive symptoms, as indicated by a score of 5 and above (mild: 5-9, moderate: 10-19, and severe: 20-27) on the 9-item Patient Health Questionnaire (PHQ-9) (57); (2) have a valid email address; (3) possess an iPhone or Android smartphone with internet access to download and use the app; (4) able to read and write in English. Patients with the following self-reported conditions were excluded: physical disability preventing exercise, active psychosis or mania, active suicidal ideation, severe cognitive impairment, and current pregnancy. Participants who reported 90 minutes or more of at least moderate-intensity PA per week were also considered ineligible. Participants were compensated with a CAD $20 Amazon e-gift card for their time.
2.3.1.1 Procedures and measurements
Participants were asked to sign up on Pathverse to access MoodMover using the same email through which they had been contacted by the researcher. The virtual interviews lasted approximately 60 minutes and were conducted over participants’ smartphones. During the meeting, participants first partook in a series of goal-oriented tasks while sharing their phone screens, aimed at obtaining user feedback and identifying potential navigation issues within specific areas of the prototype. The tasks included: 1) logging onto the app; 2) completing the introduction module; 3) syncing steps from either Google Fit (Android) or Health (iOS); 4) completing the first major lesson; 5) setting a personal step goal; 6) logging one exercise session; 7) completing one complementary module; 8) scanning the fifth lesson (Self-regulatory skills) and creating an action plan after watching the tutorial embedded; and 9) scanning the sixth lesson (Social support) and sharing their experience in the community forum. Participants were encouraged to "think-aloud", sharing their ongoing thought processes and any challenges they encountered while using the program throughout these tasks. A separate research assistant (JK) served as an observer, responsible for documenting any issues encountered by participants during the tasks. Both the transcriptions of the "think-aloud" sessions and the field notes were integral to the data analysis process. After completing the goal-oriented tasks, a semi-structured interview followed aiming at gathering open-ended feedback and obtaining deeper insights. Interview questions (e.g., “what did you like best about the MoodMover app?”; see details in Appendix 4) were mainly derived from the previous usability testing study of a Pathverse app (56).
Last, participants completed a usability evaluation tool (Appendix 5) revised from the patient version of the mHealth App Usability Questionnaire (MAUQ) (58) for standalone apps. MAUQ has been considered the gold-standard reference for usability analysis of mHealth apps (59). The original MAUQ is a new, 18-item validated usability questionnaire, assessing three domains of usability guided by the International Organization for Standardization (ISO) definition of usability (60): ease of use (MAUQ_E; 5 items), interface and satisfaction (MAUQ_I; 7 items), and usefulness (MAUQ_U; 6 items). Given that MoodMover does not provide healthcare services, its usefulness was assessed with a single item: “The app would be useful for my mental health and well-being.” Participants were asked to rate each item on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). A higher total score and averages of each domain indicate better app usability. MAUQ shows strong construct validity and criterion validity. The internal consistency of the MAUQ_E (Cronbach alpha=0.847) and MAUQ_I subscales (Cronbach alpha=0.908) is high. Since no specific threshold of the MAUQ has been established to indicate good usability, we set a cut-off score of ≥ 5 for each domain to indicate acceptable usability, based on previous mHealth app usability studies (61, 62).
2.3.1.2 Data analysis
Quantitative data were analyzed using Microsoft Excel to describe participant demographics and summarize the MAUQ results descriptively. The interviews and think-aloud recordings were independently transcribed verbatim using Otter (www.otter.ai) and analyzed in Microsoft Excel by two researchers (YL and JK). Any discrepancies were resolved through discussions to ensure the consistency of analyses. Qualitative content analysis approach (63) was employed for its ability to provide consistent content categories of interest and flexibility in identifying emerging patterns. The data analysis began after the first usability session was conducted to ensure that issues identified in early sessions can inform later sessions using constant comparative analyses. Additionally, some of the issues identified (e.g., functional bugs) and suggestions raised by previous participants were used to inform ongoing modifications, which were then evaluated by the subsequent participants. Using deductive content analysis, the collected data were coded to correspond to three broad categories: app design (e.g., layout, navigation and aesthetics), content (e.g., educational material) and features (e.g., step tracker), and ideas for improvement. These data were cross-referenced with notes taken by the researcher (JK) during the think-aloud process. Subsequently, inductive content analysis was also used to further explore sub-categories.
2.3.1.3 Results of usability test
A total of 49 individuals who expressed interest in participating through REACH BC were contacted. Of the 19 individuals who met the eligibility criteria, 12 (63.2%) were enrolled, while the remaining individuals did not respond to the invitation emails. Of these enrolled participants, two did not attend the scheduled meeting without providing a reason. One participant was excluded due to technical issues not related to Pathverse/MoodMover. The remaining nine participants (five women, three men, one non-binary) had a mean age of 38.4 years, ranging from 24 to 53 years. Six participants self-reported a clinical diagnosis of major depressive disorder. All participants self-reported a mean of 14.1 points on the PHQ-9. Of these, three scored within the mild threshold, while four were categorized as moderate, and two as severe. Further demographics are displayed in Appendix 6.
Due to time constraints, only the first seven goal-oriented tasks were assigned to all participants. Task 8, scanning the fifth lesson (Self-regulatory skills) and creating an action plan, was assigned to three participants. Task 9, which involved scanning the “Lesson 6: Social Support” and sharing their experience in the community forum, was not assigned; instead, participants were introduced to the “Social – Community Forum” feature and asked to provide feedback.
Quantitative results: MAUQ
Table 2 presents the results of the adapted MAUQ. The prototypes of MoodMover received an average MAUQ score of 5.79 (SD = 1.04), ranging from 5.08 to 6.62 across most (8/9) participants, indicating good to high usability. When looking at the individual domains, MoodMover received an average score of 5.84 (SD = 0.88) for “Ease of use”, with 91.1% (41/45) of the responses scoring 5 (“somewhat agree”) or higher. In the “Interface and satisfaction” domain, the average score was 5.67 (1.25), with 81.0% (51/63) of responses being at least “somewhat agree”. The average score for “Usefulness” was 6.33 (SD =1.00), with eight (88.9%) participants scoring 6 or 7.
Table 2.
Usability of MoodMover prototypes as assessed by the adapted MAUQ for standalone apps (Patient version)
|
Domains and statements
|
Mean (SD)
|
Median (min, max)
|
|
Ease of use
|
5.84 (0.88)
|
6.20 (3.80, 6.60)
|
|
The app was easy to use.
|
5.67 (1.00)
|
6 (4, 7)
|
|
It was easy for me to learn to use the app.
|
6.00 (0.87)
|
6 (5, 7)
|
|
The navigation was consistent when moving between screens.
|
5.56 (1.13)
|
6 (3, 7)
|
|
The interface of the app allowed me to use all the functions (such as setting a step goal, logging a physical activity session, receiving notifications) offered by the app.
|
5.67 (1.87)
|
6 (1, 7)
|
|
Whenever I made a mistake using the app, I could recover easily and quickly.
|
6.33 (1.00)
|
7 (4, 7)
|
|
Interface and satisfaction
|
5.67 (1.25)
|
5.71 (2.71, 6.71)
|
|
I like the interface of the app.
|
5.56 (1.94)
|
6 (1, 7)
|
|
The information in the app was well organized, so I could easily find the information I needed.
|
5.44 (1.13)
|
6 (4, 7)
|
|
The app adequately acknowledged and provided information to let me know the progress of my action.
|
5.56 (0.73)
|
6 (4, 6)
|
|
I feel comfortable using this app in social settings.
|
5.44 (1.94)
|
6 (1, 7)
|
|
The amount of time involved in using this app has been fitting for me.
|
5.67 (1.66)
|
6 (2, 7)
|
|
I would use this app again.
|
6.22 (1.20)
|
7 (4, 7)
|
|
Overall, I am satisfied with this app.
|
5.78 (1.56)
|
6 (2, 7)
|
|
Usefulness
|
|
|
|
The app would be useful for my mental health and well-being.
|
6.33 (1.00)
|
7 (4, 7)
|
|
Overall MAUQ
|
5.79 (1.04)
|
6 (3.38, 6.62)
|
Note. MAUQ = mHealth App Usability Questionnaire
Qualitative feedback
Table 3 displays a summary of participants' responses to semi-structured interview questions with sample quotations. More detailed usability results from the think-aloud processes and semi-structured interviews are categorized into three predefined broad areas: app design, content and features, and ideas for improvement.
Table 3.
Interview question responses.
|
Interview questions
|
Summary
|
Sample quotations
|
|
Q1: Do you use, or have you used, any mental health/PA apps/wearable devices? Why/why not?
|
Most participants reported having used PA or mental health apps before at least for short periods of time. Some participants expressed a clear need for a PA app tailored for people with depression.
|
It's actually surprising that no one has done this [develop an app specifically designed for depression] yet... especially since depression is such a common mental health issue. [Mood23]
|
|
Q2: What did you like best about the MoodMover app?
|
Gamification with incentives, exercise logging with mood tracking, and resources with YouTube workout videos were the top three mentioned features. Many participants also favored the flexible attitude conveyed by MoodMover.
|
I like that the more activities you do, you accumulate points. [Mood04]
|
|
Q3: What did you like least about the app?
|
No major issues were reported. Some participants mentioned that the initial navigation took some time.
|
There's nothing that really strikes me. [Mood09]
|
|
Q4: How easy was it to navigate or find your way around the app?
|
Most participants explicitly commented that the app is intuitive, simple, or easy to navigate, although the initial navigation may take them some time.
|
I feel it was pretty easy… Like even without the instructions. [Mood42]
|
|
Q5: What did you think about the overall look of the app?
|
Most participants favored the overall look of the app, except for two of three men.
|
Pretty nice overall look of the app. [Mood49]
|
|
Q6: What did you think about the information provided on the app?
|
Most participants explicitly stated that the content is very helpful, and the scripting is basic and easy to understand.
|
Very helpful…explained in a very simple, easy to understand way. [Mood04]
|
|
Q7: Is there anything you think the app might be missing?
|
Strategies. A participant mentioned providing daily suggestions for accumulating steps.
|
Maybe a daily suggestion of how to get more steps or something like that. [Mood05]
|
|
Q8: Would you be interested in using the upgraded MoodMover in the future to increase your PA and reduce depressive symptoms? Why/why not?
|
Nearly all participants showed a strong interest in using the upgraded MoodMover in the future, even for Mood02 who recorded a relatively low score on MAUQ.
|
Definitely. Why not? Because at the end of the day, it's all resources at one place. And again…I know that there are researchers, there are experts behind designing the app that shows you tangible benefits. [Mood02]
|
Note. MAUQ = mHealth App Usability Questionnaire; PA = Physical Activity
App design
No participants encountered major difficulties in navigating through the app. All participants logged onto the app (Task 1) without additional instructions. Most participants experienced no issues completing the lessons (Tasks 2, 4, 7-8). An issue encountered exclusively by Android users was that the keyboard hid part of the textbox when entering survey responses, which has been reported to the Pathverse team. Additionally, four participants did not notice that some lesson cards were longer and required scrolling down for more information. To address this, relevant instructions were added and the content of many longer cards was divided into two or more cards as suggested. In terms of layout, three participants preferred the “My Points” tab, which shows participants’ accumulated points, to be displayed on the main page rather than under the “Menu”. Comments relating to aesthetics were positive. In particular, participants appreciated the selection of pictures and the colors.
I love your pictures. Good selection of pictures really representing lots of different people… good colors, bright colors, stimulating colors…those were all visually soothing, but inspiring. Like they're motivating colors. [Mood04]
Content and Features
Content
Participants mentioned their favorable perceptions of the gradually increasing step goal recommendations and the nonjudgmental manner consistently conveyed by the app, highlighted by the flexibility it encourages in meeting step goals. Most participants deemed the recommended step goals achievable, manageable, or attainable. Some users got confused by the examples of step goals (i.e., a baseline of 2000 daily steps) provided on the goal recommendations card, which was then removed. Mood07 suggested adding the time equivalence of steps when introducing the recommended step goals. This information was added as a tip card, which many subsequent participants appreciated. In terms of content design, all participants favored the incorporation of mixed media (e.g., images, GIFs, and podcasts) within the lessons. Some participants explicitly preferred fewer plain texts and more infographics.
Features
Key features were evaluated through tasks including syncing steps (Task 3), setting step goals (Task 5), logging an exercise session (Task 6), and creating an action plan (Task 8). With the intention of developing a self-help app requiring minimal human support, participants were expected to complete the tasks after reading the instructions provided in the corresponding lessons. However, many participants needed some verbal guidance, even though these were generally minimal.
Step tracker and exercise logging
Both tools were embedded within the “Trackers” tab. Most participants agreed that the instructions were straightforward and easy to understand, although some participants had questions about whether MoodMover can sync step data from their fitness trackers. This issue was resolved by adding a Q&A card that explains the app only retrieves step data from fitness trackers linked to Google Fit or Apple Health. However, many participants forgot the instructions after completing the module and needed additional verbal instructions to locate the tab.
There are instructions in the module…And then once I completed the module and want to go do what I had to do. I forgot a little bit and I had to find my way to things. [Mood05]
In response, the instructional infographics were transformed into short videos. The videos were favored by subsequent participants over the initial infographics and were further refined based on their feedback, including a change from landscape to vertical. Regarding exercise logging, most participants particularly appreciated this feature, especially for its encouragement of logging short sessions (e.g., 5 or 10 minutes) and the ability to record their mood after exercising using emojis.
That's cute…It is very motivating to have the option to put the mood. [Mood23]
Gamification: My Points
Figure 5 illustrates different levels of earned points and their corresponding incentives. Most participants were surprised by and excited about this feature. When participants were asked whether the amount of money corresponding to the points (i.e., every 60 points = $5) was motivating, most said they would be motivated, particularly because not much commitment was required.
It doesn't matter. It could be $1…and I'd still be like, “I'm getting something.” [Mood49]
Figure 5. Point levels and incentives
Goals: Action planning
Action planning was implemented using the “Goals” feature (Figure 6). Mood42 was excited about the ability to review a list of completed action plans, and stated, “I'd have a list of all of them…that's cool.” However, two issues were identified. First, the tab was labelled “Goals”, which caused confusion with the step “goal” within the step tracker. Second, the action plan example listed below the textbox was obscured when the keyboard appeared.
Figure 6. Screenshots of action planning
Social - Community Forum
Only two participants showed interest in and favored the social feature, while most participants expressed a lack of interest. After being told that the forum was completely anonymous, some participants showed increased interest.
If it's anonymous, then I might be inclined to use it, especially on a day where I'm struggling, I might just check in and see ‘is anyone else having a hard time getting out walking today?’ I know I am. It might be a way to provide some support without feeling vulnerable or exposed. So, I think that can be a really helpful tool. [Mood07]
Resources
Most participants particularly appreciated the curated selection of workout YouTube videos with different durations, intensity, and types. Three of them mentioned this feature as one of the best parts of the app. In particular, many participants favored the selected walking workout videos designed to help accumulate a certain number of steps, which can align with the recommended step goals of MoodMover. More relevant YouTube videos were selected by the researcher and grouped into a separate subcategory titled “Videos for Accumulating Steps.”
Ideas for improvement
Table 4 shows a list of other ideas for improvement along with sample quotations. Minor modifications were made immediately following the interviews. Further adjustments were discussed with the Pathverse development team to enhance the usability of MoodMover.
Table 4.
A list of additional ideas for improvement with sample quotations.
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Ideas for improvement
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Modifications or actions
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Layout
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“I think just having a date up here [lesson previews] that says coming on this day...would be super helpful.” [Mood47]
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Consulted with the Pathverse team to add scheduled release dates on the lesson previews.
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Navigation
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“I would expect this to be the main page because there's only one program here.” [Mood49]
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Consulted with the Pathverse team to set the study page as the main page for participants registered in only one study
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Content
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“Add a disclaimer on the top to remind participants even if there are many cards in one lesson. Each of them includes very limited content.” [Mood02]
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A tip card was added
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Exercise logging and mood tracking
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“People with depression is almost never happy, and the neutral is just blah. We are usually in between.” [Mood23]
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Consulted with Pathverse team to add additional mood choices between neutral and happy.
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Goals
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“I think it would be nice to have a box for each thing...instead of an action plan box. If there was a "What" box, "When" box, "Where" box.” [Mood42]
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Consulted with Pathverse team to break down for each domain
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Social – Community Forum
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“There should be something where you can connect to technicians for any technical problems.” [Mood02]
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Added a topic “If you need technical support…” to allow users to report technical issues using the social feature
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