When it comes to creating a new health app, involving target users in the design process can provide valuable insight to developers. With this in mind, when researchers wanted to design a sun-protection intervention for children, they involved elementary school children in an iterative design process that ultimately led to the development of a mobile-based intervention, the Mobile SunSmart app. The app provides general educational material about sun exposure, personalized information about sun exposure risk, and just-in-time alerts to encourage sun protection. The design process is detailed in a recent paper about the making of Mobile SunSmart.

“If kids really learn and internalize sun protection practices at a young age, they’ll carry those habits with them through their lives. But currently available school-based interventions that teach sun protection are only moderately effective,” said Jimi Huh, Ph.D., an NIEHS grantee and preventive medicine researcher at the University of Southern California. “That was the gap we were trying to address, and we knew that having a true and meaningful partnership with children and their families would help maximize our intervention’s utility.”

Children engaged in the Mobile SunSmart design process. (Photo courtesy of Jimi Huh, Ph.D.)

The researchers partnered with two groups of children — technology experts and subject experts — to design the app. The technology experts had knowledge in technology and usability, while the subject experts had their own experiences relating to sun exposure, sun protection, and technology usage. Each group of children participated in three design workshops from summer 2019 to summer 2020.

“We didn’t want the kids to just give us feedback on an intervention that researchers had already built – that would have meant the fundamental design was driven by adults. We really wanted the kids to be equal partners so their ideas could inform the intervention’s design from the ground up. The children’s parents’ input and collaboration were also critical,” said Huh.

Engaging Children as Equal Research Partners

Involving children as equal and equitable research partners requires intentional effort, as children do not immediately become design partners from the first day. It takes time to build trusted relationships in which children feel comfortable enough to share ideas and partner equally with adults. The researchers were also intentional in how the children were recruited and engaged in the co-design workshops.

To recruit the technology expert children, the researchers turned to KidsTeam UW, an ongoing intergenerational co-design group at the University of Washington that meets twice a week throughout the school year. All the technology expert children involved in the Mobile SunSmart project had at least one year of experience co-designing projects, so they were comfortable with this type of collaboration with adults.

“Co-designing technology over the course of a year or several years gets you deeper engagement with children who will be honest and not afraid to tell adults what they really think,” said Jason Yip, Ph.D., director of KidsTeam UW.

During the Mobile SunSmart workshops, the technology expert groups did hands-on educational activities that were part of an already-established classroom curriculum about sun protection. The groups then discussed how to best digitize those activities in a mobile intervention and how to encourage children to continuously wear sensors or their mobile phones so that the app would be maximally useful.

The subject experts were recruited through elementary schools and after-school programs near the University of Southern California. Since most parents are responsible for their children’s sun protection, the researchers included parents in the subject expert co-design workshops.

The researchers used techniques they learned from KidsTeam UW to lead these workshops. For example, the researchers recognized that engaging parents and children requires different strategies. Therefore, parents and children were separated into small peer groups to maximize participant comfort in discussing potentially sensitive topics and to allow for discussion of different aspects of sun protection. Subject expert groups discussed design ideas that had evolved from the technology expert workshops and ways to improve the ideas.

Using Children’s Input to Create the Intervention

After the six initial co-design workshops with KidsTeam UW, the team started the next design phase – incorporating the children’s and parents’ ideas into specific features of the app.

In the workshops, both children and parents agreed that storytelling is an effective teaching strategy since app users would be able to relate to characters in a story. Therefore, rather than formal, didactic lessons about sun protection, the app conveys important information through storytelling. The stories address different real-life scenarios that participants brought up in the co-design workshops, such as whether being underwater is protective against ultraviolet exposure.

Other app features also directly reflect input from the workshops. For example, children’s concerns over privacy led the team to include extra information for parts of the app that ask for personal information, such as eye color (as an indicator of melanin). The added information empowers children as users and minimizes suspicion of the app. Additionally, technology expert children were concerned with minimizing user burden and the amount of irrelevant information the app gave them. Therefore, it delivers just-in-time alerts based on data that accounts for the user’s location, whether the user is outside or inside, person-level data such as skin type, the real-time ultraviolet index at the user’s location, and how long the user has been outside.

“As we worked with the children, we could see that they became increasingly confident in their abilities and invested in the process to be design partners with adults,” said Huh. “We also noticed that some of the children became more interested in science or technology as a result of their involvement in our design process. They were very engaged and excited that their thoughts and critiques were being taken seriously and reflected at every iteration of the development. We are definitely looking forward to continuing this work.”

What’s next for the Mobile SunSmart intervention? Now that it’s been fully designed and created, the research team is looking forward to continuing their work with different groups of children to pilot test a beta version of the intervention.

“We think we have a great tool and are eager to test it with a new group of kids,” said Huh. “We’ll be looking at things like engagement with using the app daily, but also whether usage predicts sun-protective behavior and how the process of internalizing healthy habits unfolds. We hope that this scalable approach to a mobile intervention to improve sun protection will lay the foundation for future public health investigators in other areas.”