A Sustainable mHealth Intervention to Promote Physical Activity for Healthy Aging: A Pilot Study of the “Every Walk You Take” Citizen Science Initiative

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Comments on the review

This is a critical study that describes a digital intervention based on a community co-designed mobile tool used as a physical activity promotion strategy for older adults. This is an important topic for discussion in order to improve health promotion interventions for older adults. In addition, it is important to present some considerations that the authors address:

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Digital literacy among older people is still low. The target population (i.e. people over 55 years of age) may have problems with the use of digital devices, an important issue that may complicate the use of the proposed tool. Considering this, and in accordance with the results addressed by Majed et al, 2023, the analysis of digital devices for health proposal should present an approach guided by end-user requirements and formal evaluation across technical, clinical, usability and cost domains, data not shown by the authors. In addition, the results should include a more detailed discussion of the community-based participatory research protocol used and the assessment of barriers and facilitators to use of the device.

The manuscript needs to revise the references throughout the document as we see different ways of citing.

The manuscript is in need of revision on the references over the document.

Suggested references to help authors incorporate the revised proposed approach:

https://doi.org/10.3390/su152316503

 https://doi.org/10.1038/s41746-019-0111-3

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The text provided  a detailed description of a research initiative aimed at promoting physical activity among older adults through a sustainable mHealth intervention. Everyone needs activity for better health.

Although the work is interesting, it is very weak from a scientific point of view. This work is written more as an article for an online newspaper or for magazines dealing with the topic of Health, rather than as a scientific article.

I believe that this paper is not suitable for publication in a scientific journal, but for an online magazine.

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This is a great study and well done to the citizen scientists and the authors. The paper describes the intervention but there should be more detail.

The methodology does not describe how much input citizen scientists had in the study - did they set the questions? Did they feed back on the findings? Did they help write the manuscript? The ethics should be developed to say whether usual informed consent was given. The paper describes using Learning Centres for recruitment, but does not address that certain people who want to learn will go to these places. They may only have primary studies but their life/career may have been good, so the socioeconomic status would be useful. Those on low SES have poorer health behaviours and health outcomes.

For ease of reading for people with lower literacy, change SD to variation. Why were Roman numerals used for referencing the background? These are longer and not so easy to read either.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The objective of this study is to co-design and test a sustainable mHealth intervention prototype (mobile app) to promote active living among individuals over the age of 55. This will involve identifying the barriers and facilitators to active living. While the authors have addressed some of the comments raised in the first round of the review, it is still necessary to make substantial revisions to the methods and other sections in accordance with the comments. Further clarification is required on how the device was co-designed and the contribution of the community stakeholders.

A flow chart of the design process and the pilot analysis would provide a more detailed description of the method. Furthermore, the participatory methodology used for the development of the prototype should be described in greater detail. For instance, references 14 and 15 were not included in the methods section, which would have provided relevant information for the description of the process of device design. The following steps are proposed for consideration as an example:

1) Engagement and capacity building

2) Exploration and visioning

3) Visual and narrative

4) Mobilisation

5) Evaluation

It is recommended that the quantitative variables be given less importance in the pilot study, as presented in the method section. It is of the utmost importance to prioritise the prototype, its development and performance at the pilot study stage. It would be beneficial to ascertain which steps were used to develop the prototype.

Authors repeated the informatiom about the ethics committee (lines 148-149 and 150-152).

Please refer to the following suggested reference:Doi:10.35844/001c.32605.

Author Response

REVIEWER 1

Comments on the review

The authors appreciate all the reviewer comments

The objective of this study is to co-design and test a sustainable mHealth intervention prototype (mobile app) to promote active living among individuals over the age of 55. This will involve identifying the barriers and facilitators to active living. While the authors have addressed some of the comments raised in the first round of the review, it is still necessary to make substantial revisions to the methods and other sections in accordance with the comments. Further clarification is required on how the device was co-designed and the contribution of the community stakeholders.

Reply: We have improved the text at Methods and Results for the sake of clarity, regarding particularly on how the device was co-designed and the contribution of the community stakeholders.

Methods

A new section 2.2 Intervention Prototype has been added

Lines 133-140: “An iterative process was implemented to validate the mHealth intervention. The starting point was the evaluation of the first protype of the app designed by the re-search team. This protype recommended healthy routes according to the weather pre-diction and the real-time data on air quality. In the first meeting (June-2023), the community of stakeholders suggested enhancements and modifications, which were promptly incorporated by the research team to develop a refined second prototype. This iteration was followed by a second meeting (September-2023) wherein the stake-holders re-evaluated and endorsed the latest prototype.”

Results

Lines 183-186: “The enhancements proposed by the stakeholders primarily focused on improving the interaction between the application and its users. Consequently, features such as the collection of barriers and facilitators through images and voice notes, along with route rating functionality, were seamlessly integrated into the second prototype.”

 

A flow chart of the design process and the pilot analysis would provide a more detailed description of the method. Furthermore, the participatory methodology used for the development of the prototype should be described in greater detail. For instance, references 14 and 15 were not included in the methods section, which would have provided relevant information for the description of the process of device design. The following steps are proposed for consideration as an example:

1) Engagement and capacity building

2) Exploration and visioning

3) Visual and narrative

4) Mobilisation

5) Evaluation

Reply: A new Figure 1 has been added to the manuscript (page 4) with a flow chart of the design process.

Figure 1. Flow chart of the design process and the pilot analysis in Every Walk You Take initiative

This flow chart has been cited in Methods, section 2.1 Community of stakeholders

Lines 118-131: “Every Walk You Take started with the constitution of a community of stakehold-ers that acted as the steering committee of the project. Citizens, researchers, health professionals, health planners, policymakers, and teachers, familiar with the social and economic burden of aging in developed societies took part of this community that had representatives from both economically deprived and privileged areas of the city. The public-owned life-long learning centres of two deprived neighbourhoods of Barcelona (Trinitat Vella and Bon Pastor) were the executive offices of the project and meeting points for the community of stakeholders. They had the following responsibilities: (1) Project planning: supervision of the project management in periodic meetings and co-designing and prototyping the Every Walk You Take mHealth intervention addressed to promote active living; (2) Interpretation and awareness: discussion and interpretation of the data collected in the pilot study; (3) Reflection: remembering what worked properly during the study and what are the points for improvement and; (4) Legacy: co-designing and implementation of the communication strategy of the project (Figure 1).” 

It is recommended that the quantitative variables be given less importance in the pilot study, as presented in the method section. It is of the utmost importance to prioritise the prototype, its development and performance at the pilot study stage. It would be beneficial to ascertain which steps were used to develop the prototype.

Reply: The steps given to develop the protype has been detailed in Figure 1 and in Methods. In addition, we have added a new sentence in Results, section 3.2 Pilot study to highlight the formative sessions given to the citizen scientists (lines 201-202): “The research team gave a formative session in each long learning centre to get the citizen scientists familiar with the application and the data collection (EMAs).”

Authors repeated the information about the ethics committee (lines 148-149 and 150-152).

Reply: We have corrected the typo leaving one single message in the new version of the manuscript (lines 162-165): “All citizen scientists were duly informed and signed an informed consent to be involved in the study. The protocol of the study was approved by the Bioethics commit-tee of the University of Barcelona (#IRB00003099)”.

Please refer to the following suggested reference: Doi:10.35844/001c.32605.

Reply: We have added the proposed reference in lines 236-237: “In Every Walk You Take, to tackle the issue of underrepresentation of people from deprived areas, we focused our efforts within the economically disadvantaged Barcelona neighbourhoods of Trinitat Vella and Bon Pastor. In this context, community engagement strategies are crucial (Duea et al., 2022), as indicated in the Smart Framework, which integrates citizen science with community-based participatory research (Katapally et al., 2019).”

Author Response File: Author Response.pdf