Actify! A smoking Cessation App for Fred Hutch

Research

We combed through scientific research papers and worked closely with Fred Hutch to understand the foundation of the Behavioral Activation Treatment in smoking. With Behavioral Activation therapy for depression, we help users identify values that are important to them and complete activities that align with those values to elevate their mood, which then makes it easier to quit smoking and help replace smoking with healthier habits.

‘Sometimes it’s difficult to want to do anything with a low mood, but completing activities that are important to us helps rewire our brain to feel better.’

Restructuring the original program into the App

The original in-person program consisted of a structured format of activity monitoring, setting a quit date, identifying valuable life areas and creating activities around it, monitoring progress and creating strategies around high-risk situations that spanned between Week 1 to Week 5-8. We wanted to ensure that these phases were accessible to the users of the app without the pressure of responsibility and accountability in having to follow the structure the same way they would if they were taking it in-person in a clinical setting. We thought about simplifying the app and started by identifying the key areas of the in-person therapy

Key Areas of In-Person Therapy:

• Maintain an account of daily activities and document smoking related behaviors

• Designate a quit date

• Identify life areas and personal values to create mindful activities around them

• Monitor progress on a daily basis and work with the therapist to address problem areas and possible regression

• Learn strategies to combat high-risk situations (events when the need to smoke is greater)

• Receive support & monitoring to adjust to life as non-smoker

We identified that the app program would need to allow users to begin thinking about their values, identify meaningful activities around them and access important supporting resources early on. We wanted to enable the app users to set a quit date according to their comfort level ascertained based on the guidance and resources they receive when they set up their app. An app would provide several benefits to its users such as flexibility and control, but we understood that an app can also feel impersonal in comparison to a personal therapist who may play the role of a guide. Hence we wanted to ensure that the app feels encouraging and supportive in leading the user towards their goal rather than feeling overbearing and judgemental.

Key Features of the App:

• Receive guided introduction to the process, the role of personal values and activities at onboarding

• Set a quit date that can be changed if and when necessary

• A quick access to scheduling activities around the chosen life areas and values

• Progress tracking and milestone celebrations

• Access to community stories, quit guide and relapse prevention support

Preliminary Usability Test

We created low fidelity wireframes of the flow using the key features as a starting point. We conducted quick guerrilla testing of the screens to learn if participants understood the nature of the app and if they found value in using it. Our findings showed that while the participants understood the purpose of the app they were unsure of how creating and tracking activities might help them reduce their smoking behavior. They also felt overwhelmed when presented with the dashboard. Most of them were unsure of what they might need to do next. We realized that a more hand held guidance might be necessary during onboarding and the initial days of using the app.

Design Iterations and Testing

We partnered with University of Washington graduate students taking a user research course to assist in testing the onboarding to better understand how users think when interacting with the app. We tested out the next iteration with a more structured onboarding and guidance. We created an outline of key questions we wanted to answer such as ‘how might we maximize the utility of the Dashboard navigation’, and ‘how might we encourage users to schedule and complete activities’, before moving into the next step of designing.

Participants:

• Nicotine smokers between 18 and 55

• Have smart phones, and familiar with using apps

• Mixed prior attempts to quit smoking, with 2 participants previously trying smoking cessation apps

Methods:

Usability Test - In-person session to complete tasks and provide feedback upon each step

Desirability Test - Which words best describe your experience with the app

Participatory Design Activity - What might help you stay engaged with the app?

Findings

The findings showed us that the general navigation through onboarding was easy to follow, but there were several areas that needed simplification and clarity

• The guided onboarding although helpful felt lengthy

• The dashboard felt overwhelming

• The relationship between life areas, values, activities, and smoking cessation was ambiguous

Participants also described the app as personal, useful, easy, comfortable, but also annoying, irrelevant, and busy. We used participatory designing methods with our test participants to gather deeper insights into where gaps existed in the current design and how those could be improved. The method led us to several useful features such as

• Additional metrics to show progress and view smoking behavior over time

• Suggestion on activities to try to remove initial barrier or scheduling activities

• A visual display of upcoming activities

Funding & Partnership with Development Agency

As the project advanced, Fred Hutch also acquired a research grant to fund the development of the app. We partnered with Moby, a Seattle-based development firm to help with the branding and implementation of our App. We had also grown considerably in size, adding two more designers to our team and running cross-organisational as well as cross-disciplinary collaborations between the Fred Hutch Research team, Moby - the development team and our team of volunteer designers and UX researchers from both Salesforce and University of Washington.

We provided the foundational criteria for the Visual Design and the UX flows as Moby helped us with the visual polish and implementation of the Fred Hutch app that we call Actify! We worked closely with the agency to improve the final flows and ensured that the screens followed accessibility standards set by the WCAG guidelines at the component level.

We wanted the app to feel…

• Non-judgmental

• Welcoming

• Inclusive

• Positive

• Calming yet action-oriented

• Friendly but professional

• Inspirational

App Development

Onboarding

• Provide guidance to learn more about how the program works, with the ability to skip through

• Collect smoking behavior information from the get go

• Introduce daily to-dos showing resources and upcoming tasks

Dashboard

• Show progress of smoking cessation, quit date, money saved

• Provide guidances to users around why life areas and values are important and how to think about scheduling meaningful activities within those areas

• Track upcoming activities, with the ability to reflect and rate importance and mood upon completion

Quit Guide & Inspiration

• Surface Quit Guide content throughout the program in daily to-dos and check-ins, which can also be accessed in the Quit Guide tab

• Inspire users with with stories and quotes of previous smokers who have quit using behavioral activation therapy treatment

Milestones & To-dos

• Encourage users to return to the app and check in each day with daily to-dos, which include their scheduled activities and a daily smoking behavior check-in

• Show streaks and milestones of the smoking cessation journey and progress

Diary Study

We launched a pilot diary study with the beta version of the App involving 6 smokers to track adherence, bugs and general usability.

• Though the motivation to quit smoking was generally similar as before and after the program, the confidence of quitting within the next 30 days increased from an average of 7.2 to 8.4 on a scale of 10.

• Most participants appreciated the guidance information provided within the app and reported a change in the smoking behavior

• One participant requested that the app be used in combination with a patch in order to be successful

• A few technical issue and bugs made parts of the app tricky to use

At the end of the study, we assimilated the findings and worked with Moby to address the general issues and bigs within the app. Currently the Fred Hutch team is leading a year long pilot clinical trial to test the Actify! App with over 240 participants.