Considering User Experience and Behavioral Approaches in theDesign of mHealth Interventions for Atrial Fibrillation:SystematicReview

Background: Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiaccomplications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in thedetection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider userexperiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence,hopefully, yield an increase in positive outcomes in the lives of users. Objective: This study aims to show how research has considered user experiences and behavioral approaches in designingmHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from theUK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, andimplementation.Methods: Studies published until September 7, 2022, that examined user experiences and behavioral approaches associatedwith mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred ReportingItems for Systematic reviews and Meta-Analyses) guidelines were used.Results: A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioralapproaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases ofthe UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identificationphase, there were significant differences between the needs of patients and health care workers. In the development phase, userperspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55,78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were notdesigned together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reportingon challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. Torealize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior changeapproaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at thelevel of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were foundintervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in thedesign of long-term behavioral interventions. Conclusions: In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRCframework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levelsof health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research