Stakeholder groups

3.1.1 Public Health department

Several meetings were conducted with staff from Public Health Warwickshire regarding the development and use of a mHealth app to complement their existing family weight management services (Section 1.5). Hence, the methodology drew on an intervention mapping approach (Bartholomew et al., 2011) with regards to the importance of stakeholder involvement. Public Health Warwickshire were important stakeholders in this research and ensuring they were fully on board from the start and throughout the intervention development process, will help to increase the likelihood of an intervention being used once developed (Wallace et al., 2014).

Stakeholder discussions led to decisions to focus on parents of overweight children as the main target population, wherein the majority of the study participants were recruited from two local family weight management programmes (69%). In

67 addition, the decision was made to target parents with children above the age of 5 years old where current local public health resources were lacking.

3.1.2 Participant groups

Prior to recruiting parents, a focus group (FG1) was conducted with Change4life advisors as a way of scoping the problem and allowing: (i) familiarisation with the context of childhood obesity; and (ii) a ‘preliminary theoretical explanation’ to help guide decisions regarding questions to focus on with parents (see section 3.4.3).

Focus groups conducted with parents comprised of those with overweight children recruited from the weight management programmes (FG2, FG3, FG4, FG5, FG7, FG8 and the usability workshop) and those with healthy weight children (although some of them were classed as overweight) recruited from the university (FG6, FG9), to help extend the applicability of the app to other parent populations. This was mainly guided by the rationale that the app can be used in childhood weight management including both the prevention and the treatment of childhood

overweight and obesity. Participants of the Think Aloud study were recruited from the university and comprised students and staff.

As shown in Figure 6 below, the thesis drew on the data collected in three empirical studies comprised of nine focus groups (studies one and two), one workshop and one Think Aloud study (study three).

68 Figure 6: Overview of study plan

3.1.3 Consultations with experts

Expert opinion was sought and obtained for each of the research objectives (section 2.9.1) and throughout the app development process from a wide range of disciplines.

3.1.3.1 Experts in childhood weight management

For the first part of objective (i) experts were consulted to help identify which nutrition behaviour(s) to target in the intervention. Consultations took place alongside the first three focus groups so that parents’ acceptability for this target behaviour could also be gauged from focus group discussions. Four face to face meetings took place involving: (1) a paediatrician from the Division of Metabolic and Vascular Health, along with a community dietician both from the University Hospital Coventry and Warwickshire NHS Trust; (2) a public health specialist in childhood obesity from The University of Warwick; (3) a children, learning and

69 achievement consultant from the Healthy School, Learning and Young People's Directorate, Coventry City Council; and (4) a family lifestyle officer from Rugby Borough Council. Experts were asked for their views on what particular nutrition behaviours were contributing most to children’s weight gain.

3.1.3.2 Experts in health behaviour change

For the second part of objective (i), which concerned the identification of theoretical components to target in the intervention, expert advice was obtained to: (i) advise on how to select data (e.g. codes) to focus on in the intervention; (ii) ensure findings from the focus groups had been coded under the relevant TDF and COM-B domains and; (iii) ensure appropriate mapping of TDF components to relevant intervention functions and behaviour change techniques (Sections 6.3.1 and 6.5.1). Several face to face meetings, email communications and telephone calls took place with a chartered psychologist, specialised in behaviour change, at UCL Centre for

Behaviour Change, University College London and a health psychologist specialised in behaviour change and eHealth, from the Centre for Technology Enabled Health Research (CTEHR) Faculty of Health & Life Sciences Coventry University.

3.1.3.3 Expert in user-centred design (UCD)

For objective (ii), the project sought advice from an expert in UCD from

Loughborough Design School, Loughborough University with regards to the process of conducting UCD approach to mHealth development. In particular, advice was given before conducting focus groups regarding key literature and design models to draw on during the research process.

70 3.1.3.4 Experts in app design and development

For objective (iii), expert advice was obtained from the app company (Virtually Free ltd) in regards to the concept design and technical development of the app.

Therefore, the app company was consulted at key stages in the research process including: (1) after data analysis to help make decisions on what is amendable to change in an app (Section 6.2); (2) to help with translating behaviour change techniques into potentially engaging app features (Section 6.6.1 & 6.6.2); and to develop a conceptual specification to help foster communications on what

amendments need to be make before the prototype app is developed (Section 6.5.5). Consultations took place via face to face meetings, Skype video calls, telephone calls and email communications.

3.1.3.5 Experts in nutrition

A dietary steering board was convened to receive advice for the dietary content of the app. A working relationship was established with two dieticians, working for South Warwickshire NHS Foundation Trust, and a family lifestyle officer, with a background in nutrition, working for Rugby Borough Council. This involved email communication and several face to face meetings. Advice was sought and obtained at key stages in the research including: (1) to provide recommendations of age appropriate portion sizes (Section 7.1.4.1; Table 17); (2) to review portion guide artwork (Section 7.5); (3) to review the nutritional information in quiz (Appendix 4D); and (4) to review and make suggestions for tips on portion control (Appendix 4E).

3.1.3.6 Consultation with an expert in usability evaluation

A meeting took place with a Knowledge Transfer Specialist, to advice on the process of evaluating the usability of the prototype app. It was recommended that a

71 ‘cognitive walkthrough’ (referred to in this thesis as ‘task scenarios’, Section

8.4.4.1.1) document was developed to indicate a chronological list of tasks required to use the app to measure and log portion sizes.