Theory-Based Problem Formulation and Ideation in mHealth: Analysis and Recommendations

Introduction

The background context of the research reported in this paper is that melanoma has become the third most prevalent cancer in Australia (Welfare, 2019) and is a significant cancer worldwide. As global warming and sun strength continue to advance, melanoma rates may rise both in Australia and worldwide. Although progress in treatment in recent years has led to increased survival (Moser & Meunier, 2014), survivors still have a high risk of recurrence, which remains constant regardless of the length of time from initial diagnosis (Jones et al., 2016). This necessitates a life-long vigilance of the patient’s skin, through self-checks and clinical based monitoring (Shead et al., 2018). However, several studies (Bowen et al., 2012; Glenn et al., 2017; Mujumdar et al., 2009) have found that only approximately a third of survivors tend to regularly carry out this preventative after-care.

mHealth is the utilisation of a mobile device to provide support within the healthcare domain (Hallberg & Salimi, 2020). mHealth is being applied to several domains, including chronic disease management and improving fitness, with the latter being the most common mHealth app (Korzh et al. 2019). mHealth research largely works to solve problems in the problem domain of healthcare such as accessibility to information and disease management (Jupp et al., 2018).

mHealth research, which aims to solve health-related problems through developing a new mHealth app, clearly fits within the Design Science Research (DSR) paradigm. DSR “requires the creation of an innovative, purposeful artifact for a specified problem domain” (A. R. Hevner et al., 2004); a new mHealth solution is such a purposeful artefact. While the objective of the project reported in this paper is to improve skin check adherence, provide patient empowerment through education, and support chronic disease management, the specific scope of this article is to report on a novel approach for the problem formulation and ideation stages of the broader mHealth research project.

The overall mHealth project follows the Action Design Research (ADR) methodology (Sein et al., 2011). Like most DSR, the ADR methodology (Sein et al., 2011) requires the researcher to undertake problem formulation, to understand the problem, set the scope of the research, and ideate features for the solution to be developed. Comprehensive problem formulation must be undertaken to ensure that a DSR mHealth project has a solid foundation. It is this initial stage upon which the rest of the project will be built and, if done without proper rigor, risks compromising the success of the final outcomes. ADR’s explicit problem formulation stage articulates both principles and tasks to be performed. However, it is a problem that stating activities and principles does not necessarily equate to them being performed and followed faithfully. It is a problem in the design of a DSR methodology (in this case, ADR) that guidance may be insufficient or omit aspects of problem formulation, which can potentially compromise success.

In accordance with ADR, the overall project aims to develop and evaluate a “theory-ingrained artifact¹” i.e., an mHealth mobile application whose design is based on or informed by extant theory. However, the problem formulation must also account for knowledge not yet incorporated into theory, including aspects of the problem discovered during the research and the needs of stakeholders, especially the often rich and complex needs of mHealth users. It is within this context that the authors have been conducting the first stage of ADR; Problem Formulation, and the tasks associated with it (Sein et al., 2011), which prompts questions about how to effectively undertake problem formulation in ADR and other DSR methodologies.

This paper addresses two research questions:

• RQ1: “How are problem formulation and ideation currently performed in published DSR/ADR mHealth projects?”

• RQ2: “How can problem formulation and ideation be performed better (more rigorously and with better ideation outcomes) in DSR/ADR mHealth projects?”