Engaging Stakeholders in the Iterative Development of an Air Quality App to Improve Asthma Control

Introduction: Poor air quality can trigger asthma exacerbations, but existing mobile applications lack forecast capabilities. Developing an app that can alert people with asthma to upcoming pollution episodes requires effective stakeholder engagement. Methods: A multidisciplinary research team of app developers (n=3), eHealth experts (n=5), air quality experts (n=7), and clinicians (n=6) collaborated using the Agile Development Framework. The development process involved iterative testing and refinement, starting with team discussions to determine app requirements. A stakeholder engagement session involving 12 researchers and 6 patients helped fine-tune the app features. Alpha testing was conducted internally, followed by external testing with stakeholders (13 researchers, 4 patients). Beta-testing was then conducted with 30 users before the app was released. Results: Key requirements identified during the initial internal discussions were air quality forecasts (generated by the ADMS-Urban model), symptom monitoring, educational materials and emergency alerts. Stakeholders additionally emphasised the importance of weather information, particularly temperature, leading to its incorporation into the app. Stakeholders wanted a 7-day forecast valid over a wide area, but based on our prior work, the app could only provide a locally accurate 2-day air quality forecast. Stakeholders’ feedback during the external testing highlighted the need for customisation options for notifications, integration with phone calendars and a personalised interface. Subsequent beta-testing led to further refinements. The challenges encountered were balancing functionality with data consumption and ensuring privacy without location tracking. Mindful of our plans for a pilot randomised controlled trial, we decided to exclude some additional desired features (e.g. a ‘super-app’ for asthma, educational materials and asthma action plan) which would have affected outcomes. Discussion: Stakeholder engagement and feedback are vital for the air quality app development. The main challenge was to strike a balance between stakeholders’ wishes and maintaining a focused app for future testing. Funding: This research was funded by the UK National Institute for Health and Care Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); NIHR132826) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Government.