Exploring Conceptualizations of a Healthy Lifestyle and the Potential of Health Apps: Co-creation Workshops with Children, Parents, and Health Experts (Preprint)

BACKGROUND Digital interventions for childhood obesity prevention have potential to support healthy lifestyle behaviors, but real-world effectiveness is often limited by low engagement and poor alignment with children’s developmental needs and family contexts. Co-creation with end users and clinical stakeholders can generate actionable requirements to inform the design of age-tailored, acceptable, and scalable mobile health (mHealth) solutions. OBJECTIVE This study aimed to (1) elicit user requirements for a pediatric mHealth app to support healthy lifestyle behaviors relevant to overweight/obesity prevention and (2) examine how requirements differ across child age groups and stakeholder types (children/adolescents, parents, and health professionals). METHODS A total of 113 children and adolescents, 47 parents and 13 health experts participated in co-creation workshops as part of the BIO-STREAMS project. Children in each age group participated in two 90-minute workshops that were conducted between November 2024 and March 2025 across five European countries. Participants responded to questions regarding healthy lifestyle behaviors and were subsequently invited to articulate their vision for a potential health application. Two researchers analyzed the data using a thematic analysis approach. RESULTS Stakeholders described mHealth requirements that clustered into distinct but complementary domains. Children emphasized (1) practical health guidance (e.g., food and activity ideas), (2) personalization and goal support, (3) engaging and interactive features (e.g., gamification and feedback), and (4) accessible learning resources. There was clear age differences: younger children preferred concrete, routine-based guidance, while older adolescents more often referenced balanced lifestyle concepts, mindful decision-making, and mental well-being–related support. Parents prioritized (1) guidance and coaching features, (2) tracking that is flexible and not overly burdensome, (3) usability and comfort considerations (including oversight preferences), and (4) credible information sources and functionality expectations for family use. Health professionals highlighted (1) clinically meaningful monitoring and communication, (2) stigma-sensitive and developmentally appropriate feedback, and (3) considerations for managing and governing digital health platforms used in pediatric obesity prevention. CONCLUSIONS The presented co-creation with children, parents, and clinicians produced actionable requirements for designing an age-tailored pediatric mHealth intervention for obesity prevention and to support relevant healthy lifestyle behaviors. Findings support a multi-actor approach (child-, parent-, and health expert-relevant views), strong personalization, and engagement-focused interaction design, while addressing usability, burden, and appropriate oversight to facilitate adoption in real-world family and clinical contexts. CLINICALTRIAL The study was registered at ISRCTN (ISRCTN44876661, registered on 23/04/2025)