Juliane Ort

Juliane Ort

Master's Thesis

Enhancing User Engagement in a Breast Cancer Prevention App: User-Centered Design Features to Promote Preventive Behavior


Madeleine Flaucher (M. Sc.), Michael Nissen (M. Sc.), Prof. Dr. Björn Eskofier , Dr. Ing. Heike Leutheuser


06 / 2023 – 12 / 2023


Breast cancer is the most common cancer in women worldwide, with 2.26 million new cases diagnosed in 2020 [1]. Based on current incidence rates in Germany, approximately one in eight women will develop breast cancer during her lifetime [2]. Early prevention strategies play a critical role in the early detection of malignant cells in breast tissue. Due to the introduction of mammography screening for women between the ages of 50 and 69, the mortality rate for late-stage breast cancer in Germany has steadily declined in recent years [3]. Nevertheless, it is critical to focus on a multifaceted approach to reduce risk factors for breast cancer through interventions in young and middle adulthood [4]. Therefore, further efforts are needed to raise awareness of breast cancer prevention and educate the public about risk factors in order to reduce the morbidity mortality rates associated with breast cancer [5]. The emergence of mobile health (mHealth) applications has opened up convenient access
to essential health information and services and empower individuals in managing their health. However, ensuring user engagement is crucial for the success of these interventions. Without sustained engagement, the effectiveness of mHealth applications in motivating people to adapt health behaviors may be limited [6]. Therefore, behavior change techniques have been incorporated into mHealth to create digital behavior change interventions. With this, user participation and engagement could be increased [7]. Surprisingly, most commercially available breast cancer apps have not prioritized the integration of behavior change techniques, despite their potential to improve public health [8]. As part of the DigiOnko project, a study app is being developed to improve the early detection and prevention of breast cancer. One aspect of this involves actively educating patients and raising their awareness [9]. Given the one-year duration of the study, it is important to promote user engagement within the app as well as motivate users to engage with behavior change techniques [10]. Therefore, this thesis aims to integrate theoretical techniques and practical insights of user experience (UX) design to improve user engagement with the DigiOnko study app. The existing UX design will be further developed through a user-centered design process. Consequently, the research objectives of this study are to determine important user engagement factors for digital behavior change interventions in mHealth, explore user preferences for engagement in a breast cancer prevention app and evaluate design features that enhance use engagement in the DigiOnko study app.


[1] Ferlay J, Ervik M, Lam F, Colombet M, and Mery L. Global Cancer Observatory: Cancer Today., 2020.
[2] Zentrum für Krebsregisterdaten. Krebs in Deutschland für 2017/2018. Technical Report 13, Robert Koch-Institut, Berlin, 2021.
[3] Joachim Hübner, Alexander Katalinic, Annika Waldmann, and Klaus Kraywinkel. Longterm Incidence and Mortality Trends for Breast Cancer in Germany. Geburtshilfe und Frauenheilkunde, 80(06):611–618, June 2020.
[4] Signe Borgquist, Per Hall, Isaac Lipkus, and Judy E. Garber. Towards Prevention of Breast Cancer: What Are the Clinical Challenges? Cancer Prevention Research, 11(5):255–264, May 2018.
[5] Global breast cancer initiative implementation framework: assessing, strengthening and scaling up of services for the early detection and management of breast cancer, 2023.
[6] Heather Cole-Lewis, Nnamdi Ezeanochie, and Jennifer Turgiss. Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions. JMIR Formative Research, 3(4):e14052, October 2019.
[7] Marianne Holdener, Alain Gut, and Alfred Angerer. Applicability of the User Engagement Scale to Mobile Health: A Survey-Based Quantitative Study. JMIR mHealth and uHealth, 8(1):e13244, January 2020.
[8] Kerstin Kalke, Tamar Ginossar, Joshua M Bentley, Hannah Carver, Sayyed Fawad Ali Shah, and Anita Y Kinney. Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis. JMIR mHealth and uHealth, 8(1):e14082, January 2020.
[9] Medical Valley EMN e. V. DigiOnko.
[10] Paula Voorheis, Albert Zhao, Kerry Kuluski, Quynh Pham, Ted Scott, Peter Sztur, Nityan Khanna, Mohamed Ibrahim, and Jeremy Petch. Integrating Behavioral Science and Design Thinking to Develop Mobile Health Interventions: Systematic Scoping Review. JMIR mHealth and uHealth, 10(3):e35799, March 2022.