Considerations for mHealth development: lessons learned from two diabetes education apps

Mobile health (mHealth) technologies offer promising tools for supporting behavior change and chronic disease management, yet the development of such tools remains complex and underexplored. While existing frameworks provide high-level guidance, they often lack practical detail, particularly regarding the logistics of app design and development with external vendors. This study addresses this gap by sharing lessons learned from the mHealth development process involving a multidisciplinary team. We report on the iterative process of re-designing, re-developing and re-evaluating two health education apps: Glow, for people living with type 2 diabetes, and WellFeet, for those at risk of developing foot ulcers. The development and evaluation followed a hybrid of two frameworks: Design Thinking framework and Rapid Application Development. The apps were evaluated in a co-design study, randomized controlled trial and a feasibility study. This report follows autoethnographic methods for data collection and analysis. The process of (re-)designing, (re-)developing and (re-)evaluating the apps yielded valuable insights in three areas: (re-)designing app features, adjusting to regulatory landscape, and synchronizing with the developer. (Re-)designing app features included improvements in tracking and gamification, notifications, and tailored education. Adjusting to the regulatory landscape occurred at the institutional, platform, and national levels. Effective synchronization with the developer required understanding and adapting to their workflow, improving testing protocols, and maintaining a strong rapport to navigate unexpected challenges. Key practice implications emerged: the need to clarify and adjust the project vision iteratively within multidisciplinary teams, and to approach this work with resilience, humility, and curiosity instead of authority. It is equally important to prepare for uncertainty and remain flexible, as evolving requirements and regulatory shifts can influence both product and project plans. In such environments, adaptability is not merely helpful-it is imperative.