The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda

Lauren Lacey English, Dustin Dunsmuir, Elias Kumbakumba, John Mark Ansermino, Charles P Larson, Richard Lester, Celestine Barigye, Andrew Ndamira, Jerome Kabakyenga, Matthew O Wiens, Lauren Lacey English, Dustin Dunsmuir, Elias Kumbakumba, John Mark Ansermino, Charles P Larson, Richard Lester, Celestine Barigye, Andrew Ndamira, Jerome Kabakyenga, Matthew O Wiens

Abstract

Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation.

Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool.

Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children's Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient's risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements.

Results: The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system.

Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes.

Keywords: Africa; infectious disease; mHealth; postdischarge mortality; prediction model; resource-limited settings; risk assessment; usability.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PARA app modifications to the Oxygen Saturation and Summary pages from Phase 1 to Phase 2.

References

    1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet. 2015 Jan;385(9966):430–440. doi: 10.1016/S0140-6736(14)61698-6.
    1. Wiens MO, Pawluk S, Kissoon N, Kumbakumba E, Ansermino JM, Singer J, Ndamira A, Larson C. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS One. 2013;8(6):e66698. doi: 10.1371/journal.pone.0066698.
    1. Wiens MO. University of British Columbia. 2015. [2016-01-26]. Childhood mortality from acute infectious diseases in Uganda: Studies in sepsis and post-discharge mortality (doctoral dissertation) .
    1. Wiens MO, Kumbakumba E, Larson CP, Ansermino JM, Singer J, Kissoon N, Wong H, Ndamira A, Kabakyenga J, Kiwanuka J, Zhou G. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open. 2015;5(11):e009449. doi: 10.1136/bmjopen-2015-009449.
    1. African Health Observatory. 2015. Mobile health: Transforming the face of health service delivery in the African Region
    1. Crul S. Deloitte. 2014. [2016-01-26]. The mHealth Opportunity in Sub-Sahara Africa: The path towards practical application .
    1. Uganda Communications Commission. 2014. [2015-10-22]. Facts and Figures .
    1. Bastawrous A, Armstrong MJ. Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature. J R Soc Med. 2013 Apr;106(4):130–142. doi: 10.1177/0141076812472620.
    1. Dunsmuir D, Petersen C, Karlen W, Lim J, Dumont G, Ansermino J. The Phone Oximeter for mobile spot-check. Anest Analg; 2012 Society for Technology in Anesthesia Annual Meeting; January 18-21, 2012; Palm Beach, FL. 2012. p. 26.
    1. Karlen W, Dumont G, Petersen C, Gow J, Lim J, Sleiman J, Ansermino J. Human-centered Phone Oximeter interface design for the operating room. HEALTHINF; International Conference on Health Informatics; 2011; Rome, Italy. 2011. pp. 433–438.
    1. Adair-Rohani H, Zukor K, Bonjour S, Wilburn S, Kuesel AC, Hebert R, Fletcher ER. Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability. Glob Health Sci Pract. 2013 Aug;1(2):249–261. doi: 10.9745/GHSP-D-13-00037.
    1. Petersen C, Görges M, Dunsmuir D, Ansermino J, Dumont G. Experience report: Functional programming of mHealth applications. University of British Columbia; 18th ACM SIGPLAN International Conference on Functional Programming; 2013; Boston, MA. 2013. p. 357.
    1. GitHub. [2015-09-01]. LNhealth
    1. Nielsen J, Landauer T. A mathematical model of the finding of usability problems. INTERACT '93 and CHI '93 Conference on Human Factors in Computing Systems; 1993; New York, NY. 1993. pp. 206–213.
    1. Daniels J, Fels S, Kushniruk A, Lim J, Ansermino JM. A framework for evaluating usability of clinical monitoring technology. J Clin Monit Comput. 2007 Oct;21(5):323–330. doi: 10.1007/s10877-007-9091-y.
    1. Lewis Jr. IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use. International Journal of Human-Computer Interaction. 1995 Jan;7(1):57–78. doi: 10.1080/10447319509526110.
    1. Lim J, Cloete G, Dunsmuir DT, Payne BA, Scheffer C, von DP, Dumont GA, Ansermino JM. Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage. JMIR Mhealth Uhealth. 2015;3(2):e37. doi: 10.2196/mhealth.3942.
    1. Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014;14:188. doi: 10.1186/1471-2458-14-188.
    1. Auger KA, Kenyon CC, Feudtner C, Davis MM. Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review. J Hosp Med. 2014 Apr;9(4):251–260. doi: 10.1002/jhm.2134.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa