Development and Pilot-Testing of a Patient Decision-Making Aid for Nutrition in Age-Related Macular Degeneration

Abstract

Objective We described the development and pilot-testing of an application based patient decision-making aid (PDA) for nutrition in age-related macular degeneration (AMD). Alpha-testing and beta-testing were performed to explore the PDA’s usability, acceptability, and comprehensibility in the design stage and in “real-life” conditions. Methods A nutrition PDA was developed in this study by a multidisciplinary steering committee that consisted of ophthalmologists, nurses, nutritionists, and methodologists using a systematic development process. The PDA was based on a smartphone native installation and a free-to-use app. First, based on information from literature reviews and focus group interviews for needs assessment, we developed a decision aid prototype. Second, we conducted the alpha testing to explore the acceptability, usability, and comprehensibility of the PDA prototype among 18 AMD patients. Third, a before/after study was conducted to assess changes in the attitudes, risk perceptions, intentions, knowledge, decisional conflicts, and decision self-efficacy of 33 AMD patients. Results The alpha test proved that the nutrition PDA is acceptable and usable. In the beta test, after the AMD participants used the PDA, their scores for knowledge [mean = 13.3, standard deviation (SD) = 2.92], attitude (mean = 18.97, SD = 2.19), decision self-efficacy (mean = 23.94, SD = 6.04), and preparation significantly increased (mean = 26.30, SD = 4.90), and their score for decisional conflict significantly decreased (mean = 10.15, SD = 3.66). There was no significant difference in anxiety (mean = 2.64, SD = 1.08) before and after the use of the PDA. The mean score in the system usability scale was above 70 (mean = 72.61; SD = 5.38), which indicates the good usability of the PDA. With regard to the PDA acceptability, the scores for satisfaction with its comprehensibility, satisfaction with its attractiveness, and satisfaction with its emotional support were 5.49 (SD = 1.03), 5.30 (SD = 1.40), and 4.91(SD = 1.07), respectively, which show its adequate acceptability. Conclusion Our study showed that the nutrition PDA was an acceptable and suitable instrument for AMD patients and fit the values of all its stakeholders. This study is an important step in supporting shared decision-making, which has the potential to provide a more patient-centered and value-based nutrition health system for individuals with different types of AMD.

Nurses’ Roles in mHealth App Development: Scoping Review

“…This was followed by the role of informant or SME (106/157, 67.5%) [ 32 - 37 , 39 - 41 , 43 , 46 , 49 , 50 , 52 - 56 , 58 - 61 , 63 , 64 , 67 , 69 , 72 - 75 , 77 , 79 - 81 , 83 - 86 , 89 - 91 , 93 , 95 , 98 , 99 , 102 , 104 , 106 - 110 , 113 , 114 , 116 , 119 , 121 , 123 - 127 , 129 , 132 - 134 , 137 - 139 , 141 , 146 , 148 - 160 , 162 - 171 , 173 - 175 , 177 , 178 , 181 , 182 , 184 - 188 ], designer or creator (31/157, 19.7%) [ 42 , 45 , 56 , 57 , 72 , 78 , 88 , 92 ,…”

“…Nurses served in different roles across different phases of development. The most common co-occurrence was a nurse acting as an informant or SME during the requirements gathering phase (88/157, 56.1%) [ 32 - 37 , 39 - 41 , 43 , 46 , 49 , 50 , 52 - 56 , 58 , 59 , 61 , 63 , 64 , 67 , 72 - 75 , 77 , 79 - 81 , 83 , 84 , 86 , 89 - 91 , 95 , 98 , 99 , 102 , 104 , 106 - 110 , 114 , 116 , 119 , 123 - 126 , 129 , 132 , 134 , 136 - 138 , 146 , 148 , 150 , 153 - 155 , 158 - 160 , 162 - 171 , 173 , 178 , 181 , 184 - 188 ], closely followed by acting as an evaluator during the design and prototyping phase (84/157, 53.5%) [ 32 - 34 , 36 , 37 , 39 , 41 , 43 ,…”

“…These apps were often in the early stages of development, although 26.1% (41/157) of the publications described multiple versions of the app [ 33 , 34 , 41 - 43 , 57 , 58 , 63 , 71 , 73 , 77 , 78 , 83 , 86 , 92 , 95 , 99 , 102 , 104 , 116 , 119 , 122 , 123 , 126 , 128 , 129 , 135 , 136 , 145 , 146 , 148 , 153 , 158 - 160 , 171 , 172 , 175 , 177 , 178 , 184 ]. Most commonly, the apps were the alpha or prototype versions (117/157, 74.5%) [ 32 , 33 , 35 , 37 , 39 - 43 , 45 , 46 , 49 , 51 , 52 , 55 - 58 , 60 , 61 , 63 , 65 , 67 , 68 , 71 , 73 - 75 , 77 - 80 , 83 - 88 , 90 ...…”