Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage

Abstract

BackgroundPre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter.ObjectiveThe aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system.MethodsDevelopment of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town.ResultsAfter ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec).ConclusionsBy including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway.

Designing a Pregnancy Care Network for Pregnant Women

“…None of the applications such as [4,[21][22][23][24] or applications that already exist on Microsoft, Google Play or Apple stores on maternal health issues have all four of the major functionalities of PCN (listed below).…”

“…PCN focuses on personalized information where data in the client application can also be browsed and searched in a sequential manner, but intelligent techniques will be used to bring forward the most relevant topics automatically to women according to their pregnancy stage and health conditions. Similarly, the applications such as [4,[21][22][23][24] do not provide this functionality.…”

“…PotM, a mobile health application [22,23], was developed to assist health professionals in the management of pre-eclampsia. PotM was a decision-based model that integrated the risk prediction of adverse maternal outcomes associated with pre-eclampsia with the recommendations of WHO for the management of pre-eclampsia.…”

“…It will work as maternal health indicators for policymakers and health officials. This functionality is available in a limited form in [4,[21][22][23][24], while not available in applications on the Microsoft, Google Play or Apple stores.…”

Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review (Preprint)

“…Full-text publications were obtained of the resulting 20 articles. 9 of them were excluded due to the following reasons: different population group (pregnant women without hypertensive disorders or postpartum women) [76][77][78]; other disorders (gestational diabetes mellitus) [79], [80]; the same m-Health solution [81][82][83][84]. Finally, data extraction was performed on the final 11 included articles.…”