Parent priorities and perceptions of impact: co-design of an mHealth app with parents for managing their child’s illness.

Introduction Patients under 18 have more than 150% as many avoidable visits to the emergency department as other age groups. Parent education has been identified as a key factor in decreasing avoidable hospital visits. While conventional means of parent education have been ineffective, apps have been shown to increase engagement, improve health outcomes, reduce health disparities, and reach diverse populations. In this study, we translated findings from two parent co-design studies, a survey and focus group, into app development priorities. Our aims were to (1) rxplore which app attributes influence parents’ perceptions of an app’s potential for real-world impact, and (2) identify app development priorities by understanding how different app attributes are valued and perceived by parents. Methods We carried out a survey and focus group. In the survey, parents (n=26) were asked to evaluate a commercially available app, Baby and Child First Aid, for parents managing children’s illnesses and injuries, and answer a set of six questions to share their perceptions of the types of impact generated from using the app. In the focus group (n=9), parents were asked about their app use experiences and preferences. The survey and focus group were analyzed separately using thematic analyses. The results of these two analyses were compared, synthesized, and approached through the lens of the User Experience Honeycomb to suggest an initial set of prioritized app features for development. Results Parents perceived the app as most impactful to their knowledge of appropriately treating child illnesses (Mean 4.2/5, SD 1.1), and least impactful to attitudes (Mean 3.5/5, SD 1.12). Paired t-tests between parents’ perceptions of impact type showed parents perceived the app to impact knowledge significantly more than it impacted awareness (P=0.031), help seeking (P=0.008), intention to change (P<0.001) and attitudes (P<0.001), but not significantly different from behaviour change (P=0.057). Qualitative thematic analysis of the survey identified six themes to increase perceived impact including concise and actionable information, knowledge quizzes, and app visibility. Five focus group themes examining parent priorities for app development identified that parents were embedded in communities of trust, suggested the app focus on actionable information, and highlighted widgets as a means of expediting care. Three development priorities were identified from examining these findings using the User Experience Honeycomb: usefulness, accessibility, and findability. Conclusion Parents prioritized app usefulness, accessibility, and findability. Usefulness involved presenting all KT tools as core elements of the app, and designing the app with features to make use of the KT tool information. Accessibility prioritized enabling parents to communicate symptoms without an underlying literacy requirement. Findability translated to a dissemination strategy that presented parents with the app in multiple contexts. Taken together, this app will help parents find the right health information, engage effectively with the KT tools, and take evidence-supported steps for their children's health.