BACKGROUND
Children with a history of in-utero opioid exposure have an increased risk of abnormal brain development and various developmental and academic challenges. Mobile device use is widespread in medicine.
OBJECTIVE
To develop and refine an app-based tool for community pediatric care providers to facilitate evidence-based screening and referral to local developmental specialists in infants and children with neonatal abstinence syndrome (NAS).
METHODS
In phase 1: conceptualization and planning, we partnered with a local software development firm to translate the desired app input and output into a user-responsive prototype version of the “Connecting Care for NAS” tablet-based app for iOS systems. In phase 2: user feedback and refinement, we conducted focus groups to obtain feedback on app prototype design, usability, and content and summarized feedback using thematic analysis. In phase 3: app development: beta version, we used focus group feedback to guide the prototype app modifications. In phase 4: validation and field testing, providers from 2 different clinical primary care settings participated in real-time beta testing. We used pre- and post-testing and weekly questionnaires via REDCap to assess knowledge base, app use, usability, and solicit other feedback.
RESULTS
In phase 1, we developed an app and unique risk algorithm to calculate areas of possible developmental concern based on exposures and perinatal variables; developmental resources available for app-identified issues were provided through an extensive local database. In phase 2, we completed 2 focus groups with 20 providers in total, identifying 6 major themes from the feedback: 1) input, 2) app screen organization and flow, 3) output, 4) dynamic family and living environment, 5) link with EHR, and 6) workflow integration. In phase 3, we translated focus group feedback into actionable changes for app features and design, producing the app’s beta version. In phase 4, 19 clinical providers completed real-time beta testing from February to July 2021. On average, each provider entered 1.7 patients into the app per week. Eighty-four percent reported that with regular use, it took 1-3 minutes to navigate through the app for 1 applicable patient. Provider self-reported confidence level in knowledge of developmental outcomes after NAS increased from the pre- to post-beta testing questionnaire for all developmental domains.
CONCLUSIONS
Participants reported the app was easy to navigate and added little extra time to their clinical workflow for applicable patients, indicating the app is a potentially useful tool for developmental surveillance in an at-risk population.