Mixed-Methods Evaluation as Scaffold to the Development of a Mobile Health Application to Support the Prescription of Wheelchairs and Postural Support Devices (Preprint)

Abstract

EasySeating is a mobile health (mHealth) app that supports the prescription of wheelchair and postural support devices (WPSD). It can be used by occupational therapists (OT) and physiotherapists (PT) who prescribe WPSD. The app offers a standardization of the prescription procedure, showing images, metrics and details that guide the prescriber to decide on the best equipment. It was developed with an iterative mixed-methods evaluation approach. Objective: The aim of this study was to investigate the processes involved in the prescription of WPSD and to propose, develop and evaluate a mHealth to support OT and PT prescribers.

The aim of this study was to investigate the processes involved in the prescription of WPSD and to propose, develop and evaluate a mHealth to support OT and PT prescribers.

This study was divided into three phases and was carried out as an iterative process composed of user consulting/testing (using a mixed-methods evaluation approach), system (re)design and software development. The first phase consisted of the collection of qualitative and quantitative data to map and understand the users requirements and of the development of the first prototype (v1) of the app. This data collection was performed through semi-structured interviews with 14 OT and PT prescribers, 5 specialized technicians and 5 WPSD users. The second phase aimed at improving the overall functionality of the app and consisted in the development, test and evaluation of the prototypes v1, v2, v3 and v4. A total of 59 prescribers tested and evaluated these prototypes by means of open interviews, semi-structured questionnaires and focus groups. The third phase focused in the usability aspects of the app. It consisted in the development and test of the prototype v5. Eight technology specialists assessed its usability through heuristics evaluation.

Data collected in phase one indicated there is a lack of standardization on the prescription of postural support devices (PSD). A divergent nomenclature for the PSDs was also found and classified in eight categories. These information guided the development of the first prototype of the EasySeating app. Phase two results pointed that the prescribers value the insertion of the app into their clinical practice, as it accelerates and increases the quality of the evaluation process and improves the organization of the prescription information. Significant suggestions for the improvement of the app were given during the users tests, including the use of images to represent the PSDs. The usability tests from the third phase revealed two strong issues that must be solved: the need of greater feedback and failures in the persistence of the input data.

This study demonstrated that there is a lack of systematization of the WPSD prescription process. The evaluation of the developed EasySeating app demonstrated that there is a potential to standardize, integrate and organize the WPSD prescription information, supporting and facilitating the decision making process of the prescribers.

This study was approved by the Research Ethics Board of the Universidade de São Paulo (registered protocol n°53929516.6.0000.0065) URL - http://plataformabrasil.saude.gov.br/login.jsf