iMedicalApps and JMIR Publications have partnered to help disseminate interesting & innovative digital health research being done worldwide. Each article in this series will feature summaries of interesting studies to help you keep up to date on the latest in digital health research. We invite you to share your thoughts on the study in the comments section.

The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda

1. What was the motivation behind your study?

Mortality following hospital discharge is an important, but neglected, contributor to under-5 mortality in resource poor countries such as Uganda. Our research team has been working towards the development of prediction models to assist in identifying vulnerable children for the purpose of enhanced care following discharge. These models are mathematically complex and cannot be used to quickly identify these vulnerable children. The incorporation of these models into a simple mHealth application will allow front-line health workers to identify those children in need of additional care.

2. Describe your study.

The PARA app is an mHealth tool developed to aid health care workers in resource limited settings to identify pediatric patients at high risk of both in-hospital and post-discharge mortality. The intended users are Ugandan health care workers with varying levels of education and technological exposure, making testing of this clinical tool imperative to implementation. This usability study evaluated the PARA app among target users, which consisted of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool.

3. What were the results of the study?

The average time to complete the PARA app decreased by 30% following user feedback and modifications. Doctors and medical students had shortest task completion times, but all participants reported the usefulness of this tool to improve post-discharge outcomes. Participants proposed interventions for children identified by the PARA app as high risk of post-discharge mortality, which involved strengthening discharge and referral procedures within the current health care system.

4. What is the main point that readers should take away from this study?

Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly application, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. All participants (doctors, nurses, clinical officers) said they would use the PARA app if available at their health care facility.

5. What was the most surprising finding from your study?

The most striking area of this area of research is the very high rate of child mortality following discharge, with as many children dying following discharge as during admission. With respect to our application, we found very high adaptability of individuals with limited technological exposure. For example, some nurses who had never before used a tablet or medical application, who took upwards of 10 minutes to complete the app the first time, cut their completion time by 30% during their second try!

6. What are the next steps? How do you envision this work ultimately translating into clinical practice or affect R&D?

Our research has created predictive models to be able to identify children who are vulnerable to death following hospital discharge. We have now incorporated these models into the PARA mobile application and streamlined the user-centric design through this usability study. In the coming years, the PARA app will to be used by front-line health workers to identify, and intervene upon, vulnerable children. We aim for eventual scaling in the southwestern region of Uganda, and possibly elsewhere in Sub-Saharan Africa.

Matthew WiensThis Q&A was contributed by Matthew Wiens (@Matthew_Wiens), a postdoctoral fellow at the University of British Columbia. My primary area of research is in global health where I have been focusing on improving child health in Uganda. The focus of his research has been on post-discharge mortality. He has been working in Uganda to develop ways to (1) identify children who are likely to die after discharge and (2) develop ways to improve the health of vulnerable children following discharge.