Abstract
Background mHealth apps may be useful tools for supporting chronic disease management.
Objective Our aim was to apply user-centered design principles to efficiently identify core
components for an mHealth-based asthma symptom–monitoring intervention using patient-reported
outcomes (PROs).
Methods We iteratively combined principles of qualitative research, user-centered design,
and “gamification” to understand patients' and providers' needs, develop and refine
intervention components, develop prototypes, and create a usable mobile app to integrate
with clinical workflows. We identified anticipated benefits and burdens for stakeholders.
Results We conducted 19 individual design sessions with nine adult patients and seven clinicians
from an academic medical center (some were included multiple times). We identified
four core intervention components: (1) Invitation—patients are invited by their physicians.
(2) Symptom checks—patients receive weekly five-item questionnaires via the app with
48 hours to respond. Depending on symptoms, patients may be given the option to request
a call from a nurse or receive one automatically. (3) Patient review—in the app, patients
can view their self-reported data graphically. (4) In-person visit—physicians have
access to patient-reported symptoms in the electronic health record (EHR) where they
can review them before in-person visits. As there is currently no location in the
EHR where physicians would consistently notice these data, recording a recent note
was the best option. Benefits to patients may include helping decide when to call
their provider and facilitating shared decision making. Benefits to providers may
include saving time discussing symptoms. Provider organizations may need to pay nurses
extra, but those costs may be offset by reduced visits and hospitalizations.
Conclusion Recent systematic reviews show inconsistent outcomes and little insight into functionalities
required for mHealth asthma interventions, highlighting the need for systematic intervention
design. We identified specific features for adoption and engagement that meet the
stated needs of users for asthma symptom monitoring.
Keywords
mHealth - symptom monitoring - provider workflows - electronic health record
