JMIR Publications

ABSTRACT

Background:

A growing number of cancer and hematopoietic stem cell transplant (HSCT) survivors require long-term follow-up with optimal communication schemes and patients' compliance is crucial. Adolescents have various unmet needs. Regarding self-report of symptoms/health status mobile applications (mApp) showed enhanced compliance. Currently, HSCT-aftercare at the HSCT-Outpatient clinic of the St. Anna Children’s Hospital is based on handwritten diaries, carrying various disadvantages. Recently, we developed the prototype of a web-based self-monitoring gamified mApp (INTERACCT-App) tailored for adolesents.

Objective:

The observational, prospective study evaluated the usability of the INTERACCT-App for tracking real-time self-reported symptoms/health status data in adolescent HSCT-patients and a healthy matched control group. The primary outcome of the study was the quality of the self-reported medical information. We hypothesized that the mApp provides superior medical information for the clinicians than the handwritten diaries.

Methods:

Health data was reported via paper diary and mApp for 5 consecutive days, respectively. The quality of medical information was rated (5-point scale) independently and blinded by two HSCT-clinicians and duration of use was evaluated. In 52 participants questionnaires for assessment of gaming patterns and device preferences, self-efficacy, users’ satisfaction, acceptability and suggestions for improvement of the mApp were applied. Interrater-reliability was calculated by the intraclass correlation coefficient (ICC), based on a two-way mixed model; one-way repeated measures ANOVA and t-tests were conducted post-hoc. Descriptive methods were used for correlation with participants’ demographics. For users’ satisfaction and acceptability of the mApp the median and the interquartile range (IQR) were calculated.

Results:

Data of 42 participants (15 patients, 27 healthy students) with comparable demographics were evaluated. The results of our study indicated a superiority of the quality of self-reported medical data in the INTERACCT-App over traditional paper-pencil assessment (mApp 4.14 vs paper 3.77, P = .023). The mApp outperformed paper and pen mainly within the patients, in particular in patients with treatment-associated complications (mApp 4.43 vs paper diary 3.73, P = .011). The mApp was significantly longer used by adolescents (14years 4,57 days vs 13years 3,14 days, P = .025) and females (4,76 vs 2,95 days, P = .004). This corresponds with a longer duration in impaired patients with comorbidities. User satisfaction and acceptability rating for the mApp was high across all groups, but adherence entering a large amount of data decreased over time. Based on our results we developed a case vignette of the target group.

Conclusions:

Our study was the first to show that the quality of patient-reported medical information submitted in the INTERACCT-App embedded in a serious game is superior to the handwritten diary. In light of the results, a refinement of the mApp supported by a machine learning approach is planned within an international research project.