JMIR Publications

ABSTRACT

Background:

Vaccine preventable infections result in significant morbidity, mortality and costs in pediatric transplant recipients. However, at the time of transplant less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone applications (apps) have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical.

Objective:

The aim of this study is to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pre-transplant immunization and to report on app functionality and quality when applied to the target population.

Methods:

We used a mixed methods study design guided by the mHealth agile development and evaluation lifecycle. We first completed formative research including semi-structured interviews with 82 transplant stakeholders (12 primary care physicians, 40 parents/guardians of transplant recipients, 11 transplant nurse coordinators,19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pre-transplant period. Based on these findings, CANImmunize Inc. developed the Immunize PediatricTransplant app. We next held two focus group discussions with 5-6 transplant stakeholders/group (5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, 2 transplant subspecialists) to get feedback on the app. After app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators and 2 transplant subspecialists) to refine the app through an iterative process. Finally, stakeholders completed the User Version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app.

Results:

A new Android and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pre-transplant period. The app contains information about vaccine use in the pre-transplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and providers when immunizations are due. During usability testing, stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8 minutes) with 87% accuracy. Stakeholders rated engagement, functionality, aesthetics and information quality of the app as 4.2/5, 4.5/5, 4.6/5 and 4.8/5 respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant.

Conclusions:

Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app has been developed to improve immunization delivery in the pre-transplant period. The app tested well with end-users. Further testing and agile development amongst patients awaiting transplant is needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant.