JMIR Publications

ABSTRACT

Background:

Trauma care faces challenges to innovate their services, such as with mHealth applications, to improve quality of care and patients experience of health. For developing and preparing the future implementation of such innovations, systematic needs inquiries and collaborations with professional and patient end-users are highly recommended.

Objective:

To develop a trauma-mHealth application for patient information and support in accordance with the CeHRes roadmap, and describe (1) experiences of (unmet) information and support needs of injured trauma patients; (2) barriers and facilitators for trauma care professionals for the provision of information and support; (3) drivers of value of a mhealth application in trauma patients and trauma care professionals.

Methods:

Formative evaluations were conducted using both quantitative and qualitative methods. Ten semi structured interviews with trauma patients and a focus group with four trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete-choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated over hypothetical mHealth products with various ‘attributes’. The panel data from the DCE were analyzed with conditional and mixed logit models.

Results:

In the interviews, patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences and future prospects. Health care professionals designated workload as a crucial issue; a digital solution should not cost additional time. The conditional logit model of DCE results suggested that access to patient application data through Electronic Medical Record integration (OR = 3.3) or a web-viewer (OR = 2.3), was considered most important in a mHealth solution by surgeons, followed by the inclusion of periodic self-measurements, (OR = 2), local adjustment of patient information (OR = 1.8), local hospital identification (OR = 1.7), complication detection (OR = 1.5), and personalization of rehabilitation through artificial intelligence (OR = 1.4); all with P values <.05.

Conclusions:

In the context of trauma care, end-users have a broad range of requirements for a mHealth solution to also address psychosocial functioning, dependable information and possibly a prediction on how a patients ‘recovery trajectory is evolving. A structured development approach provided insights into value drivers, and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and currently easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most - but plausibly not yet all - end-users in trauma care will value. Hereto, this study can inspire the trauma care community.