JMIR Publications

ABSTRACT

Background:

The human papillomavirus (HPV) vaccine can prevent up to six types of cancer and is recommended by the Centers for Disease Control and Prevention for universal coverage. In the United States, HPV vaccination rates remain below recommendations especially within some states including Florida. While strategies are available to aid clinicians in recommending vaccines, clinicians may benefit from tailored resources that aid in addressing parental concerns. ProtectMe4 is a tablet-based intervention with evidence of increasing HPV vaccination among adolescents in primary care settings with prior implementation limited by workflow challenges. Following Diffusion of Innovation Theory plus formal and informal user feedback, updates to the ProtectMe4 interface and recommended workflow include an expansion from HPV vaccine only to include the two other recommended adolescent vaccines - meningococcal vaccine and tetanus, diphtheria, and pertussis vaccine.

Objective:

This study aims to allow parents and clinicians to aid in the co-design of the updated ProtectMe4 intervention with a near-live usability test.

Methods:

Within three pediatric primary care clinics in Florida, primary care clinicians (MDs and PAs) were recruited to evaluate the ProtectMe4 intervention. Upon specified testing days in 2020 and 2021, the study team recruited parents of 11-to-12-year-old patients who were seeing the participating clinicians. The study team guided the parent and clinicians to use the ProtectMe4 app during their routine clinic visit. Parents and clinicians participated in co-design of the app content and implementation via mixed methods including a think-aloud usability protocol and a brief usability survey to assess acceptability and feasibility of the intervention.

Results:

A total of nine parents participated in the usability evaluation along with their children’s clinicians (n=4). Among the 8 parents who completed the survey, ≥75% agreed with each of the 14 acceptability measures regarding user satisfaction, perceived usefulness, and acceptance. The average clinician score for the System Usability Scale was 87.5 (standard error=2.5). Think-aloud usability testing identified addressable changes including wording clarification, the need for increased user knowledge and rationale of the app, and additional instructions based on prior vaccine receipt. We also identified limitations of the vaccine registry that impeded the usefulness of the app in transient populations.

Conclusions:

The enhanced ProtectMe4 was usable and acceptable to parents and clinicians. Near-live usability testing allowed parent and clinician co-design to refine the application and adjust workflow to improve the interventions’ perceived advantages and reduce complexity.