JMIR Publications

ABSTRACT

Background:

Perioperative patient-reported outcomes (PROs) allow patients to share their experiences of surgical procedures with their healthcare teams using standardised measures. Despite increasing recognition of their value, PROs are not routinely used in clinical practice, partly due to limited evidence of their impact on traditional clinical outcomes and uncertainty among clinicians about their utility. Digital health tools offer a promising way to integrate PROs into clinical workflows and enhance patient-clinician interaction, but their success depends on person-centred design to ensure usability and relevance. Safe Surgery South Africa, a non-profit organisation, developed the Perioperative Shared Health Record (PSHR), a secure web-based tool that enables patients to share personal health information and PROs with their anaesthetist and surgeon before and after surgery. Initial implementation revealed significant user experience challenges, which contributed to poor uptake.

Objective:

This study aimed to explore factors influencing the PSHR user experience in a low- and middle income country (LMIC) using human-centred design principles.

Methods:

This observational qualitative user experience study followed the five design thinking stages: empathise, define, ideate, prototype, and test. Semi-structured interviews were conducted with postoperative patients from both the public and private healthcare sectors, including those with and without prior experience using the PSHR. Thematic analysis followed the six-phase framework described by Braun and Clarke and was structured using Karagianni’s Optimised Honeycomb user experience model. A problem statement was developed, followed by ideation to explore solutions. Paper prototypes were created, refined, and tested through observation, interviews, and validated usability questionnaires (SUS and UEQ).

Results:

Empathise: Twenty-two interviews were conducted in the private and public healthcare sectors in South Africa; seven participants had previous experience using the PSHR. Define: Participants emphasised the need for connection, feedback, information and support through their surgical journey. Contrary to expectations, patients were not discouraged by the length of questionnaires if they perceived them as purposeful. Ideate: The team considered user expectations and PSHR integration into care processes. Prototype: Low-fidelity mock-ups were created and refined into paper prototypes. Test: Testing with five participants highlighted the importance of trust, communication, and user-friendly interfaces. Feedback loops and clinician engagement were identified as key motivators for sustained use. The mean SUS score indicated excellent usability, and UEQ scores reflected high levels of user satisfaction across most domains.

Conclusions:

Digital health tools like the PSHR can strengthen communication and support person-centered perioperative care by integrating PROs into clinical workflows. The study shows the importance of engaging patients throughout the design process to ensure usability and contextual relevance. Human-centered design approaches offer valuable insights for improving adoption and sustainability of digital health interventions in LMICs. Future research should focus on integrating such tools into clinical workflows and assessing their impact on patient-centered outcomes and care delivery.