JMIR Publications

ABSTRACT

Background:

Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they support the user. Pictorial support for person-centred care in children (PicPecc) is a mobile health (mHealth) tool developed to enable children to remotely assess symptoms and to communicate with healthcare professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology.

Objective:

The aim was to test a digital intervention with PicPecc (PicPecc outside hospital) in pediatric oncology care through the lens of access to technology.

Methods:

This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6–17 years), five parents, and six nurses from two pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for two weeks (median two weeks) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed by recording consumption of PicPecc, through a questionnaire and interviews. Data analysis was based on the five dimensions of access (availability, accessibility, accommodation, affordability and acceptability).

Results:

The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way and feeling safe when they were discharged from hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with login procedures related to the pin code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children’s motivation varied depending on symptom burden. Acceptability was strong among younger children, who appreciated the design and gaming function, while older children found the visual design less age-appropriate.

Conclusions:

PicPecc outside hospital is seen as a promising digital tool for remote symptom assessment in pediatric oncology, particularly among the younger children. PicPecc outside hospital supports children’s symptom assessments and communication. However, challenges, such as motivational factors and integration into the health system, need to be addressed.