title: Co-Creation With TickiT: Designing and Evaluating a Clinical eHealth Platform for Youth.
abstract: BACKGROUND
  All youth are susceptible to mental health issues and engaging in risky behavior, and for youth with chronic health conditions, the consequences can be more significant than in their healthy peers. Standardized paper-based questionnaires are recommended by the American Academy of Pediatrics in community practice to screen for health risks. In hospitals, psychosocial screening is traditionally undertaken using the Home Education, Eating, Activities, Drugs, Depression, Sex, Safety (HEEADDSS) interview. However, time constraints and patient/provider discomfort reduce implementation. We report findings from an eHealth initiative undertaken to improve uptake of psychosocial screening among youth.
  
  
  OBJECTIVE
  Youth are sophisticated "technology natives." Our objective was to leverage youth's comfort with technology, creating a youth-friendly interactive mobile eHealth psychosocial screening tool, TickiT. Patients enter data into the mobile application prior to a clinician visit. Response data is recorded in a report, which generates alerts for clinicians, shifting the clinical focus from collecting information to focused management. Design goals included improving the patient experience, improving efficiency through electronic patient based data entry, and supporting the collection of aggregated data for research.
  
  
  METHODS
  This paper describes the iterative design and evaluation processes undertaken to develop TickiT including co-creation processes, and a pilot study utilizing mixed qualitative and quantitative methods. A collaborative industry/academic partnership engaged stakeholders (youth, health care providers, and administrators) in the co-creation development process. An independent descriptive study conducted in 2 Canadian pediatric teaching hospitals evaluated the feasibility of the platform in both inpatient and ambulatory clinical settings, evaluating both providers and patient responses to the platform.
  
  
  RESULTS
  The independent pilot feasibility study included 80 adolescents, 12-18 years, and 38 medical staff-residents, inpatient and outpatient pediatricians, and surgeons. Youth uptake was 99% (79/80), and survey completion 99% (78/79; 90 questions). Youth found it easy to understand (92%, 72/78), easy to use (92%, 72/78), and efficient (80%, 63/79 with completion rate < 10 minutes). Residents were most positive about the application and surgeons were least positive. All inpatient providers obtained new patient information.
  
  
  CONCLUSIONS
  Co-creative design methodology with stakeholders was effective for informing design and development processes to leverage effective eHealth opportunities. Continuing stakeholder engagement has further fostered platform development. The platform has the potential to meet IHI Triple Aim goals. Clinical adaptation requires planning, training, and support for health care providers to adjust their practices.
authors.affiliation: BC Children's Hospital, Division of Adolescent Medicine, University of British Columbia, Vancouver, BC, Canada. sandypenn@gmail.com.
authors.forename: Sandy R
authors.initials: SR
authors.lastname: Whitehouse
authors.forename: Pei-Yoong
authors.initials: PY
authors.lastname: Lam
authors.forename: Ellen
authors.initials: E
authors.lastname: Balka
authors.forename: Shelagh
authors.initials: S
authors.lastname: McLellan
authors.forename: Mariana
authors.initials: M
authors.lastname: Deevska
authors.forename: Daniel
authors.identifier: 0000-0001-9953-515X
authors.initials: D
authors.lastname: Penn
authors.forename: Robert
authors.initials: R
authors.lastname: Issenman
authors.forename: Mary
authors.initials: M
authors.lastname: Paone
keywords: adolescent; adolescent health services; chronic illness; communication; delivery of health care; eHealth; health surveys; information technology; mobile technology; questionnaires; youth