title: Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage.
abstract: BACKGROUND
  Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter.
  
  
  OBJECTIVE
  The aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system.
  
  
  METHODS
  Development of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town.
  
  
  RESULTS
  After ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec).
  
  
  CONCLUSIONS
  By including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway.
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada. jlim2@cw.bc.ca.
authors.forename: Joanne
authors.identifier: http://orcid.org/0000-0001-9290-8806
authors.initials: J
authors.lastname: Lim
authors.forename: Garth
authors.identifier: http://orcid.org/0000-0003-0731-3598
authors.initials: G
authors.lastname: Cloete
authors.forename: Dustin T
authors.identifier: http://orcid.org/0000-0001-9717-3685
authors.initials: DT
authors.lastname: Dunsmuir
authors.forename: Beth A
authors.identifier: http://orcid.org/0000-0001-6150-8703
authors.initials: BA
authors.lastname: Payne
authors.forename: Cornie
authors.identifier: http://orcid.org/0000-0003-4785-927X
authors.initials: C
authors.lastname: Scheffer
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0003-4136-3070
authors.initials: P
authors.lastname: von Dadelszen
authors.forename: Guy A
authors.identifier: http://orcid.org/0000-0003-2048-4391
authors.initials: GA
authors.lastname: Dumont
authors.forename: J Mark
authors.identifier: http://orcid.org/0000-0001-8427-2035
authors.initials: JM
authors.lastname: Ansermino
keywords: design methodology; mHealth app; predictive model; pulse oximetry; usability analysis