title: Development of a Culturally Appropriate Bilingual Electronic App About Hepatitis B for Indigenous Australians: Towards Shared Understandings.
abstract: BACKGROUND
  Hepatitis B is endemic in Indigenous communities in Northern Australia; however, there is a lack of culturally appropriate educational tools. Health care workers and educators in this setting have voiced a desire for visual, interactive tools in local languages. Mobile phones are increasingly used and available in remote Indigenous communities. In this context, we identified the need for a tablet-based health education app about hepatitis B, developed in partnership with an Australian remote Indigenous community.
  
  
  OBJECTIVE
  To develop a culturally appropriate bilingual app about hepatitis B for Indigenous Australians in Arnhem Land using a participatory action research (PAR) framework.
  
  
  METHODS
  This project was a partnership between the Menzies School of Health Research, Miwatj Aboriginal Health Corporation, Royal Darwin Hospital Liver Clinic, and Dreamedia Darwin. We have previously published a qualitative study that identified major knowledge gaps about hepatitis B in this community, and suggested that a tablet-based app would be an appropriate and popular tool to improve this knowledge. The process of developing the app was based on PAR principles, particularly ongoing consultation, evaluation, and discussion with the community throughout each iterative cycle. Stages included development of the storyboard, the translation process (forward translation and backtranslation), prelaunch community review, launch and initial community evaluation, and finally, wider launch and evaluation at a viral hepatitis conference.
  
  
  RESULTS
  We produced an app called "Hep B Story" for use with iPad, iPhone, Android tablets, and mobile phones or personal computers. The app is culturally appropriate, audiovisual, interactive, and users can choose either English or Yolŋu Matha (the most common language in East Arnhem Land) as their preferred language. The initial evaluation demonstrated a statistically significant improvement in Hep B-related knowledge for 2 of 3 questions (P=.01 and .02, respectively) and overwhelmingly positive opinion regarding acceptability and ease of use (median rating of 5, on a 5-point Likert-type scale when users were asked if they would recommend the app to others).
  
  
  CONCLUSIONS
  We describe the process of development of a bilingual hepatitis B-specific app for Indigenous Australians, using a PAR framework. The approach was found to be successful with positive evaluations.
authors.affiliation: Menzies School of Health Research, Global and Tropical Health, Charles Darwin University, Darwin, Australia. jane.davies@menzies.edu.au.
authors.forename: Jane
authors.identifier: http://orcid.org/0000-0002-3843-837X
authors.initials: J
authors.lastname: Davies
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0002-2207-7215
authors.initials: S
authors.lastname: Bukulatjpi
authors.forename: Suresh
authors.identifier: http://orcid.org/0000-0003-4785-3337
authors.initials: S
authors.lastname: Sharma
authors.forename: Luci
authors.identifier: http://orcid.org/0000-0001-9038-0390
authors.initials: L
authors.lastname: Caldwell
authors.forename: Vanessa
authors.identifier: http://orcid.org/0000-0001-7602-6854
authors.initials: V
authors.lastname: Johnston
authors.forename: Joshua Saul
authors.identifier: http://orcid.org/0000-0001-9864-5699
authors.initials: JS
authors.lastname: Davis
keywords: culture; development; health literacy; hepatitis B; indigenous population; language; portable electronic apps