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Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage.

Lim, J; Cloete, G; Dunsmuir, DT; Payne, BA; Scheffer, C; von Dadelszen, P; Dumont, GA; Ansermino, JM (2015) Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage. JMIR Mhealth and Uhealth, 3 (2). ISSN 2291-5222
SGUL Authors: von Dadelszen, Peter

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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.

Item Type: Article
Additional Information: ©Joanne Lim, Garth Cloete, Dustin T Dunsmuir, Beth A Payne, Cornie Scheffer, Peter von Dadelszen, Guy A Dumont, J Mark Ansermino. Originally published in JMIR Mhealth and Uhealth (, 17.04.2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Keywords: design methodology, mHealth app, predictive model, pulse oximetry, usability analysis
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JMIR Mhealth and Uhealth
Article Number: e37
ISSN: 2291-5222
Language: eng
17 April 2015Published
Project IDFunderFunder ID
0038-03-01-01-01Grand Challenges Canada
OPP1017337Bill and Melinda Gates Foundation
PubMed ID: 25887292
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