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Development and usability test of ‘PROMIS Assessment’: a smartphone WeChat mini-program for children and adolescents with cancer (Preprint)


 BACKGROUND
 The main goal for the healthcare of children and adolescents with cancer is to cure and better manage the distress caused by the multiple symptoms that may manifest during chemotherapy. Patient-reported outcomes (PROs) are considered to be the best way to obtain a subjective measure of symptoms. As such, it is crucial to select appropriate pediatric PROs tools, taking advantage of technologies to develop a suitable platform, and assess and manage symptoms over long-term cancer treatment.
 
 
 OBJECTIVE
 This study aimed to develop and test a smartphone application's usability, known as the WeChat mini-program. It enables children and adolescents with cancer aged 5 to 17 years old and their parent proxies to assess pediatric patients' quality of life-related symptoms using Pediatric Patient-reported Outcome Measurement Information System (PROMIS) profile-25.
 
 
 METHODS
 A focus group interview among researchers, clinical professionals, and software engineers, as well as personal qualitative interviews with pediatric patients and proxies, were conducted to form the development proposal. The iterative method was used to develop and assure the quality of the mini-program. The usability test was performed based on the standards of ISO 9241-11 among target users. Effectiveness and efficiency were based on usability tasks, satisfaction was measured with the Post-Study System Usability Questionnaire (PSSUQ), and additional qualitative interviews were conducted following all tests. Further modifications and tests would be performed to improve the mini-program based on feedback.
 
 
 RESULTS
 The WeChat mini-program 'PROMIS Assessment' included demographic and clinical information and the profile-25 questionnaire (which assesses and collects data on depressive symptoms, anxiety, fatigue, physical activity-mobility, peer relationships, pain interference, and pain intensity). Functions such as voice assistance, a reward system, data visualization, and reminders were added to improve accessibility and compliance. A total of 16 target users participated in the first round of usability tests. The completion rate of the three tasks ranged from 80.0% (for the proxy task of 'search and open') to 100.0%, and most users could complete tasks quickly. Satisfaction scores of the four dimensions of PSSUQ ranged from 6.2 to 6.8 (out of 7.0). In qualitative interviews, most participants thought the mini-program was convenient, easy to use, and helpful. Disadvantages were mainly problems with searching, expressions, and interaction with reality. The revised mini-program gained positive feedback during the second round of usability tests.
 
 
 CONCLUSIONS
 The 'PROMIS Assessment' and its administration website were developed and proved to have good usability. It can be used both inside and outside hospitals by children and adolescents with cancer and their proxies during treatment to assess their quality of life and offer significant patient-reported data to assist clinical decisions.
