In this study, an approach was the user-centered design used to design, implement, and evaluate the CAC mobile health application. This application allows users to identify and manage symptom data due to chemotherapy in children with ALL in one place. Besides, it also records body temperature and anthropometric status of children as indicators of monitoring possible fever or infection and decreasing or improving nutritional quality. This application feature can encourage users to be more involved in their own child's health care by implementing chemotherapy-induced symptom management recommendations and ultimately improving health care quality. In addition, information features in 12-minute animated video format can provide insight into children's disease and treatment and motivation to undergo chemotherapy treatment regularly. Using this mobile app to flexibly manage chemotherapy-induced symptom data can also fill the information gap that currently exists between clinical visits. Mobile-based education effectively increased mothers' knowledge and decisions about managing children when choking [20]. Similarly, a critical review by Aldiss et al. (2015) found that using supportive technology for children and young people with a chronic condition improved the knowledge of disease and psychosocial aspects.
The CAC mHealth application was designed and developed based on the exploration of the role of parents in the management of chemotherapy-induced symptoms and the need for health application media for children with ALL and supplemented by a literature review of current studies. There are seven application modules: patient demographic data, primary health data, regulation of caloric and fluid requirements, symptom identification with Symptom Screening in Pediatrics (SSPedi) tools [22], symptom management due to chemotherapy, information, and consultation implemented into a mobile application. These modules make it easy for users to manage the health data of children with ALL.
This CAC mHealth application is designed to be easy to use and user-friendly for both parents and children. Individual pages in the CAC mobile application are designed to be simple and have a specific purpose, such as entering children's chemotherapy data and identifying chemotherapy symptoms. Therefore, the usability of this application is high, and the participants are satisfied with the application. Ten parents with very diverse social, educational, and ethnic backgrounds tested the CAC mobile health application. In this way, we could get varied input and accommodate the needs expressed by users with various characteristics. The CAC mHealth application users were involved throughout the application trial implementation process. During the procedure, users actively contribute by providing ideas and feedback on the prototyping version in usability tests. Suggestions and feedback from users at the pilot stage have been incorporated into the current version of the CAC mHealth application. In general, respondents felt satisfied and felt that the application provided information, assistance, and solutions during chemotherapy treatment and treatment. Overall, the mHealth application was easy to understand and use.
This app includes strong security measures to protect user data. In this CAC mHealth application, users must register their account with a private password before opening the menus. All data entered by a user are protected using an encrypted token that is unique to each user. The data entered by the user are saved after the application retrieves the data for display on the local device, and only authorized users can enter, view, or modify the data in the application.
The application’s scalability is determined by the capacity of the secure remote server. Currently, the application utilizes server shared hosting, which is reliable with high-security features and unlimited storage capacity. The CAC mHealth application presently uses the development tool Flutter, which can be used for both Android and iOS-based mobile operating systems.
With the availability of this CAC mobile app, users will be able to easily manage all of their health data in one place, including data during treatment and those generated between their typical clinical visits. These data are often not available to medical professionals. As a result, the information gap will be filled. Healthcare providers can obtain more reliable and comprehensive patient data, which can help them better understand the ineffectiveness of specific therapies. Health care providers can utilize information in their decision-making, leading to an increase in the quality of the health services provided.
The application implementation design has also integrated several solutions for the barriers to adopting CAC. As obtained from the exploration findings, there are concerns about cybercrime and the possibility of internet signal/network constraints. Several mHealth security threats include malware infections, hackers, mobile phone theft, human users, and data theft by third parties such as insurance companies and intelligence departments [23]. The application has used strong security measures with password criteria of at least eight characters with a combination of upper- and lower-case letters. This feature will help the CAC mHealth application achieve higher adoption rates.
Meanwhile, to overcome internet network problems, this CAC mHealth application is designed to be used when an internet connection is unavailable, or the network is in inadequate condition. Some users do not always have a strong network or internet signal, so that any data that the users' input is stored in advance on the mobile device or Smartphone. Then when users have a strong network, these data are automatically entered and uploaded into the application system. This action allows users not to need to repeat data entry. This finding aligns with the review [24] that one of the barriers to using mHealth applications is internet connectivity.
This CAC mHealth app is designed to be extendable, and therefore, it will be easier to add new features according to user needs and feedback. This research aimed not to create mobile applications to meet everyone's needs but to build an mHealth application with a specialized purpose and provide the CAC mHealth application to specific users. After users use it for a certain period, they will better understand what further improvements may be needed.
There were some limitations of our study that deserve note. The usability test instrument is currently a questionnaire made by researchers to assess respondents' satisfaction with using the application from five aspects: material coverage and accuracy, recency, encouraging curiosity, clarity of material and language, and attractiveness of the application. This approach may miss some data in the collection, such as future application usage issues and obstacles encountered while using the application. Accordingly, these concerns can be addressed more in-depth through follow-up interviews in the future. However, the researchers encourage respondents to continue to provide comments and suggestions to obtain feedback on changes that need to be made to the application. The usability test should be done in a room, such as a laboratory, so respondents are in an air-conditioned, comfortable situation and environment. However, this study was conducted in a childcare facility, which could interfere with application testing.
Implications for further research
Future research needs to determine the efficacy and effectiveness of using the CAC mHealth application in clinical and community settings. The collection of qualitative data in evaluating user experience, benefits and challenges felt by users, significant and less important features of the mHealth application is also vital to improve the application's performance and quality.
Implications for health services
The presence of the CAC mHealth application for children with ALL can fill in the gaps in data that were not evaluated while patients are out of the hospital. The availability of recommendations and information on symptom management due to chemotherapy in the CAC mobile application can further increase independence and empower parents and children. In addition, the application can accommodate communication between parents, children, and health practitioners in recognizing and dealing with symptoms that arise during chemotherapy.