iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents

Kathryn A Birnie; Fiona Campbell; Cynthia Nguyen; Chitra Lalloo; Argerie Tsimicalis; Clyde Matava; Joseph Cafazzo; Jennifer Stinson

doi:10.2196/12028

iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents

JMIR Form Res. 2019 Apr 22;3(2):e12028. doi: 10.2196/12028.

Authors

Kathryn A Birnie^{1

2}, Fiona Campbell³, Cynthia Nguyen¹, Chitra Lalloo¹, Argerie Tsimicalis^{4

5}, Clyde Matava³, Joseph Cafazzo^{6

7

8}, Jennifer Stinson^{1

2}

Affiliations

¹ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
² Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
³ Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
⁴ Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁵ Shriners Hospitals for Children - Canada, Montreal, QC, Canada.
⁶ Centre for Global eHealth Innovations, Techna Institute, University Health Network, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.

PMID: 31008704
PMCID: PMC6658275
DOI: 10.2196/12028

Abstract

Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management.

Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app.

Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain.

Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education).

Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care.

Keywords: adolescent; mHealth; mobile applications; pain management; postoperative pain; self-management; smartphone.

©Kathryn A Birnie, Fiona Campbell, Cynthia Nguyen, Chitra Lalloo, Argerie Tsimicalis, Clyde Matava, Joseph Cafazzo, Jennifer Stinson. Originally published in JMIR Formative Research (http://formative.jmir.org), 22.04.2019.