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Access to an mHealth Tool for Symptom Management in Pediatric Oncology Care: Triangulation Study
Angelica Höök1,2,3, Emma Forsgren1,2, Maria Björk4
1Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Göteborg, Västra Götaland, 40530, Sweden, 46 736855342.
Insights
Digital health tools like PicPecc (Pictorial Support in Person-Centered Care for Children) show promise for pediatric oncology symptom assessment post-discharge. While generally accessible, barriers like motivation and age-appropriate design require attention for effective implementation.
Area of Science:
- Digital health
- Pediatric oncology
- Mobile health interventions
Background:
- Digital health tools can improve symptom assessment and communication for pediatric cancer patients after hospital discharge.
- Ensuring user access is crucial for the effectiveness of these digital health tools.
- PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool designed for remote symptom assessment and communication in children.
Purpose of the Study:
- To evaluate the accessibility of the PicPecc digital intervention in pediatric oncology care.
- To analyze technology access through the lens of a digital intervention in a real-world setting.
Main Methods:
- A triangulation approach was used to assess access to the PicPecc mobile health tool.
- Fourteen children (6-17 years), 5 parents, and 6 nurses participated in the 2-week intervention post-discharge.
- Data were collected through interviews, an access instrument, and usage logs, analyzed using the 5 dimensions of access (availability, accessibility, accommodation, affordability, acceptability).
Main Results:
- PicPecc enhanced symptom communication availability and provided a sense of safety for children and parents post-discharge.
- General accessibility was noted, with minor login issues; accommodation barriers included scale interpretation.
- Affordability was high, but children's motivation varied; acceptability was strong in younger children (up to 12 years) but less so in older children due to design.
- Nurses viewed PicPecc as a valuable follow-up tool.
Conclusions:
- The PicPecc mobile health tool shows potential for remote symptom assessment in pediatric oncology, especially for children up to 12 years.
- Identified barriers, including motivational factors and healthcare system integration, need to be addressed for broader successful implementation.
- Further research should focus on optimizing the tool's design and integration to overcome identified challenges.
Background:
Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology.
Objective:
The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology.
Methods:
This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6-17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability).
Results:
The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children's motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate.
Conclusions:
Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.
