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Evaluating the Picterus Jaundice Pro App for Neonatal Jaundice Screening by Parents: Prospective Mixed Methods Study
Frouke J Terpstra1, Ariela Hazan2, Elkana Kohn2
1Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Parents found the Picterus Jaundice Pro app highly usable for screening neonatal jaundice at home. Despite initial technical challenges, most parents would use the app for early detection of severe neonatal hyperbilirubinemia.
Area of Science:
- Medical Informatics
- Neonatology
- Public Health
Background:
- Neonatal jaundice is common, with severe neonatal hyperbilirubinemia (SNH) posing a risk.
- Visual inspection for jaundice is unreliable; total serum bilirubin is the diagnostic gold standard.
- Picterus Jaundice Pro (JP) is a mobile health app for SNH screening, but parental experiences are underexplored.
Purpose of the Study:
- To evaluate the usability and user-friendliness of the Picterus JP mobile health app.
- To assess parental experiences with the Picterus JP app for neonatal jaundice screening.
Main Methods:
- Prospective mixed methods study in Dutch and Israeli maternity settings (August 2023-January 2025).
- 123 parents of near-term infants (≥35 weeks gestation) used Picterus JP and completed the mHealth App Usability Questionnaire.
- Semistructured interviews and focus groups with parents and nurses provided qualitative data.
Main Results:
- Median usability score was 6/7; 87.7% of parents would use Picterus JP at home.
- Parents found the app easy and convenient, but 55.8% experienced initial failures.
- 75.2% successfully obtained a bilirubin estimate after retrying; key usability themes included intention, infant well-being, and guidance.
Conclusions:
- Parents rated Picterus JP highly for usability, despite initial use difficulties.
- Technical improvements and enhanced guidance are recommended for optimal parental use.
- Parents and nurses view Picterus JP positively for home screening of SNH.
Background:
Neonatal jaundice is a very common condition in the first week of life requiring timely recognition of the small subset of neonates at risk of developing severe neonatal hyperbilirubinemia (SNH). Total serum bilirubin, as quantified through blood testing, remains the gold standard for diagnosis, whereas screening based on visual inspection has been proven unreliable in identifying which jaundiced neonates require total serum bilirubin. Picterus Jaundice Pro (JP) is a mobile health app developed for use by health care professionals and parents to screen for imminent SNH. However, parental user experiences with Picterus JP remain largely unexplored.
Objective:
This study aimed to evaluate the usability and user-friendliness of Picterus JP when used and evaluated by parents.
Methods:
Between August 2023 and January 2025, we conducted a prospective mixed methods study at 3 maternity care settings: the maternity wards of 2 hospitals in the Netherlands and 1 hospital in Israel. Parents were invited to participate if their infant was near term born (gestational age of ≥35 weeks) and at least 12 hours old but still in the first week of life. Parents used Picterus JP once according to the manufacturer's instructions. Immediately afterward, usability was evaluated using the validated mHealth App Usability Questionnaire, an instrument measured on a 7-point Likert scale ranging from 1 ("strongly disagree") to 7 ("strongly agree"), and open-ended questions. A subset of parents and nurses participated in semistructured interviews and focus groups.
Results:
In total, 123 parents completed the questionnaire. The median mHealth App Usability Questionnaire score was 6 (IQR 5-7) out of 7. A total of 87.7% (100/114) of the parents indicated that they would use Picterus JP at home. Parents reported that they found the app easy, quick, and convenient, although 55.8% (67/120) reported a failure on the first try. Some parents struggled to find or interpret the instructions, but most of those who tried again (79/105, 75.2%) obtained a bilirubin estimate. Additionally, 12 nurses from 2 participating maternity wards provided their observations on parents' use of Picterus JP in 2 focus groups. Thematic analysis of all combined data identified 3 themes that were considered important for the usability of Picterus JP: intention to use Picterus JP, infant well-being, and instruction and guidance.
Conclusions:
Parents rated Picterus JP highly in terms of usability despite encountering difficulties during initial use. Technical improvements and more proactive guidance seem important to support successful parental use. Nonetheless, both parents and nurses were positive about the potential of Picterus JP for home screening for SNH.
