Development of a mobile application to assess quality of life of cancer patients: Results of an iterative investigation and usability testing using a user-centered approach (Preprint)

BACKGROUND The cure for cancer can not only have a negative impact on physical wellbeing, but also on mental health and quality of life (QoL). Health apps enable the monitoring of different parameters, but to date there are only few which support cancer patients and none that focus on QoL. Furthermore, patients as stakeholders are often only integrated at late stage of the development process, if at all. OBJECTIVE The aim of this research was to develop and evaluate a smartphone app (Lion-App) to enable cancer patients to autonomously measure QoL with an iterative, user-centered approach. The goal was to closely integrate end users into every stage of the development process, in order to be able to use the information gained for further development cycles to implement an applicable solution tailored to the needs of end-users. METHODS Cancer patients were included from conceptualization through different development phases in a three-staging process: First, focus groups with cancer support-groups were conducted to understand their expectations and needs. Thereafter, individual tests were performed. After developing a prototype that incorporated first findings, a second test was conducted followed by a beta test lasting several weeks. Participants could download a beta version and test it on their private devices. Lion-App assesses QoL via a patient diary and integrated questionnaires. Through all stages usability was evaluated through the modular User Experience Questionnaire (UEQ+), including the calculation of a key performance indicator (KPI). If possible, the impact of sex on the results was assessed. In the beta test, usage rates as well as age dependent differences were evaluated. RESULTS A total of 21 participants took part in the first focus groups. For the subsequent user test, 17 participants rated their impression through the UEQ+ questionnaire with a KPI [-3,3] of 2.12. In the second usability test, the KPI increased to 2.28. Within the beta test, the usage rate of 19 participants could be evaluated, of whom 14 also answered the UEQ+ (KPI=1.46). An influence of age for the number of questionnaire responses within the app were seen with a decrease of responses with increasing age (P=.02). Sex dependent analysis were only possible for the first - and beta test. CONCLUSIONS The iterative, user-centered approach for development and usability testing has been reflected in positive end-user evaluations. We have successfully developed an App suitable for everyday use to monitor QoL of cancer patients. First results indicated that sex or age of participants seem to play only a minor role. Our approach as well as the findings can be applied to other projects to develop solutions tailored to the end-user.