**5. Results**

During the three-month study period, one male participant lost his smartphone and as such was unable to complete the feedback questionnaire. Of the remaining four participants, three reported their smartphone models: a Oneplus 5, Sony Xperia M5, and Samsung Galaxy. All four participants agreed that they were provided with sufficient information to use the app. The participants were then asked to rate the appearance of the app from 1 to 5 (1 being Do not Like It, 3 being Neutral, and 5 being Like It), with two participants rating the app a 3 and the remaining participants rating the appearance a 4.

During the study period all participants reported inserting data into the app. Two participants confirmed they used the app to share their medical information. When asked to explain this further, one participant reported using the app in a clinical appointment. When asked to rate the difficulty of the app from 1 to 5 (1 being Difficult, 3 being Moderate, and 5 being Easy), one participant rated the app a 5, two participants rated the app a 4, and the remaining participant rated the app a 3. When asked which parts of the app was difficult, the participant who rated the app a 3 reported difficulty in inputting "some information". One other participant also advised that the built-in back button on their device caused the app to close instead of returning to the previous page and was therefore reliant on the built-in navigation bar. When asked which features the participant would like to remove from the app, three participants reported none. When asked what features the participant would like to add to the app, one participant advised they would like for their doctor to be able to access the data or input new data remotely.

The participants were next asked to rate the helpfulness of the app from 1 to 5 (1 being Not Helpful, 3 Indifferent, and 5 being Helpful). One participant reported a 5 for this question, two reported a 4, and one participant reported a 3. When

patients must enter a date range (*e.g.* start date and end date) it should be possible for the user to enter just a month and year as opposed to date, month, and year. Overall it is agreed that the CF patient passport can be of benefit to CF adult patients as it will allow for this cohort to always have access to their basic medical

Following on from the stress test and peer review, ethical approval was granted by the Clinical Research Ethics Committee in the University College Cork for pilot testing with CF adults from the Cork University Hospital. The inclusion criteria for this study was that patients must be 18 years old or older and own an Android smartphone. Participation in this study was voluntary and was offered to patients during clinical appointments over two consecutive days. Five eligible patients were identified and recruited by the CF nurse specialists. All five patients agreed to partake in the study; one participant was female and the remaining four were male. Each participant was provided with an information sheet outlining the purpose of the app, the data collected, intentions for the data, and security measures. After the app was installed on their devices, the participants partook in a short workshop with the CF nurse specialists, who demonstrated how to use the app. The CF nurse specialists also assisted the participants in entering any of their historical or patient file data into the passport app. The patients were then asked to test the app over 3 months before completing a feedback questionnaire, which was provided to them

During the three-month study period, one male participant lost his smartphone and as such was unable to complete the feedback questionnaire. Of the remaining four participants, three reported their smartphone models: a Oneplus 5, Sony Xperia M5, and Samsung Galaxy. All four participants agreed that they were provided with sufficient information to use the app. The participants were then asked to rate the appearance of the app from 1 to 5 (1 being Do not Like It, 3 being Neutral, and 5 being Like It), with two participants rating the app a 3 and the remaining partici-

During the study period all participants reported inserting data into the app. Two participants confirmed they used the app to share their medical information. When asked to explain this further, one participant reported using the app in a clinical appointment. When asked to rate the difficulty of the app from 1 to 5 (1 being Difficult, 3 being Moderate, and 5 being Easy), one participant rated the app a 5, two participants rated the app a 4, and the remaining participant rated the app a 3. When asked which parts of the app was difficult, the participant who rated the app a 3 reported difficulty in inputting "some information". One other participant also advised that the built-in back button on their device caused the app to close instead of returning to the previous page and was therefore reliant on the built-in navigation bar. When asked which features the participant would like to remove from the app, three participants reported none. When asked what features the participant would like to add to the app, one participant advised they would like

for their doctor to be able to access the data or input new data remotely.

The participants were next asked to rate the helpfulness of the app from 1 to 5 (1 being Not Helpful, 3 Indifferent, and 5 being Helpful). One participant reported a 5 for this question, two reported a 4, and one participant reported a 3. When

data and become more aware of their own condition and symptoms.

*Cystic Fibrosis - Heterogeneity and Personalized Treatment*

*4.4.3 Patient review*

**5. Results**

**118**

at their next closest clinical appointment.

pants rating the appearance a 4.

asked to explain their answer, the participant who reported a 3 did not elaborate further. However, two other participants remarked that the app is helpful as it allows them access to their medical information:

*"It's useful to have this information in an easily accessible place" "It's handy for me to have my information so readily accessible"*

This is further enforced in Question 10, where all participants agreed that it was beneficial to have access to their basic medical information through the app. When asked who the participants believe is responsible for inputting data into the app, three participants reported that the responsibility is theirs, while one participant believed it was the shared responsibility of the participant and their CF treatment team. The users were then asked to explain their answer. It was found from these answers that users believe it is their responsibility as entering data should be at their discretion. However, one participant welcomes guidance from their healthcare team.

*"I put what I think is necessary"*

*"Personal info on a personal device should only be entered by the owner unless explicit permission is given. I think I am ultimately responsible for knowing about my condition and recording the information but I might not always know the most important information to be recorded which is why my nurses and doctors should also have input."*

*"It's my app and on my phone, so it's my own responsibility to keep it updated"*

One participant reported a barrier which prevented the editing of data. This participant found that some saved data in the My CF Info section of the app could not be edited, and instead needed to be deleted and inputted again, which they regarded as frustrating. The participants were then asked to rate the regularity of using the app from 1 to 5 (1 being Not Regularly, 3 being Sometimes, and 5 being Regularly). Two participants rated this question a 1, one participant reported a 3, and the remaining participant reported a 4. When asked to list scenarios in which they felt the app maybe useful, the participants reported the following scenarios:

*"If I got sick on holidays could show what I'm on" "Listing medication/medical details at clinics etc" "Sharing information with my GP or if I'm traveling and need to share information with a doctor. Going abroad or another hospital/GP"*

It can be seen from the above scenarios that participants felt that the app maybe of most benefit when travelling abroad or sharing information with medical and healthcare professionals. Lastly, the participants were asked to rate how adequate the security precautions within the app are from 1 to 5 (1 being not adequate and 5 being adequate), to which two participants rated a 5, and the remaining two rated a 4.

## **5.1 Initial observations**

It is acknowledged that some limitations of this study are the small number of participants and the disproportionate ratio of male to female participants, which could present a potential gender bias. There was a notable difference in the participants reported regularity of the apps use. Patients were asked about how often they would use the app. At face value, not regularly could be perceived as concerning; however, CF patients attend CF clinic appointments quarterly, and entering data is at the patient's discretion. In addition to this, minor issues in device functionality were reported by this cohort, which have since been addressed and resolved.

on the old smartphone device will be deleted. In conclusion, an mHealth

*Designing Heterogeneous-mHealth Apps for Cystic Fibrosis Adults*

*DOI: http://dx.doi.org/10.5772/intechopen.85512*

to their data.

**Acknowledgements**

**Conflict of interest**

**Author details**

Ireland

**121**

Tamara Vagg1,2,3\*, Cathy Shortt2

Sabin Tabirca<sup>1</sup> and Barry J. Plant2,3

under grant agreement no 603038.

There is no conflicts of interest.

patient passport is desirable among the adult CF cohort and we believe it can have significant impact on how patients can manage their condition and have access

We would like to acknowledge funding from CFMATTERS which is funded under the European Union's Seventh Framework Programme (FP7/2007–2013)

, Claire Fleming<sup>2</sup>

2 Cork Adult CF Centre, Cork University Hospital, University College Cork, Cork,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Department of Computer Science, University College Cork, Cork, Ireland

3 CRF-C, HRB Clinical Research Facility, Cork, Ireland

\*Address all correspondence to: tv3@cs.ucc.ie

provided the original work is properly cited.

, Mairead McCarthy<sup>2</sup>

,

Interestingly, unlike the findings of the paper-based patient passport, participants of this study identified themselves as the sole or major inputter of data. This is perhaps a clear advantage to paper-based passports, which reported uncertainties in this responsibility, as discussed previously. This may be attributed to the passport being based on a patient's personal device, as opposed being provided to them in a hospital branded booklet.

Moreover, the app in its current form was received positively by the participants of this study. All participants agreed that having access to their basic medical information is of benefit to them. Furthermore, these patients envision practical scenarios in which this app may be of benefit to them in the future.

### **6. Conclusion and future works**

The app is currently available for free on the Google Play Irish store. Future works would include deploying the app to iOS app store and being linked to the Cork CF Centre website. Information pertaining to data usage intentions and storage will is made available on the app store description page. The results of the patient survey conducted found that this cohort showed interest in the recording and viewing of their medical data in a convenient and manageable way. To this end, it was found that the concept of a patient passport could prove to be a suitable solution. Patient passports have been proven to help patients with self-management as it facilitates the ability to closely monitor their own condition. Hence a passport application was developed so that CF adults could record their medications and basic CF information. It is also anticipated that this will allow these patients to receive care when travelling between centers and abroad. A pilot study with four participants demonstrates that CF adults perceive this passport app to be beneficial as it allows them access to their basic medical information. It was also found through the pilot study that participants would not use this mHealth app frequently. This is a similar finding to paper-based passports, as patients only enter the data into the app during clinical appointments (quarterly) and share data in specific scenarios such as with a GP, or when travelling abroad. As the app is password protected, the user must be able to enter in their correct credentials and navigate through the app to share data. However, in situations such as needing to attend the accident and emergency room, this may cause further frustration to the patient, whereas a paper-based passport can be handed to medical professional who can locate all data needed in order to provide care. This is perhaps one advantage of the paper-based system over the digital mHealth app. To contend with this, future iterations of the app may include a Generate PDF button on the main menu which will compile all the most pertinent medical data into an A4 PDF which can be shown to medical professionals via the device or emailed to them directly. This suggestion can also be applied to mHealth patient passports for other conditions. It is also noted that the data from the app is stored locally only. For this reason if the phone became lost or stolen, it would not be possible to restore a profile onto a new phone, in this case the user would have to re-input all their data. This design choice was made based on the feedback from the mHealth survey regarding security and the app connecting to other online sources. However, future iterations of this app will implement the ability to migrate data from one smartphone to another in the event the user purchases a new phone. Once the data has been migrated, data stored *Designing Heterogeneous-mHealth Apps for Cystic Fibrosis Adults DOI: http://dx.doi.org/10.5772/intechopen.85512*

on the old smartphone device will be deleted. In conclusion, an mHealth patient passport is desirable among the adult CF cohort and we believe it can have significant impact on how patients can manage their condition and have access to their data.
