A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach
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Abstract
BACKGROUND: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. OBJECTIVE: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. METHODS: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life-focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. RESULTS: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. CONCLUSIONS: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users-patients or caregivers, LHWs, and members of the palliative care team-and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas.
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An Android app that both educates girls on menses and helps them manage their period was developed.
“an Android app that both educates girls on menses and helps them manage their period is developed.”
From Current evidence on the use of mHealth approaches in Sub-Saharan Africa: A scoping review (2023) · cites this paper as [49]
The Objective identifies mPCL as an app for outpatient symptom assessment and palliative care, with a focus on pain. The Results’ Educational Module describes information on late-stage cancer symptoms, not menstruation or period management for girls. (LLM, conf=0.90)
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“Similarly, Morse et al [35] designed, developed, and tested mPCL, a human-centered mobile and web application that supports outpatient palliative symptom assessment, care coordination, and pain control among Tanzanian patients with cancer by connecting patients, caregivers, local health workers,…”
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- Authors
- Morse, R. S., Lambden, K., Quinn, E., Ngoma, T., Mushi, B., Ho, Y. X., Ngoma, M., Mahuna, H., Sagan, S. B., Mmari, J., & Miesfeldt, S.
- Affiliations
- Dimagi (United States) (US)
- Muhimbili University of Health and Allied Sciences (TZ)
- Ocean Road Cancer Institute (TZ)
- Maine Medical Center (US)
- Corresponding author
- Miesfeldt, Susan
- ORCID
- Venue
- JMIR Cancer
- Publisher
- JMIR Publications Inc.
- Published
- 2021-03-23
- Volume
- 7
- Issue
- 1
- Pages
- e24062
- ISSN
- 2369-1999 (ISSN-L)
- PMC
- PMC8088847
- OpenAlex
- W3122772050
- Cited by
- 25
- References
- 35
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 1
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Cancer (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- Fogarty International Center (R21TW010190)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- mobile health, palliative care, cancer pain management, end-of-life care, shared care, community health workers, palliative care specialists, symptom assessment, care coordination, lay caregivers, quality of life, Tanzania, human-centered design, usability testing, mobile app prototype, telemedicine, health information exchange, clinical record
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