Methods Inf Med 2022; 61(03/04): 123-138
DOI: 10.1055/s-0042-1749359
Original Article

Eliciting Information Needs of Child Patients: Adapting the Kano Model to the Design of mHealth Applications

Sune Dueholm Müller
1   Department of Informatics, University of Oslo, Ole-Johan Dahls Hus, Oslo, Norway
,
Georgios Tsirozidis
2   Department of Management, Aarhus BSS, Aarhus University, Aarhus, Denmark
,
Morten Mathiasen
3   Research and IT, Business Academy Aarhus, Aarhus, Denmark
,
Louise Nordenhof
2   Department of Management, Aarhus BSS, Aarhus University, Aarhus, Denmark
,
Daniel Jakobsen
2   Department of Management, Aarhus BSS, Aarhus University, Aarhus, Denmark
,
Birgitte Mahler
4   Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations

Abstract

Background Health care services are increasingly being digitized, but extant literature shows that digital technologies and applications are often developed without careful consideration of user needs. Research is needed to identify and investigate best-in-class methods to support user-centered design of mHealth applications.

Objectives The article investigates how the Kano model can be adapted and used for the purpose of eliciting child patients' information needs during the design phase of mHealth application development. The aim is to demonstrate its applicability for collecting and analyzing patient-centered data that are key to designing technology-supported solutions for health management.

Methods The article is based on a mixed-methods case study, which includes interviews with 21 patients aged 6 to 18. Structured interviews are analyzed based on prescriptions of the Kano model. Semi-structured interviews about child patients' information needs are analyzed thematically.

Results The results demonstrate several improvements to the Kano model that take into account the difficulties of effectively communicating with child patients. The combination of two types of interviews offers unique insights into the what, how, and why of patients' needs. Adaptation of the Kano model, simplification of response options, and participation of child patients' parents in interviews facilitate data collection.

Conclusion The article shows how the Kano model can be adapted to provide an effective means of eliciting child patients' needs. Adapting the model by combining structured and semi-structured interviews makes it a powerful tool in designing mHealth applications.

Supplementary Material



Publication History

Received: 02 December 2021

Accepted: 14 April 2022

Article published online:
11 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Adibi S. Ed. Mobile Health: A Technology Road Map. Heidelberg: Springer; 2015
  • 2 Bhavnani SP, Narula J, Sengupta PP. Mobile technology and the digitization of healthcare. Eur Heart J 2016; 37 (18) 1428-1438
  • 3 Fadahunsi KP, Akinlua JT, O'Connor S. et al. Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth. BMJ Open 2019; 9 (03) e024722
  • 4 Brown III W, Yen P-Y, Rojas M, Schnall R. Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology. J Biomed Inform 2013; 46 (06) 1080-1087
  • 5 Peng W, Kanthawala S, Yuan S, Hussain SA. A qualitative study of user perceptions of mobile health apps. BMC Public Health 2016; 16 (01) 1158
  • 6 Shrestha R. Imaging on mobile device. Appl Radiol 2013; 42 (10) 24-26
  • 7 Kano N, Seraku N, Takahashi F, Tsjui S. Attractive quality and must-be quality. Hinshitsu 1984; 14 (02) 147-156
  • 8 Gimpel H, Manner-Romberg T, Schmied F, Winkler T. Understanding the evaluation of mHealth app features based on a cross-country Kano analysis. Electron Mark 2021; 2: 1-30
  • 9 Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inform 2019; 126: 95-104
  • 10 van't Riet A, Berg M, Hiddema F, Sol K. Meeting patients' needs with patient information systems: potential benefits of qualitative research methods. Int J Med Inform 2001; 64 (01) 1-14
  • 11 Harte R, Glynn L, Rodríguez-Molinero A. et al. A human-centered design methodology to enhance the usability, human factors, and user experience of connected health systems: a three-phase methodology. JMIR Human Factors 2017; 4 (01) e8
  • 12 Waite-Jones JM, Majeed-Ariss R, Smith J, Stones SR, Van Rooyen V, Swallow V. Young people's, parents', and professionals' views on required components of mobile apps to support self-management of juvenile arthritis: Qualitative study. JMIR Mhealth Uhealth 2018; 6 (01) e25
  • 13 Kappelgaard L. Det monitorerede mig – empowerment eller patologisering?. Nord J Appl Ethics 2015; 9 (01) 37-54
  • 14 Kumar S, Nilsen WJ, Abernethy A. et al. Mobile health technology evaluation: the mHealth evidence workshop. Am J Prev Med 2013; 45 (02) 228-236
  • 15 Soto-Rey I, Rehr M, Bruland P. et al. Electronic collection of multilingual patient-reported outcomes across Europe. Methods Inf Med 2018; 57 (Suppl. 02) e107-e114
  • 16 Majeed-Ariss R, Baildam E, Campbell M. et al. Apps and adolescents: a systematic review of adolescents' use of mobile phone and tablet apps that support personal management of their chronic or long-term physical conditions. J Med Internet Res 2015; 17 (12) e287
  • 17 Lupton D. The digitally engaged patient: self-monitoring and self-care in the digital health era. Soc Theory Health 2013; 11 (03) 256-270
  • 18 Ball MJ, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inform 2001; 61 (01) 1-10
  • 19 Abaza H, Marschollek M. mHealth application areas and technology combinations*. A comparison of literature from high and low/middle income countries. Methods Inf Med 2017; 56 (07, Suppl 1): e105-e122
  • 20 Rubeis G, Schochow M, Steger F. Patient autonomy and quality of care in telehealthcare. Sci Eng Ethics 2018; 24 (01) 93-107
  • 21 Gustavsson S, Gremyr I, Sarenmalm E. Using an adapted approach to the Kano model to identify patient needs from various patient role. TQM J 2016; 28 (01) 151-162
  • 22 Butterworth K, Allam O, Gray A, Butterworth H. Providing confusion: the need for education not information in chronic care. Health Informatics J 2012; 18 (02) 111-123
  • 23 Lo B, Parham L. The impact of web 2.0 on the doctor-patient relationship. J Law Med Ethics 2010; 38 (01) 17-26
  • 24 Attfield SJ, Adams A, Blandford A. Patient information needs: pre- and post-consultation. Health Informatics J 2006; 12 (02) 165-177
  • 25 Becker S, Miron-Shatz T, Schumacher N, Krocza J, Diamantidis C, Albrecht UV. mHealth 2.0: experiences, possibilities, and perspectives. JMIR Mhealth Uhealth 2014; 2 (02) e24
  • 26 Oudshoorn N. Telecare Technologies and the Transformation of Healthcare. New York, NY: Palgrave Macmillan; 2011
  • 27 Stinson JN, Toomey PC, Stevens BJ. et al. Asking the experts: exploring the self-management needs of adolescents with arthritis. Arthritis Rheum 2008; 59 (01) 65-72
  • 28 Barlow JH, Shaw KL, Harrison K. Consulting the ‘experts’: children's and parents' perceptions of psycho-educational interventions in the context of juvenile chronic arthritis. Health Educ Res 1999; 14 (05) 597-610
  • 29 Stinson JN, Feldman BM, Duffy CM. et al. Jointly managing arthritis: information needs of children with juvenile idiopathic arthritis (JIA) and their parents. J Child Health Care 2012; 16 (02) 124-140
  • 30 Simons L, Valentine AZ, Falconer CJ. et al. Developing mHealth remote monitoring technology for attention deficit hyperactivity disorder: a qualitative study eliciting user priorities and needs. JMIR Mhealth Uhealth 2016; 4 (01) e31
  • 31 Chowdhury M, Quaddus M. A multi-phased QFD based optimization approach to sustainable service design. Int J Prod Econ 2016; 171 (Part 2): 165-178
  • 32 Herzberg F, Mausner B, Snyderman B. The Motivation to Work. 2nd ed.. Oxford: Wiley; 1959
  • 33 Witell L, Löfgren M. Classification of quality attributes. Manag Serv Qual 2007; 17 (01) 54-73
  • 34 Shen X, Tan K, Xie M. An integrated approach to innovative product development using Kano's model and QFD. Eur J Innov Manage 2000; 3 (02) 91-99
  • 35 Witell L, Löfgren M, Dahlgaard J. Theory of attractive quality and the Kano methodology – the past, the present, and the future. Total Qual Manage 2013; 24 (11) 1241-1252
  • 36 Materla T, Cudney E, Antony J. The application of Kano model in the healthcare industry: a systematic literature review. Total Qual Manage Bus Excell 2019; 30 (5–6): 660-681
  • 37 Beyer H, Holtzblatt K. Contextual Design: Design for Life. San FCancisco, CA: Morgan Kaufmann; 2016
  • 38 Kensing F, Simonsen J, Bødker K. MUST: a method for participatory design. Hum Comput Interact 1998; 13 (02) 167-198
  • 39 Müller S, Mathiasen M, Mahler B. The value of patient-reported outcome (PRO) data in digital healthcare: using the How-R-you app as a PRO instrument. Paper presented at: The 52nd Hawaii International Conference on System Sciences (HICSS), Hawaii, United States, January 8–11, 2019
  • 40 Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res 2001; 1 (03) 385-405
  • 41 Creswell J, Clark V. Designing and Conducting Mixed Method Research. Thousand Oaks, CA: SAGE Publications; 2011
  • 42 Berry SL, Hayford JR, Ross CK, Pachman LM, Lavigne JV. Conceptions of illness by children with juvenile rheumatoid arthritis: a cognitive developmental approach. J Pediatr Psychol 1993; 18 (01) 83-97
  • 43 Tong A, Jones J, Craig JC, Singh-Grewal D. Children's experiences of living with juvenile idiopathic arthritis: a thematic synthesis of qualitative studies. Arthritis Care Res (Hoboken) 2012; 64 (09) 1392-1404
  • 44 Rasmussen K, Kampmann J, Warming H. eds. Interview Med Børn. København: Hans Reitzels Forlag; 2017
  • 45 Ross DM, Ross SA. The importance of type of question, psychological climate and subject set in interviewing children about pain. Pain 1984; 19 (01) 71-79
  • 46 Hughes J, Baker D. The Clinical Child Interview. New York, NY: The Guilford Press; 1990
  • 47 Mrklas KJ, Barber T, Campbell-Scherer D. et al. Co-design in the development of a mobile health app for the management of knee osteoarthritis by patients and physicians: qualitative study. JMIR Mhealth Uhealth 2020; 8 (07) e17893
  • 48 Liao G-Y, Chien Y-T, Chen Y-J. et al. What to build for middle-agers to come? Attractive and necessary functions of exercise-promotion mobile phone apps: a cross-sectional study. JMIR Mhealth Uhealth 2017; 5 (05) e65
  • 49 Müller SD, Lauridsen KG, Palic AH, Frederiksen LN, Mathiasen M, Løfgren B. Mobile app support for cardiopulmonary resuscitation: development and usability study. JMIR Mhealth Uhealth 2021; 9 (01) e16114
  • 50 Larsen K, Akindele B, Head H. et al. Developing a user-centered digital clinical decision support app for evidence-based medication recommendations for type 2 diabetes mellitus: prototype user testing and validation study. JMIR Human Factors 2022; 9 (01) e33470
  • 51 Yuan Y, Liu Y, Gong L. et al. Demand analysis of telenursing for community-dwelling empty-nest elderly based on the Kano model. Telemed J E Health 2021; 27 (04) 414-421
  • 52 Gruber T, Reppel A, Szmigin I, Voss R. Revealing the expectations and preferences of complaining customers by combining the laddering interviewing technique with the Kano model of customer satisfaction. Qual Mark Res 2008; 11 (04) 400-413
  • 53 Clarke MA, Moore JL, Steege LM. et al. Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: a literature review. Health Informatics J 2016; 22 (04) 992-1016
  • 54 Hummelinck A, Pollock K. Parents' information needs about the treatment of their chronically ill child: a qualitative study. Patient Educ Couns 2006; 62 (02) 228-234
  • 55 Stinson J, McGrath P, Hodnett E. et al. Usability testing of an online self-management program for adolescents with juvenile idiopathic arthritis. J Med Internet Res 2010; 12 (03) e30
  • 56 Lee A, Baskerville R. Generalizing generalizability in information systems research. Inf Syst Res 2003; 14 (03) 221-243