设计和评估一款移动应用程序，以辅助发展中国家的慢性肾脏病自我监测。
Design and evaluation of a mobile application to assist the self-monitoring of the chronic kidney disease in developing countries.
机构信息
Federal Rural University of the Semiarid, Rodovia BR-226, Pau dos Ferros, 59900-000, Brazil.
Federal University of Alagoas, Av. Lourival Melo Mota, S/N Tabuleiro do Martins, Maceió, 57072-900, Brazil.
出版信息
BMC Med Inform Decis Mak. 2018 Jan 12;18(1):7. doi: 10.1186/s12911-018-0587-9.
BACKGROUND
The chronic kidney disease (CKD) is a worldwide critical problem, especially in developing countries. CKD patients usually begin their treatment in advanced stages, which requires dialysis and kidney transplantation, and consequently, affects mortality rates. This issue is faced by a mobile health (mHealth) application (app) that aims to assist the early diagnosis and self-monitoring of the disease progression.
METHODS
A user-centered design (UCD) approach involving health professionals (nurse and nephrologists) and target users guided the development process of the app between 2012 and 2016. In-depth interviews and prototyping were conducted along with healthcare professionals throughout the requirements elicitation process. Elicited requirements were translated into a native mHealth app targeting the Android platform. Afterward, the Cohen's Kappa coefficient statistics was applied to evaluate the agreement between the app and three nephrologists who analyzed test results collected from 60 medical records. Finally, eight users tested the app and were interviewed about usability and user perceptions.
RESULTS
A mHealth app was designed to assist the CKD early diagnosis and self-monitoring considering quality attributes such as safety, effectiveness, and usability. A global Kappa value of 0.7119 showed a substantial degree of agreement between the app and three nephrologists. Results of face-to-face interviews with target users indicated a good user satisfaction. However, the task of CKD self-monitoring proved difficult because most of the users did not fully understand the meaning of specific biomarkers (e.g., creatinine).
CONCLUSION
The UCD approach provided mechanisms to develop the app based on the real needs of users. Even with no perfect Kappa degree of agreement, results are satisfactory because it aims to refer patients to nephrologists in early stages, where they may confirm the CKD diagnosis.
背景
慢性肾脏病（CKD）是一个全球性的重大问题，尤其是在发展中国家。CKD 患者通常在晚期才开始接受治疗，这需要透析和肾移植，进而影响死亡率。一款移动医疗（mHealth）应用程序（app）旨在帮助早期诊断和自我监测疾病进展，由此便产生了这个问题。
方法
2012 年至 2016 年，用户为中心的设计（UCD）方法涉及卫生专业人员（护士和肾病学家）和目标用户，指导了该应用程序的开发过程。在需求挖掘过程中，与医疗保健专业人员一起进行了深入访谈和原型设计。挖掘出的需求被转化为针对 Android 平台的本地 mHealth 应用程序。之后，应用 Cohen's Kappa 系数统计来评估应用程序与三位分析 60 份病历收集的测试结果的肾病学家之间的一致性。最后，八名用户测试了该应用程序，并就可用性和用户感知进行了访谈。
结果
mHealth 应用程序旨在协助 CKD 的早期诊断和自我监测，同时考虑了质量属性，如安全性、有效性和可用性。应用程序与三位肾病学家之间的总体 Kappa 值为 0.7119，显示出了相当大的一致性。目标用户的面对面访谈结果表明用户满意度良好。然而，由于大多数用户并不完全理解特定生物标志物（如肌酐）的含义，因此自我监测 CKD 的任务较为困难。
结论
UCD 方法提供了根据用户的实际需求开发应用程序的机制。即使没有完美的 Kappa 一致性程度，结果也是令人满意的，因为它旨在让患者尽早转介给肾病学家，在那里他们可以确认 CKD 的诊断。
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