Health Technology, 2021Page 2 of 11
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Health Technol 2021;5:10 | http://dx.doi.org/10.21037/ht-20-29
released 325,000 apps on the marketplace which indicates
the increased number of choices available to users thus
worsening the search for evidence-based apps which
are comparatively very few and require more time and
resources to develop (9,10). Some researchers have reported
content credibility and security concerns as barriers to app
utilization (3,11,12). Many parents, however, overlook the
credibility of the content and security of the personal data
concerns due to the benets gained from using certain app
features such as customization of data (13-15).
The importance of an organized and functional user
interface cannot be denied in the effective utilization of
apps. Users generally evaluate apps on utility, functionality,
and security standards and if these requirements are not
met, they move on to the next app. Apps with poor first
impressions, poor design, lack of interactive features,
glitches, unnecessary personal information requests, and
malware alerts lose users quickly, receive low star ratings,
and poor user reviews, negatively affecting their search
ranking in the app store (16). Evidenced-based apps are
scientically robust; however, many lack parents-preferred
user interface elements and therefore, receive less attention
and low star ratings on the app store. For example, Virani
et al. (17) reported an evidence-based app had the lowest
number of downloads, overall lowest MARS (Mobile App
Rating Scale) score, and the lowest score on the MARS
engagement subscale compared to other 15 apps that
were included in the review. Hingle et al. (18) also found
that evidence-based apps frequently lacked visual appeal,
interactive features, and intuitive user interfaces.
Users learn to locate apps through trial and error
methods. Today’s parents have limited time to scroll through
hundreds of pages or apps, rather, they typically select from
the initial few search options. Poor searching skills (e.g.,
inappropriate search terms, unfamiliarity with advanced
search functions) often lead to irrelevant results that fail to
meet parents’ needs and quality expectations. Many parents
feel trapped in cycles of app searching, installing, trialing,
uninstalling, and starting over (19-21). Thus, there is a need
for a solution that provides parents easy and efcient access
to quality apps in a way that is preferred by parents.
While evidence-based apps have been developed to
better meet the needs of parents, these apps are difficult
for parents to locate due to their low visibility among the
plethora of parenting apps. Further, evidence suggests
that co-designing with the target population leads to more
relevant and useable technologies compared to products
developed on their behalf (22,23). Therefore, the purpose of
this study was twofold: (I) to engage parents in developing
a parenting app directory that contains the list and brief
information about quality parenting apps to support their
search for apps; and (II) to involve parents in designing
a user interface of Webpages featuring a parenting app
directory.
The rapid rate at which apps develop, update, and
disseminate requires constant maintenance of the existing
apps, and the addition of new apps to the directory. It is
difficult for the student investigator (primary author) to
keep up with this challenge and sustain the intervention;
therefore, the researchers partnered with an existing
parenting Website that provides resources to parents/
caregivers of children from birth to 8 years. The Website
hereafter refers to as the host Website. The participants
were asked to design only two Webpages; a landing page
and an app description page using the basic layout, color,
and design of the host Website. Participants were also
engaged in developing links supporting feedback on existing
apps and the addition of new apps in the future. The nal
prototypes were supposed to be part of the hosting Website
but, due to unforeseen circumstances, this plan was not
implemented.
Methods
Derived from participatory action research, participatory
design approaches to software design involve users
throughout the design process from identifying needs to
developing and testing the design product. The democracy
and empowerment of users of technology are the core
principles of participatory design (22,24). Appropriate
democratic participation empowers users by involving
them in technology-related decisions that affect their
lives in some way. Final design decisions are based on
consensual agreements between researchers and users. The
participatory design creates a sense of ownership among
users and empowers them as key stakeholders (23,25). To
involve participants throughout the process the project
was divided into three phases: app review, focus group
discussions, and Webpages prototyping. To address this
aim, the study had the following objectives: (I) to gain an
insight into available parenting apps and their quality by
performing an app review on the Google Play Store; (II)
to explore parents’ perceptions of available parenting apps
and involve them in the development of a parenting app
directory through focus group discussions; (III) to engage
parents in designing Webpages prototypes to feature the