Introduction:
Pediatric burn injury remains one of the most common traumatic injuries in childhood. Fortunately, up to 90% of pediatric burns may be treated safely in the outpatient setting after appropriate burn triage. Patients face significant geographic disparities in access to expert burn due to the regionalization of burn care. To aid patients and their families during acute burn recovery, a smartphone app was developed to improve patient outcomes, increase access to care, and streamline communication. The purpose of this study is to evaluate patient-derived feedback to optimize Telemedicine Optimized Burn Intervention (TOBI) prior to subsequent efficacy testing.

Methods:
TOBI was evaluated using a mixed-method approach consisting of qualitative semistructured interviews and quantitative usability data gathered from caregivers of pediatric burn patients who utilized TOBI during the treatment phase of their child’s burn injury. Usability data were collected using a psychometrically validated mHealth App Usability Questionnaire (MAUQ). The responses range from 1 = Strongly Disagree to 7 = Strongly Agree, with higher average scores indicating greater acceptability. MAUQ yields an overall usability score and 3 subscale scores: Ease of Use and Satisfaction, System Information Arrangement, and Usefulness. To analyze the interview transcriptions, we followed the Braun and Clark (2006) framework of thematic analysis, using a sematic level of analysis, as opposed to latent interpretation. We performed a theoretical, or top-down, thematic analysis driven by our research questions specific to caregiver perceptions of smartphone-enhanced pediatric burn care and potential app improvements. These questions were focused on acceptability, usability, technical preferences, and emotional perceptions. Two independent coders reviewed the initial transcriptions of interviews and generated initial codes that were then imputed into an Excel spreadsheet for analyses.

Results:
14 caregivers (93% women; M age = 36) completed the study. Overall MAUQ scores (M = 6.46; SD = .62) indicated high app usability. Ease of Use & Satisfaction (M = 6.66; SD = .42), System Information Arrangement (M = 5.93; SD = 1.07), and Usefulness (M = 6.69; SD = .61) subscales indicated an average degree of agreement above “somewhat agree” with usability statements. All subscales showed high internal consistency in our sample (Cronbach alphas of .80, .87, and .94 for each subscale, respectively). Furthermore, 13/14 (93%) caregivers reported a positive overall experience and agreed that the app was an acceptable method to monitor burn care. 12/14 (86%) caregivers reported that the app was capable of capturing important clinical information. 53% preferred app-based burn care, 31% preferred both face-to-face and app-based care, and 15% preferred in-person only. Only 1 person preferred synchronous video-based care to asynchronous text-messaging. All study participants suggested improvements, with the most common being: (1) keeping caregiver logged in, (2) time-stamping photos and messages, (3) consolidating text-messages and pictures, (4) adding push notifications and appointment reminders, and (5) tracking pain level of child.

Conclusions:
Telemedicine presents a paradigm-shift in delivery of expert burn care. The results from this study demonstrate caregiver experiences using a novel mHealth platform for outpatient pediatric burn care. This study additionally provides consumer-focused, systematically derived data that will be used to inform TOBI app modifications to increase its acceptability and usability. Caregivers preferred asynchronous communication to synchronous video visits as an adjunct to in-person care. Once TOBI is optimized, we will conduct a randomized controlled trial to assess its feasibility and efficacy in an effort to improve the quality of and access to expert burn care for patients and their families