"An app is just available at all times"-the process and outcomes of converting the Georgia Tuberculosis Reference Guide into a mobile application

• Published in: PloS one 2024-05, Vol.19 (5), p.e0298758-e0298758
• Main Authors: Arconada Alvarez, Santiago J, Hoover, Alison T, Greenleaf, Morgan, Ray, Susan M, Schechter, Marcos C, Blumberg, Henry M, Lam, Wilbur A
• Format: Article
• Language: English
• Subjects: Adult; Applications programs; Beneficial use; Biology and Life Sciences; Care and treatment; Computer and Information Sciences; Epidemiology; Female; Georgia; Guidelines; Humans; Infections; Infectious diseases; Interviews; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Mobile Applications; Mobile communications networks; Mobile computing; Mortality; Practice Guidelines as Topic; Public health; Research and Analysis Methods; Surveys; Tuberculosis; Wireless telephone software
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0298758

The physical, paper-based Georgia TB Reference Guide has served as the clinical reference handbook on tuberculosis (TB) diagnostic and treatment guidelines for the state of Georgia in the United States. Supported by the Georgia Department of Public Health, the production of the 112-page palm-sized booklet was previously led by a team of Georgia-based TB experts at Emory University and printed every three-five years with updates to clinical management guidelines and TB consult contact information. However, the costs associated with editorial printing combined with delays in updating a static printed booklet with revised guidance hampered the utility of the tool. Considering the barriers with paper-based production and based on the beneficial use of apps to support the dissemination of clinical management guidance in other settings, the booklet was converted into a mobile application. This paper describes the process of developing a mobile app version of the Georgia TB Reference Guide in an easy-to-update and readily available format. We employed a user-centered design approach to develop the app, including a series of qualitative interviews and quantitative surveys. Participants included a mix of state officials and local TB experts. First, initial foundational interviews were conducted to conceptualize current utilization practices of both the paper and PDF versions of the tool. Second, the findings from the initial interviews were organized thematically and informed the design of the app, which was then beta tested by a round of previously unsampled TB experts as well as a re-sample from the initial interviews. Third, the designs were coded into developmental phases and beta tested among users of the current Georgia TB Reference Guide. Fourth, the app was published and downloaded by a pre-selected group of local users who provided answers to a follow-up survey after using the app for one month. Fifth, user growth, self-reported demographics, and app usage between February and July 2022 were recorded through automatic data metrics built into the app. The paper copy Georgia TB Reference Guide usage themes included commonly referenced content, navigation paths, and desired features and content. The themes were converted into features and designs such as prioritizing commonly reviewed topics and guide customization with bookmarks and notes. Iterations of the designs were driven by feedback from TB experts and included home page featured content, improving con