A lifeline connecting new parents with the hospital:Using Participatory Design to develop and test an app for parents being discharged early postnatal

摘要

A new policy was issued in the Region of Southern Denmark in 2011 in which early postnatal discharge was to become general practice following uncomplicated delivery for first-time and multiparous mothers. This presented a challenge to find new ways to provide information and support to families. One possibility is the use of telemedicine.The aim was to find new ways to provide support by investigating the needs of early discharged mothers and their partners, designing and developing a solution and exploring how they experience it and testing whether a telemedicine solution could ensure a sense of security, wellbeing and self-efficacy.The chosen research design was Participatory Design (PD), with the purpose of involving the participants. We used PD with a combination of qualitative methods, i.e. field studies, user activities and intervention. The study consisted of three phases; first an identification of needs phase, where the new parents and healthcare professionals identified support needs after early postnatal discharge. This was followed by the design, development and testing phase. Here, an app was designed, developed and tested between hospital staff and new parents at home following early postnatal discharge. The content, format and style of the app were designed on the basis of the parents’ identified needs, in close cooperation with the nurses on the postnatal ward, and with the assistance of a team of computer programmers. The app contains a chat function, a knowledgebase, and automated messages. The app was at first tested in a pilot test with 10 new families. Thereafter the app was tested more thoroughly in an intervention between March and October 2013 in the Region of Southern Denmark, involving the postnatal ward and 26 new families in their homes. The data analysis was inspired by systematic text condensation, which originated in Giorgi’s descriptive phenomenological method. The results gave a new understanding of the parents’ needs and also suggestions for a possible telemedicine solution. The families requested an individualised postnatal follow-up, timely information and guidance and accessibility to, and new ways to communicate with, healthcare professionals. On this basis, an app was developed and tested, where it was found that the nurses had difficulties fitting the new work processes into their existing working routines. However, they considered that the app gave them the possibility to offer support for the families discharged early, as it provided families with easier access to timely information and support, and it enhanced opportunities for families to initiate contact after discharge. The nurses addressed the fact, however, that the online chat function changed their way of communicating with the families, which they experienced altered their support to the new parents. The parents were confident in using an app; they did not experience any barriers in contacting the nurses with the use of asynchronous communication. The parents received timely information and guidance by communicating online and experienced that their follow-up support needs were met.The app is experienced as a lifeline that connects the homes of the new parents with the hospital. The functionalities of this app, which includes the chat, the knowledgebase and the automated messages, met the needs of the new parents, who requested accessibility to the healthcare system so that they could receive a response to their concerns, doubts and questions during the postnatal period. The app has the potential to ensure parents’ postnatal sense of security and enhance parental self-efficacy. It can be concluded that the use of an app can be a way to support new parents who are discharged early. Yet, it is important to underline the fact that one of the main contributory factors to feeling secure is parents’ sense of being in control, which underlines the importance of involvement in the decision about when to be discharged. The app could be applied in the nurses’ working practice, but challenges to the daily practice arose, around the change of work processes on the postnatal ward, and these had to be addressed before it was implemented. This study gives a new insight into the needs of new parents who are discharged early, and into new ways for organising early discharge. It shows how telemedicine can be of value from the perspective of both new parents and nurses, when it is designed to meet the parents’ needs and with the participation of users in the design process.