Evaluating the Picterus Jaundice Pro Application in Parental Use: a prospective mixed-methods study (Preprint)

<sec> <title>BACKGROUND</title> Undiagnosed severe neonatal jaundice, caused by hyperbilirubinemia, can lead to irreversible brain damage. The Picterus® Jaundice Pro application (Picterus JP) is a mobile health app developed for use by healthcare professionals and parents to screen for neonatal hyperbilirubinemia. Yet, parental experiences with the Picterus JP remain largely unexplored. </sec> <sec> <title>OBJECTIVE</title> To evaluate the usability and user-friendliness of Picterus JP when used and evaluated by parents. </sec> <sec> <title>METHODS</title> Between August 2023 and January 2025, we conducted a prospective mixed-methods study at three maternity care settings: the maternity wards of two hospitals in the Netherlands and one hospital in Israel. Parents were invited to participate if their infant was term-born, at least 12 hours old, but still in the first week of life. Parents used Picterus JP once according to the manufacturer’s instructions. Immediately afterwards, usability was evaluated using the validated mHealth App Usability Questionnaire (MAUQ) and open-ended questions. A subset of parents and nurses participated in semi-structured interviews and focus groups. </sec> <sec> <title>RESULTS</title> : In total, 123 participants completed the questionnaire. The median [IQR] MAUQ-score was 6 [5-7] out of 7. Ninety-seven (88%) parents indicated they would use Picterus JP at home. Parents reported they found the app easy, quick and convenient, although sixty-seven (56%) reported a failure on the first try. Some parents struggled to find or interpret the instructions, but most (75%) who tried again obtained a bilirubin estimate. The thematic analysis identified three themes that were considered important for the usability of Picterus JP: intention to use Picterus JP, infant wellbeing and instruction and guidance. </sec> <sec> <title>CONCLUSIONS</title> Parents rated Picterus JP highly in terms of usability, despite encountering difficulties during initial use. Technical improvements and more proactive guidance seem important to support successful parental use. Nonetheless, both parents and nurses are positive about the Picterus JP potential for home screening of severe neonatal jaundice. </sec> <sec> <title>CLINICALTRIAL</title> N/A This study was registered in PaNaMa (ID 10763), the internal research registry of the University Medical Center Groningen (UMCG). Formal trial registration in a WHO-recognized trial registry was not required because the study did not fall under the Dutch Medical Research Involving Human Subjects Act (WMO). </sec>