Evaluating the Picterus Jaundice Pro App for Neonatal Jaundice Screening by Parents: Prospective Mixed Methods Study.

Abstract

Background: Neonatal jaundice is a very common condition in the first week of life requiring timely recognition of the small subset of neonates at risk of developing severe neonatal hyperbilirubinemia (SNH). Total serum bilirubin, as quantified through blood testing, remains the gold standard for diagnosis, whereas screening based on visual inspection has been proven unreliable in identifying which jaundiced neonates require total serum bilirubin. Picterus Jaundice Pro (JP) is a mobile health app developed for use by health care professionals and parents to screen for imminent SNH. However, parental user experiences with Picterus JP remain largely unexplored.

Objective: This study aimed to evaluate the usability and user-friendliness of Picterus JP when used and evaluated by parents.

Methods: Between August 2023 and January 2025, we conducted a prospective mixed methods study at 3 maternity care settings: the maternity wards of 2 hospitals in the Netherlands and 1 hospital in Israel. Parents were invited to participate if their infant was near term born (gestational age of ≥35 weeks) and 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 afterward, usability was evaluated using the validated mHealth App Usability Questionnaire, an instrument measured on a 7-point Likert scale ranging from 1 ("strongly disagree") to 7 ("strongly agree"), and open-ended questions. A subset of parents and nurses participated in semistructured interviews and focus groups.

Results: In total, 123 parents completed the questionnaire. The median mHealth App Usability Questionnaire score was 6 (IQR 5-7) out of 7. A total of 87.7% (100/114) of the parents indicated that they would use Picterus JP at home. Parents reported that they found the app easy, quick, and convenient, although 55.8% (67/120) reported a failure on the first try. Some parents struggled to find or interpret the instructions, but most of those who tried again (79/105, 75.2%) obtained a bilirubin estimate. Additionally, 12 nurses from 2 participating maternity wards provided their observations on parents' use of Picterus JP in 2 focus groups. Thematic analysis of all combined data identified 3 themes that were considered important for the usability of Picterus JP: intention to use Picterus JP, infant well-being, and instruction and guidance.

Conclusions: 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 were positive about the potential of Picterus JP for home screening for SNH.