Development of an application for self-monitoring to empower patients with rheumatoid arthritis (MyRA).

Objective: To develop a web-based self-monitoring tool including motivational elements to improve empowerment of patients with rheumatoid arthritis.

Methods: Following a design thinking approach, the development included three iterative, co-creative phases involving different stakeholders. In the 'empathise and define' phase, two focus groups gave insight into patients' wishes and needs regarding self-monitoring with an application. During the 'ideation' phase, two co-creation sessions were organised to establish the content and consider motivational elements. For the 'prototyping and testing' phase, usability was assessed through both formative (heuristics evaluation) and summative (System Usability Scale, 0-100, ≥68 is good to excellent) evaluations.

Results: The focus groups resulted in a shortlist of what to monitor (physical possibilities, quality of life, pain, fatigue, mental wellbeing, and social participation) and preferences on how to monitor (single item questions, 0-10 scale, frequency not fixed). The co-creation sessions revealed preference for empathetic dialogues with an avatar for self-monitoring. Setting goals, adding notes, sharing results, and receiving tips could further increase motivation for use. Initial experiences regarding heuristics of the tool were generally positive and confirmed by a System Usability Scale score of 84.4 (SD 11.6). Points for improvement included simplifying login procedures, adding notifications, and adjusting the avatar's tone of voice.

Conclusion: A web-based self-monitoring application (MyRA) was developed, with an avatar asking patients in dialogues to score six domains, showing graphical displays, a diary functionality, and practical tips. Further studies are needed to confirm its usability and effectiveness in empowering patients.