Chemo assist for children mobile health application to manage symptoms of chemotherapy in acute leukemia in Indonesia: A user-centered design approach

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Several monitoring systems available today are diverse in terms of features and system basis. This study aimed to develop and trial the Chemo Assist for Children (CAC) mHealth application for symptom management due to chemotherapy in children with acute lymphoblastic leukemia (ALL). Methods In this study, the development of the CAC application went through four phases. The initial phase was conducting a literature study for application content. The application design phase involved five experts to validate application content. In the implementation phase, the application was piloted on ten parents with ALL children undergoing chemotherapy at two teaching hospitals, Indonesia. At the evaluation stage, the CAC application was improved according to the test results. The data were obtained descriptively from the validation and application testing using the average and total item scores. Results Phase 1 obtained 17 reference sources in textbooks and research journal articles to design the mHealth application content. Phase 2 received the value of the content validity of all statements was 0.96, which means that the application material is declared valid. In phase 3, the average total usability test score was 4.28. Finally, an evaluation phase was applied continuously to produce a valid, accessible, and appropriate application for users. Conclusions The CAC mHealth application developed can meet the needs of technology users to identify symptoms and manage symptoms due to chemotherapy in children with ALL. The CAC mHealth application can accommodate data not recorded at out-of-hospital care, increase the independence of symptom management, and improve communication between parents of children with ALL and health workers. symptoms of chemotherapy mobile health literature review user-centered design Figures Figure 1 Introduction Acute lymphoblastic leukemia (ALL) is a malignancy that attacks blood-forming tissues [ 1 ], most found in children [ 2 , 3 ], which is about 74% [ 2 ]. Global Cancer Statistics (2018) noted that the prevalence of leukemia from all countries was 2.4% of new cases and 3.2% of deaths. The increase in ALL subjects in children is followed by advances in cancer treatment, namely, chemotherapy which has shown an increase in survival rates [ 4 ], reaching more than 80% in developed countries [ 5 ]. Indonesia is one of the top 30 countries with the biggest and rapid rise in age-standardized incidence rate (ASIR) in 2017 compared to 1990 (33,37%) [ 6 ]. Chemotherapy is considered effective in treating leukemia because it can maintain and contain the spread of cancer cells, slow the growth of cancer cells, kill cancer cells, and reduce symptoms caused by cancer [ 2 ]. However, chemotherapy causes various symptoms in each child that are individual and unique. Monitoring symptoms based on what the child feels and providing effective symptom management are essential aspects [ 7 ]. Moreover, it can also aid in overcoming chemotherapy side effects [ 7 , 8 ], shortening the treatment period, and preventing death [ 7 ], while improving children's psychosocial well-being and quality of life [ 9 ]. Recently, the rapid development of technology in the health/nursing sector and the pandemic of COVID-19 have amplified the need for specific mobile health (mHealth) applications that are user-friendly, allowing for real-time monitoring for parents and children with ALL to benefit and facilitating them in long-term care and treatment. In ​​pediatric cancer health services, several countries in the world have developed single or multiple symptoms monitoring and management applications, including web-based [ 10 – 12 ], smartphones [ 13 , 14 ], and computers [ 15 ]. A review suggests designing policies following the utilization of mHealth in developed countries because it does not require costly infrastructure and can increase the accessibility of education and information about childhood cancer [ 16 ]. Mobile health as technologies such as mobile phones, personal digital assistance (PDA), smartphones, patient monitoring devices, mp3 players for mobile learning, and mobile computing [ 17 ]. Therefore, we developed a mobile health-based symptom management intervention, called Chemo Assist for Children (CAC), as the first step in monitoring and symptom management interventions to increase knowledge, self-management of symptoms, and quality of life in acute lymphoblastic leukemia children. The aims of this study are 1) to describe the process of developing a mobile health-based chemotherapy symptom management intervention program for children with acute lymphoblastic leukemia and 2) to evaluate its usefulness to improve the program. Methods Design This research was established in 4 stages (Fig. 1 ) and was guided by a user-centered design approach. The type of research applied was research and development, which aimed to design and develop a mobile application to manage symptoms due to chemotherapy in children with ALL using an approach that applied a user-centered design and an extensive literature review. Population and Sample At the application design development stage, we involved five experts in different fields including a hemato-oncology pediatric clinician, child health clinician, psychologist, pediatric nurse, and an information and technology specialist. Research subjects were selected based on their respective expertise to obtain content validity. Next, the trial phase involved ten parents of children with ALL who underwent chemotherapy at two teaching hospitals in Indonesia. This trial stage was done to determine how easy and user-friendly were the menus in the application to use by five users (usability test) [ 18 ]. This research has obtained ethical approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (KE/FK1007/EC/2020), and the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020). Instruments The tool used by researchers in collecting data at application development stage was a validation sheet designed by the researcher in the form of appropriate or inappropriate statements according to experts from each step of identifying and managing symptoms due to chemotherapy. If there were any differences of opinions between the experts, clarification efforts were made to reach an agreement through continued discussion via email and short message service (SMS). Reminders and clarifications were sent through the WhatsApp application to reach a consensus. At the trial stage, researchers used direct observation and questionnaires. In the observation method, one author (DN) observed the user directly on the first day with the help of an observation sheet. The user is given an instruction sheet to carry out the commands in the use of the application. Then the observer puts a checkmark on the observation sheet whether the order is successful or not executed by the user. At the end of using the application, users are asked to fill out a satisfaction questionnaire for using the mHealth application in a usability test. This questionnaire was developed based on application content consisting of five domains, namely Material Coverage and Accuracy (2 items), Recency (1 item), Encouraging Curiosity (2 items), Clarity of Material and Language (5 items), and Attractiveness (5 items). Respondents can choose from 1 to 5, where 1 means unsatisfactory, while 5 means very satisfactory. The users can add comments and suggestions to the mHealth application. Development Process The software/application development requirements were collected and analyzed to produce a complete and final requirements specification in this phase. This activity was done as a basis for designing the mobile health application product. The design of mHealth was developed based on literature review and field/empirical studies. Researchers conducted a literature study examining questionnaires for chemotherapy symptoms, quality of life, and symptom management due to scientific evidence-based chemotherapy published in textbooks and research journal articles. Furthermore, a field study using a qualitative design was conducted to analyze the needs of users for the mobile health application through exploration of the experiences of participants, namely parents who have ALL children and are undergoing chemotherapy and pediatric nurses in identifying and managing symptoms due to chemotherapy and knowing the workflow of symptom management due to chemotherapy at home. The results of this qualitative study are presented in a separate article. After that, the design mHealth moved into prototyping to be read and understood by one expert in the field of information and technology (IT) who collaborates with the researchers in making mHealth applications. Furthermore, application standards such as the menu contained in the prototyping application were developed. Researchers made the initial prototype of the mobile health application. Moreover, the testing was done by several experts to obtain validation of the application. The experts in this phase 2 research were given an overview of the application design in the mHealth form of a prototyping mockup link and a module containing the material contained in the application. Then the experts filled out a questionnaire to assess and review the contents of the CAC mHealth application. The questionnaire contains statements according to (true) or inappropriate (false) according to the experts from each application menu content that the researcher designed. Experts provided input and advice independently. After the experts validated the application design, we consulted the language with a linguist from the Indonesian Language Study Program, Faculty of Cultural Sciences, Universitas Gadjah Mada, to obtain adequate and efficient use of sentences in an application. After receiving approval for language validation, we continued in the mHealth application development process in collaboration with IT developers in the field of mobile applications. The next phase was the application trial conducted from July 2021 to August 2021. In this phase, the researcher met the respondents, explained the purpose of the application trial, and obtained their informed consent before participating. Respondents were asked to use this application for three days. Researchers monitored the daily use of the application through their data center, communicated via telephone or message on WhatsApp to remind and control data input by respondents regarding the identification of symptoms due to chemotherapy, and recommended chemotherapy-induced symptom management programs. After three days, respondents were asked to fill out a questionnaire about the ease and satisfaction of respondents in using the application. In the final phase, this step aimed at improving the current specifications with reviews from a team of experts, combined with the test results to application users. This phase was applied continuously to add or subtract the contents and features of the application to obtain the most appropriate mHealth application for the user. Data Analysis Data analysis in the expert validation phase descriptively explained the number of scores or the proportion of statements approved by the experts. Then a validity test was done by determining the content validity index (CVI) value. CVI is done in two steps, namely 1) calculating individual items (i-CVI) and 2) adding up the total expert scores (s-CVI). The CVI assessment for new instruments is recommended to have a minimum value of 0.8, which is declared valid. If the value is in the range of 0.7–0.79, it is recommended to be revised, and if it is less than 0.7, then the item is eliminated [ 19 ]. Data analysis in the application trial phase was conducted to determine the ease and benefit felt by respondents. The study was done quantitatively by showing the average respondents' satisfaction with the mHealth application, and qualitative analysis used the comments submitted by respondents in the questionnaire. Data were processed using IBM SPSS version 25 software. Ethical considerations This research has obtained ethical approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (KE/FK1007/EC/2020), and the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020). Permission and approval to conduct the study were received from the President Director of Dr. M. Djamil Hospital, Padang, and Dr. Sardjito Hospital, Yogyakarta, Head of the Installation of Pediatric and Midwifery Inpatient Dr. M. Djamil Hospital, Head of Installation of Estella Dr. Sardjito Hospital. Before the usability test, the researchers explained the aim of the study, confidentiality of information, and participants' right to withdraw at any time. All participants in this study were parents of children with acute lymphoblastic leukemia, and no children under 16 years of age were involved. All parents or guardians obtained informed consent form for audio-recording and using excerpts in publications and reports before the test. The participants were anonymous during the analysis and presentation of results. Results The literature search and review were done to strengthen the content of chemotherapy-induced symptom management materials used in the mHealth application. Literature publications in the form of descriptive or clinical trials, systematic reviews, guidelines, and textbooks were included in this literature review. Electronic databases for searches included PubMed and Google Scholar. Search keywords involve procedures, child, pediatric, cancer, neoplasm, leukemia, symptom management, symptoms (nausea, vomiting, fever, neutropenia, fatigue, mucositis, oral mucositis, pain, cognitive impairment). We obtained 17 relevant references for the needs of CAC application materials, including four textbooks and 14 journal articles (Table 1 ). Table 1 Results of the literature search for mHealth app content Content Source Type of Source Upper arm circumference measurement [ 25 ] Textbook Calorie requirement calculation [ 25 – 27 ] Textbook Calculation of fluid requirement [ 25 ] Textbook Fulfilment of nutrition during illness in cancer children [ 25 , 28 ] Text / eBook Management of nausea or vomiting [ 29 – 33 ] Journal article Nutrition management [ 34 ] Journal article Management of fever and neutropenia [ 35 ] Journal article Fatigue management [ 36 ] Journal article Mucositis management [ 37 ] Journal article Pain management [ 38 , 39 ] Journal article Management of cognitive disorders [ 40 ] Journal article Signs and symptoms of acute lymphoblastic leukemia [ 41 ] Journal article Chemotherapy in children with acute lymphoblastic leukemia [ 42 ] Journal article [Insert Table 1 here] Furthermore, the application material was consulted with pediatric haemato-oncology experts, pediatric health experts, pediatric nursing experts, psychologists, and information technology experts. The experts who were respondents at the content validation stage of the application have experience in their fields so that the reviews provided by these experts can be scientifically justified. Generally, the experts involved in the content design of this application are male (4, 80%) and have doctoral education (3, 60%) (Table 2 ). Table 2 Characteristics of experts on content validation No. Gender Education Expertise Time of assessment P1 Male Doctoral, Subspecialist Pediatric Hematology-oncology (Consultant) 3 P2 Male Master, Specialist Child Health 2 P3 Female Master Pediatric Nursing 2 P4 Male Doctoral Psychology 2 P5 Male Doctoral Information Technology 2 Table 3 indicated that the increase in the total validity index occurred at the end by the experts from 0.75 to 0.97. We had improved the content of the application material through their suggestions and inputs submitted by the experts. The results of the revised application content were consulted again until it was declared appropriate by the experts. Experts provide essential input on almost all application content menu items, including demographic data, the addition of infection and bleeding to symptoms due to chemotherapy, the use of tools and methods for filling in children's body data, symptom management due to chemotherapy, and information about leukemia and chemotherapy in the form of animated videos. Table 4 showed an overview of the feedback provided by the experts. After the developers built the application, the researchers conducted a trial with ten users. Table 3 Content validity according to experts (n = 5) No. Statement First Assessment Last Assessment f I-CVI f I-CVI 1. Input demographic data as needed 4 0.8 5 1 2. Data input 15 symptoms due to chemotherapy using the SSPedi tools 4 0.8 5 1 3. Input body temperature, weight, height, and UAC 5 1 5 1 4. Input data for children's daily activities 3 0.6 5 1 5. How to calculate a child's calorie needs 4 0.8 5 1 6. Management of nausea or vomiting 3 0.6 4 0.80 7. Nutrition and fluid management 4 0.8 5 1 8. Mucositis management 3 0.6 5 1 9. Management of physical activity and rest (sleep) 4 0.8 5 1 10. Management of fever and neutropenia 4 0.8 4 0.80 11. Management of relaxation activities, hypnosis, and positive thoughts 4 0.8 5 1 12. Medication according to doctor's prescription 4 0.8 5 1 13. Daily, weekly, monthly chart depiction as needed in monitoring patient's health status 3 0.6 5 1 14. Acute lymphoblastic leukemia information 4 0.8 5 1 15. Chemotherapy information 3 0.6 5 1 Total mean score (S-CVI) (SD) 0.75 (0.358) 0.97 (0.058) SSPedi, symptom screening in pediatric; UAC, upper arm circumference; I-CVI, item-content validity index; S-CVI, scale-content validity index; SD, standard deviation Table 4 Recommendations for the content of the material in the application Expert Statement Suggestions 1, 2 Data input 15 symptoms due to chemotherapy using the SSPedi tools • Added signs of infection and bleeding in the Symptoms menu. • Displays a description of each symptom operationally. 1, 2 Input body temperature, weight, height, and upper arm circumference (UAC) • Using standardized nutritional status parameters and appropriate measuring tools in measuring children's nutritional status. • Added upper arm circumference measurement step. 2, 5 Input data for children's daily activities • There is a warning sign if the data is not filled in. 1, 2, 3, 4 How to calculate a child's calorie needs • Using the REE formula according to FAO/WHO/UNU. • Implementation of applicable calorie and fluid needs for families. • Calorie and fluid requirement formulas are obtained from data input by the user. 1, 2, 3 Management of nausea or vomiting • Added management of dehydration due to vomiting or mucositis. 2 Nutrition and fluid management • Adding menu recommendations according to patient needs and ready-to-use products available on the market. 1, 2, 3 Mucositis management • Create a symptom algorithm that can be treated at home or must be immediately taken to the hospital. 2 Management of physical activity and rest (sleep) • Adding material on identifying danger signs that cause fatigue, such as anemia, hypoglycemia, or electrolyte disturbances due to dehydration so that management takes the form of immediately taking them to the hospital. • Adding data on signs and symptoms that are easily recognizable by parents for decreased physiological status (not laboratory results). 1, 3 Management of fever and neutropenia • Immediately take to the hospital if fever or neutropenia. • Added anal fissure management. 2 Management of relaxation activities, hypnosis, and positive thoughts • Relaxation management is practiced in the form of video examples. 2 Medication according to doctor's prescription • Add an explanation of the type of drug that should be taken, the timing and risk of drug interactions with other foods/drinks/drugs. 1 Daily, weekly, monthly chart depiction as needed in monitoring patient's health status • What does the presentation of a graph? 2 Acute lymphoblastic leukemia information • Added explanation of invasive procedures. 2 Chemotherapy information • It uses layman's terminology and is easy to understand. REE, resting energy expenditure; FAO/WHO/UNU, food agriculture organization/world health organization/united nations university [Insert Table 3 , Table 4 here] Of the 12 parents who met, ten people were willing to participate in the trial of the CAC application. Almost all respondents were female (90%) and aged 20–40 years (90%). Most respondents' education level was intermediate (50%), and they generally worked as housewives (80%). Respondents had children with an average age of 8.75 (2–13 years) and were male (80%), undergoing chemotherapy in the induction phase (80%) and diagnosed with acute lymphoblastic leukemia less than three months (50%) (Table 5 ). Table 5 Characteristics of usability test respondents (n = 10) Variable Frequency Percentage Gender Male Female 1 9 10 90 Age (year) 20–40 More than 40 9 1 90 10 Education level High education (Academy/Bachelor/Postgraduate) Middle education (High school) Primary education (Elementary/Junior school) 3 5 2 30 50 20 Profession Working (Civil servants) Not working (Housewife) 2 8 20 80 Child's age (year) (median, min-max) 8.75 (2–13) Child’s gender Male Female 8 2 80 20 Phase of chemotherapy Induction Consolidation Maintenance 8 1 1 80 10 10 Long-time diagnosed with ALL 6 months – 1 year A year – 3 years > 3 years 5 1 0 1 3 50 10 0 10 30 [Insert Table 5 here] Almost all respondents could complete the tasks given in the trial well, taking about 15–20 minutes. However, there was one respondent who experienced problems in using the application due to cellular network interference. The average total respondents' satisfaction with the CAC application was 4.28 (0.32), indicating that the respondents were satisfied in terms of material coverage, application authenticity, curiosity, material clarity and language use, and application appearance (Table 6 ). Table 6 Average respondents' satisfaction with the use of the Chemo Assist for Children (n = 10) Statement Very dissatisfied Dissatisfied Enough satisfied Satisfied Very satisfied A. Material coverage 1. Fill in the application according to the child’s needs 0 0 3 5 2 2. Fill in the application according to the doctor's recommendation 0 0 0 8 2 B. Novelty 3. Application presentation according to the times 0 0 0 4 6 C. Encourage curiosity 4. Application helps in the identification of symptoms due to chemotherapy 0 0 1 6 3 5. Applications encourage the management of symptoms due to chemotherapy 0 0 0 6 4 D. Clarity of material and language 6. The app's learning method is easy to understand 0 0 1 5 4 7. The app's symptom management is easy to understand 0 0 0 8 2 8. The language is easy to understand and clearly read 0 0 0 3 7 9. The terms in the app are understandable 0 0 3 4 3 10. Sentence descriptions or app commands are continuous and easy to follow 0 0 0 7 3 E. Attractiveness 11. App features easy to understand 0 0 1 6 3 12. The size of the text reads well 0 0 0 5 5 13. Very interesting pictures 0 0 1 6 3 14. The activity flow is clear and interesting 0 0 1 5 4 15. Very attractive color 0 0 0 8 2 Total mean (SD) 4.28 (0.32) [Insert Table 6 here] Most of the respondents gave a good impression of the CAC mHealth application. The application contains information that is easy to understand and provides benefits during the treatment of children. The following are comments from respondents: "This application has increased our knowledge and helped us in dealing with our problems, especially in handling children's health during the treatment/chemotherapy period. In the future, hopefully, this application will be easier for users to use." (R1) "The app is good and easy to understand." (R2) "Quite understandable." (R4) "Good and helpful." (R5) "The application is easy to understand and easy to enter data." (R10) In addition to general comments, participants also gave specific suggestions for further improvement of the application, as follows: "The application is easy to understand; there are only signal problems when using it." (R1) "The symptom question no. 1 focus more on the patient's condition; No. 5 added details in the form of physical conditions, not only physical appearance." (R2) "Pease activate for a doctor's consultation while we are at home. For information, please increase the content that makes children enthusiastic about covering, for example, children/adolescents who are drug-free/recovered." (R10) Discussion In this study, an approach was the user-centered design used to design, implement, and evaluate the CAC mobile health application. This application allows users to identify and manage symptom data due to chemotherapy in children with ALL in one place. Besides, it also records body temperature and anthropometric status of children as indicators of monitoring possible fever or infection and decreasing or improving nutritional quality. This application feature can encourage users to be more involved in their own child's health care by implementing chemotherapy-induced symptom management recommendations and ultimately improving health care quality. In addition, information features in 12-minute animated video format can provide insight into children's disease and treatment and motivation to undergo chemotherapy treatment regularly. Using this mobile app to flexibly manage chemotherapy-induced symptom data can also fill the information gap that currently exists between clinical visits. Mobile-based education effectively increased mothers' knowledge and decisions about managing children when choking [ 20 ]. Similarly, a critical review by Aldiss et al. (2015) found that using supportive technology for children and young people with a chronic condition improved the knowledge of disease and psychosocial aspects. The CAC mHealth application was designed and developed based on the exploration of the role of parents in the management of chemotherapy-induced symptoms and the need for health application media for children with ALL and supplemented by a literature review of current studies. There are seven application modules: patient demographic data, primary health data, regulation of caloric and fluid requirements, symptom identification with Symptom Screening in Pediatrics (SSPedi) tools [ 22 ], symptom management due to chemotherapy, information, and consultation implemented into a mobile application. These modules make it easy for users to manage the health data of children with ALL. This CAC mHealth application is designed to be easy to use and user-friendly for both parents and children. Individual pages in the CAC mobile application are designed to be simple and have a specific purpose, such as entering children's chemotherapy data and identifying chemotherapy symptoms. Therefore, the usability of this application is high, and the participants are satisfied with the application. Ten parents with very diverse social, educational, and ethnic backgrounds tested the CAC mobile health application. In this way, we could get varied input and accommodate the needs expressed by users with various characteristics. The CAC mHealth application users were involved throughout the application trial implementation process. During the procedure, users actively contribute by providing ideas and feedback on the prototyping version in usability tests. Suggestions and feedback from users at the pilot stage have been incorporated into the current version of the CAC mHealth application. In general, respondents felt satisfied and felt that the application provided information, assistance, and solutions during chemotherapy treatment and treatment. Overall, the mHealth application was easy to understand and use. This app includes strong security measures to protect user data. In this CAC mHealth application, users must register their account with a private password before opening the menus. All data entered by a user are protected using an encrypted token that is unique to each user. The data entered by the user are saved after the application retrieves the data for display on the local device, and only authorized users can enter, view, or modify the data in the application. The application’s scalability is determined by the capacity of the secure remote server. Currently, the application utilizes server shared hosting , which is reliable with high-security features and unlimited storage capacity. The CAC mHealth application presently uses the development tool Flutter , which can be used for both Android and iOS-based mobile operating systems. With the availability of this CAC mobile app, users will be able to easily manage all of their health data in one place, including data during treatment and those generated between their typical clinical visits. These data are often not available to medical professionals. As a result, the information gap will be filled. Healthcare providers can obtain more reliable and comprehensive patient data, which can help them better understand the ineffectiveness of specific therapies. Health care providers can utilize information in their decision-making, leading to an increase in the quality of the health services provided. The application implementation design has also integrated several solutions for the barriers to adopting CAC. As obtained from the exploration findings, there are concerns about cybercrime and the possibility of internet signal/network constraints. Several mHealth security threats include malware infections, hackers, mobile phone theft, human users, and data theft by third parties such as insurance companies and intelligence departments [ 23 ]. The application has used strong security measures with password criteria of at least eight characters with a combination of upper- and lower-case letters. This feature will help the CAC mHealth application achieve higher adoption rates. Meanwhile, to overcome internet network problems, this CAC mHealth application is designed to be used when an internet connection is unavailable, or the network is in inadequate condition. Some users do not always have a strong network or internet signal, so that any data that the users' input is stored in advance on the mobile device or Smartphone. Then when users have a strong network, these data are automatically entered and uploaded into the application system. This action allows users not to need to repeat data entry. This finding aligns with the review [ 24 ] that one of the barriers to using mHealth applications is internet connectivity. This CAC mHealth app is designed to be extendable, and therefore, it will be easier to add new features according to user needs and feedback. This research aimed not to create mobile applications to meet everyone's needs but to build an mHealth application with a specialized purpose and provide the CAC mHealth application to specific users. After users use it for a certain period, they will better understand ​​what further improvements may be needed. There were some limitations of our study that deserve note. The usability test instrument is currently a questionnaire made by researchers to assess respondents' satisfaction with using the application from five aspects: material coverage and accuracy, recency, encouraging curiosity, clarity of material and language, and attractiveness of the application. This approach may miss some data in the collection, such as future application usage issues and obstacles encountered while using the application. Accordingly, these concerns can be addressed more in-depth through follow-up interviews in the future. However, the researchers encourage respondents to continue to provide comments and suggestions to obtain feedback on changes that need to be made to the application. The usability test should be done in a room, such as a laboratory, so respondents are in an air-conditioned, comfortable situation and environment. However, this study was conducted in a childcare facility, which could interfere with application testing. Implications for further research Future research needs to determine the efficacy and effectiveness of using the CAC mHealth application in clinical and community settings. The collection of qualitative data in evaluating user experience, benefits and challenges felt by users, significant and less important features of the mHealth application is also vital to improve the application's performance and quality. Implications for health services The presence of the CAC mHealth application for children with ALL can fill in the gaps in data that were not evaluated while patients are out of the hospital. The availability of recommendations and information on symptom management due to chemotherapy in the CAC mobile application can further increase independence and empower parents and children. In addition, the application can accommodate communication between parents, children, and health practitioners in recognizing and dealing with symptoms that arise during chemotherapy. Conclusions The CAC mHealth application was developed based on user needs and validated by experts to be functional and easy to use. Chemo Assist for Children is a mobile-based health application option that supports parents of children with leukemia undergoing chemotherapy treatment. The support presented through the application is expected to overcome various problems that arise from physical, psychological, and social aspects. Abbreviations mHealth Mobile health CAC Chemo assist for children ALL Acute lymphoblastic leukemia SMS Short message service CVI Content validity index I-CVI Item-Content validity index S-CVI Scale-level. App Application SSPedi Symptom screening in pediatrics UAC Upper arm circumference. Declarations Acknowledgements We are grateful to all the participants in Dr. M. Djamil Hospital Padang and Dr. Sardjito Hospital Yogyakarta for their participation and cooperation during this study. We also thank experts Bambang Ardianto, MD, MSc, Ph.D, Kristia Hermawan, MD, MPH, Yantri Maputra, M.Ed, Ph.D, Yuliana Hanaratri, BSN, MAN, and Ahmad Syafruddin Indrapiyatna, M.Eng, Ph.D, who have provided time, knowledge, and suggestions to improve the content of application. We would like to thank Research and Publication Affairs, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, who helped with the translation of this article. Authors contributions D.N: wrote, designed the study, collected the data, and edited the manuscript. L.Z: designed the study. F.H and E.S: wrote and analyzed the data. E.S.H: supervised and reviewed the manuscript. All authors commented read and approved the final manuscript. Funding This study was funded by Grant from Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This research was reviewed and approved by the Ethical Commission of Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (Reg No. KE/FK1007/EC/2020) and the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020). All the study methods were conducted in accordance to 7 (seven) WHO 2011 standards. Informed consent was obtained from parents/guardians of the participants whose age was below 16. Consent for publication Not applicable Competing interests The authors declare there is no conflict of interest. Author details 1 Department of Pediatrics and Maternity Nursing, Faculty of Nursing, Universitas Andalas, Padang, Indonesia [email protected] . 2 Student of Doctoral Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. 3 Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia [email protected] ; [email protected] 4 Department of Pediatric-Maternity Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia [email protected] 5 Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia [email protected] References Keene N. Childhood Leukemia. Childhood Cancer Guides : 2018. American Cancer Society. Cancer Facts & Figs. 2018. Atlanta: 2018. Tomlinson D, Kline NE. 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Improving Children’s cancer pain management in the home setting: Development and formative evaluation of a web-based program for parents. Comput Biol Med 2018;101:146–52. https://doi.org/10.1016/j.compbiomed.2018.08.014 . Cook S, Vettese E, Soman D, Hyslop S, Kuczynski S, Spiegler B, et al. Initial development of Supportive care Assessment, Prioritization and Recommendations for Kids (SPARK), a symptom screening and management application. BMC Med Inform Decis Mak 2019;19:1–11. https://doi.org/10.1186/s12911-018-0715-6 . Kock A-KK, Kaya RS, Müller C, Andersen B, Langer T, Ingenerf J. Design, implementation, and evaluation of a mobile application for patient empowerment and management of long-term follow-up after childhood cancer. Klin Padiatr 2015;227:166–70. https://doi.org/10.1055/s-0035-1548840 . Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, et al. A prototype exercise-empowerment mobile video game for children with cancer, and its usability assessment: Developing digital empowerment interventions for pediatric diseases. Front Pediatr 2018;6:1–18. https://doi.org/10.3389/fped.2018.00069 . Tsimicalis A, Rennick J, Le May S, Stinson J, Sarkis B, Séguin K, et al. “Tell it as it is”: How Sisom prompts children and parents to discuss their cancer experience. Cancer Rep 2019;2:1–15. https://doi.org/10.1002/cnr2.1173 . Mehdizadeh H, Asadi F, Mehrvar A, Nazemi E, Emami H. Smartphone apps to help children and adolescents with cancer and their families: a scoping review. Acta Oncol (Madr) 2019;58:1003–14. https://doi.org/10.1080/0284186X.2019.1588474 . World Health Organization. mHealth: New horizons for health through mobile technologies. Observatory 2011;3:66–71. https://doi.org/10.4258/hir.2012.18.3.231 . Nielsen J. Usability 101: Introduction to Usability 2012. https://www.nngroup.com/articles/usability-101-introduction-to-usability/ (accessed September 5, 2021). Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A-R. Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication. J Caring Sci 2015;4:165–78. https://doi.org/10.15171/jcs.2015.017 . Behboudi F, Pouralizadeh M, Yeganeh MR, Roushan ZA. The effect of education using a mobile application on knowledge and decision of Iranian mothers about prevention of foreign body aspiration and to relieve choking in children: A quasi-experimental study. J Pediatr Nurs 2021. https://doi.org/10.1016/j.pedn.2021.07.007 . Aldiss S, Baggott C, Gibson F, Mobbs S, Taylor RM. A critical review of the use of technology to provide psychosocial support for children and young people with long-term conditions. J Pediatr Nurs 2015;30:87–101. https://doi.org/10.1016/j.pedn.2014.09.014 . Hyslop S, Dupuis LL, Baggott C, Dix D, Gibson P, Kuczynski S, et al. Validation of the Proxy Version of Symptom Screening in Pediatrics Tool in Children Receiving Cancer Treatments. J Pain Symptom Manage 2018;56:107–12. https://doi.org/10.1016/j.jpainsymman.2018.03.025 . Zubaydi F, Saleh A, Aloul F, Sagahyroon A. Security of mobile health (mHealth) systems. 2015 IEEE 15th Int Conf Bioinforma Bioeng BIBE 2015 2015. https://doi.org/10.1109/BIBE.2015.7367689 . Osei E, Mashamba-Thompson TP. Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review. Heliyon 2021;7:e06639. https://doi.org/10.1016/j.heliyon.2021.e06639 . Association of Pediatric Hematology/Oncology Nurses A. Essentials of Pediatric Hematology/Oncology Nursing: A Core Curriculum. 4th ed. Association of Pediatric/Hematology Oncology Nurses; 2014. Kurniasari FN, Harti LB, Ariestiningsih AD, Wardhani SO, Nugroho S. Buku Ajar Gizi dan Kanker. Malang: Universitas Brawijaya Press; 2017. Ikatan Dokter Anak Indonesia. Rekomendasi Ikatan Dokter Anak Indonesia: Asuhan Nutrisi Pediatrik (Pediatric Nutrition Care). IDAI; 2011. Pan American Health Organization P. Early Diagnosis of Childhood Cancer. Washington, D.C.: PAHO; 2014. Flank J, Robinson PD, Holdsworth M, Phillips R, Portwine C, Gibson P, et al. Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy-Induced Nausea and Vomiting in Children with Cancer. Pediatr Blood Cancer 2016;63:1144–51. https://doi.org/10.1002/pbc.25955 . Sherani F, Boston C, Mba N. Latest Update on Prevention of Acute Chemotherapy-Induced Nausea and Vomiting in Pediatric Cancer Patients. Curr Oncol Rep 2019;21. https://doi.org/10.1007/s11912-019-0840-0 . Patel P, Robinson PD, Thackray J, Flank J, Holdsworth MT, Gibson P, et al. Guideline for the prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients: A focused update. Pediatr Blood Cancer 2017;64:1–12. https://doi.org/10.1002/pbc.26542 . Dupuis LL, Boodhan S, Holdsworth M, Robinson PD, Hain R, Portwine C, et al. Guideline for the Prevention of Acute Nausea and Vomiting Due to Antineoplastic Medication in Pediatric Cancer Patients. Pediatr Blood Cancer 2013;60:1073–82. https://doi.org/10.1002/pbc.24508 . Dupuis LL, Robinson PD, Boodhan S, Holdsworth M, Portwine C, Gibson P, et al. Guideline for the Prevention and Treatment of Anticipatory Nausea and Vomiting due to Chemotherapy in Pediatric Cancer Patients. Pediatr Blood Cancer 2014;61:1506–12. https://doi.org/10.1002/pbc.25063 . American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition. 8th ed. Itasca, IL: American Academy of Pediatrics; 2019. Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol 2017;35:2082–94. https://doi.org/10.1200/JCO.2016.71.7017 . Robinson PD, Oberoi S, Tomlinson D, Duong N, Davis H, Cataudella D, et al. Management of fatigue in children and adolescents with cancer and in paediatric recipients of haemopoietic stem-cell transplants: a clinical practice guideline. Lancet Child Adolesc Heal 2018:1–8. https://doi.org/10.1016/S2352-4642(18)30059-2 . Sung L, Robinson P, Treister N, Baggott T, Gibson P, Tissing W, et al. Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation. BMJ Support Palliat Care 2017;7:7–16. https://doi.org/10.1136/bmjspcare-2014-000804 . Çelebioğlu A, Gürol A, Yildirim ZK, Büyükavci M. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. Int J Nurs Pract 2015;21:797–804. https://doi.org/10.1111/ijn.12298 . Thrane S. Effectiveness of Integrative Modalities for Pain and Anxiety in Children and Adolescents with Cancer: A Systematic Review. J Pediatr Oncol Nurs 2013;30:320–32. https://doi.org/10.1177/1043454213511538.Effectiveness . Krull KR, Hardy KK, Kahalley LS, Schuitema I, Kesler SR. Neurocognitive outcomes and interventions in long-term survivors of childhood cancer. J Clin Oncol 2018;36:2181–9. https://doi.org/10.1200/JCO.2017.76.4696 . Clarke RT, Van Den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ. Clinical presentation of childhood leukaemia: A systematic review and meta-analysis. Arch Dis Child 2016;101:894–901. https://doi.org/10.1136/archdischild-2016-311251 . Yakin R, Syarif S, Tehuteru E. Perbandingan Kesintasan Tiga Tahun pada Anak Leukemia Limfoblastik Akut antara Protokol Pengobatan 2006 dan 2013. Indones J Cancer 2017;11:111–7. https://doi.org/10.33371/ijoc.v11i3.515 . Additional Declarations No competing interests reported. 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Global Cancer Statistics (2018) noted that the prevalence of leukemia from all countries was 2.4% of new cases and 3.2% of deaths. The increase in ALL subjects in children is followed by advances in cancer treatment, namely, chemotherapy which has shown an increase in survival rates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], reaching more than 80% in developed countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Indonesia is one of the top 30 countries with the biggest and rapid rise in age-standardized incidence rate (ASIR) in 2017 compared to 1990 (33,37%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChemotherapy is considered effective in treating leukemia because it can maintain and contain the spread of cancer cells, slow the growth of cancer cells, kill cancer cells, and reduce symptoms caused by cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, chemotherapy causes various symptoms in each child that are individual and unique. Monitoring symptoms based on what the child feels and providing effective symptom management are essential aspects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Moreover, it can also aid in overcoming chemotherapy side effects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], shortening the treatment period, and preventing death [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], while improving children's psychosocial well-being and quality of life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, the rapid development of technology in the health/nursing sector and the pandemic of COVID-19 have amplified the need for specific mobile health (mHealth) applications that are user-friendly, allowing for real-time monitoring for parents and children with ALL to benefit and facilitating them in long-term care and treatment. In ​​pediatric cancer health services, several countries in the world have developed single or multiple symptoms monitoring and management applications, including web-based [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], smartphones [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and computers [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A review suggests designing policies following the utilization of mHealth in developed countries because it does not require costly infrastructure and can increase the accessibility of education and information about childhood cancer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Mobile health as technologies such as mobile phones, personal digital assistance (PDA), smartphones, patient monitoring devices, mp3 players for mobile learning, and mobile computing [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, we developed a mobile health-based symptom management intervention, called Chemo Assist for Children (CAC), as the first step in monitoring and symptom management interventions to increase knowledge, self-management of symptoms, and quality of life in acute lymphoblastic leukemia children. The aims of this study are 1) to describe the process of developing a mobile health-based chemotherapy symptom management intervention program for children with acute lymphoblastic leukemia and 2) to evaluate its usefulness to improve the program.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis research was established in 4 stages (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and was guided by a user-centered design approach.\u003c/p\u003e\u003cp\u003eThe type of research applied was research and development, which aimed to design and develop a mobile application to manage symptoms due to chemotherapy in children with ALL using an approach that applied a user-centered design and an extensive literature review.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePopulation and Sample\u003c/h2\u003e \u003cp\u003eAt the application design development stage, we involved five experts in different fields including a hemato-oncology pediatric clinician, child health clinician, psychologist, pediatric nurse, and an information and technology specialist. Research subjects were selected based on their respective expertise to obtain content validity. Next, the trial phase involved ten parents of children with ALL who underwent chemotherapy at two teaching hospitals in Indonesia. This trial stage was done to determine how easy and user-friendly were the menus in the application to use by five users (usability test) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This research has obtained ethical approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (KE/FK1007/EC/2020), and the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cp\u003eThe tool used by researchers in collecting data at application development stage was a validation sheet designed by the researcher in the form of appropriate or inappropriate statements according to experts from each step of identifying and managing symptoms due to chemotherapy. If there were any differences of opinions between the experts, clarification efforts were made to reach an agreement through continued discussion via email and short message service (SMS). Reminders and clarifications were sent through the WhatsApp application to reach a consensus.\u003c/p\u003e \u003cp\u003eAt the trial stage, researchers used direct observation and questionnaires. In the observation method, one author (DN) observed the user directly on the first day with the help of an observation sheet. The user is given an instruction sheet to carry out the commands in the use of the application. Then the observer puts a checkmark on the observation sheet whether the order is successful or not executed by the user. At the end of using the application, users are asked to fill out a satisfaction questionnaire for using the mHealth application in a usability test. This questionnaire was developed based on application content consisting of five domains, namely Material Coverage and Accuracy (2 items), Recency (1 item), Encouraging Curiosity (2 items), Clarity of Material and Language (5 items), and Attractiveness (5 items). Respondents can choose from 1 to 5, where 1 means unsatisfactory, while 5 means very satisfactory. The users can add comments and suggestions to the mHealth application.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment Process\u003c/h2\u003e \u003cp\u003eThe software/application development requirements were collected and analyzed to produce a complete and final requirements specification in this phase. This activity was done as a basis for designing the mobile health application product. The design of mHealth was developed based on literature review and field/empirical studies. Researchers conducted a literature study examining questionnaires for chemotherapy symptoms, quality of life, and symptom management due to scientific evidence-based chemotherapy published in textbooks and research journal articles. Furthermore, a field study using a qualitative design was conducted to analyze the needs of users for the mobile health application through exploration of the experiences of participants, namely parents who have ALL children and are undergoing chemotherapy and pediatric nurses in identifying and managing symptoms due to chemotherapy and knowing the workflow of symptom management due to chemotherapy at home. The results of this qualitative study are presented in a separate article. After that, the design mHealth moved into prototyping to be read and understood by one expert in the field of information and technology (IT) who collaborates with the researchers in making mHealth applications.\u003c/p\u003e \u003cp\u003eFurthermore, application standards such as the menu contained in the prototyping application were developed. Researchers made the initial prototype of the mobile health application. Moreover, the testing was done by several experts to obtain validation of the application. The experts in this phase 2 research were given an overview of the application design in the mHealth form of a prototyping mockup link and a module containing the material contained in the application. Then the experts filled out a questionnaire to assess and review the contents of the CAC mHealth application. The questionnaire contains statements according to (true) or inappropriate (false) according to the experts from each application menu content that the researcher designed. Experts provided input and advice independently. After the experts validated the application design, we consulted the language with a linguist from the Indonesian Language Study Program, Faculty of Cultural Sciences, Universitas Gadjah Mada, to obtain adequate and efficient use of sentences in an application. After receiving approval for language validation, we continued in the mHealth application development process in collaboration with IT developers in the field of mobile applications.\u003c/p\u003e \u003cp\u003eThe next phase was the application trial conducted from July 2021 to August 2021. In this phase, the researcher met the respondents, explained the purpose of the application trial, and obtained their informed consent before participating. Respondents were asked to use this application for three days. Researchers monitored the daily use of the application through their data center, communicated via telephone or message on WhatsApp to remind and control data input by respondents regarding the identification of symptoms due to chemotherapy, and recommended chemotherapy-induced symptom management programs. After three days, respondents were asked to fill out a questionnaire about the ease and satisfaction of respondents in using the application.\u003c/p\u003e \u003cp\u003eIn the final phase, this step aimed at improving the current specifications with reviews from a team of experts, combined with the test results to application users. This phase was applied continuously to add or subtract the contents and features of the application to obtain the most appropriate mHealth application for the user.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData analysis in the expert validation phase descriptively explained the number of scores or the proportion of statements approved by the experts. Then a validity test was done by determining the content validity index (CVI) value. CVI is done in two steps, namely 1) calculating individual items (i-CVI) and 2) adding up the total expert scores (s-CVI). The CVI assessment for new instruments is recommended to have a minimum value of 0.8, which is declared valid. If the value is in the range of 0.7\u0026ndash;0.79, it is recommended to be revised, and if it is less than 0.7, then the item is eliminated [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Data analysis in the application trial phase was conducted to determine the ease and benefit felt by respondents. The study was done quantitatively by showing the average respondents' satisfaction with the mHealth application, and qualitative analysis used the comments submitted by respondents in the questionnaire. Data were processed using IBM SPSS version 25 software.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThis research has obtained ethical approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (KE/FK1007/EC/2020), and the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020). Permission and approval to conduct the study were received from the President Director of Dr. M. Djamil Hospital, Padang, and Dr. Sardjito Hospital, Yogyakarta, Head of the Installation of Pediatric and Midwifery Inpatient Dr. M. Djamil Hospital, Head of Installation of Estella Dr. Sardjito Hospital. Before the usability test, the researchers explained the aim of the study, confidentiality of information, and participants' right to withdraw at any time. All participants in this study were parents of children with acute lymphoblastic leukemia, and no children under 16 years of age were involved. All parents or guardians obtained informed consent form for audio-recording and using excerpts in publications and reports before the test. The participants were anonymous during the analysis and presentation of results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe literature search and review were done to strengthen the content of chemotherapy-induced symptom management materials used in the mHealth application. Literature publications in the form of descriptive or clinical trials, systematic reviews, guidelines, and textbooks were included in this literature review. Electronic databases for searches included PubMed and Google Scholar. Search keywords involve procedures, child, pediatric, cancer, neoplasm, leukemia, symptom management, symptoms (nausea, vomiting, fever, neutropenia, fatigue, mucositis, oral mucositis, pain, cognitive impairment). We obtained 17 relevant references for the needs of CAC application materials, including four textbooks and 14 journal articles (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the literature search for mHealth app content\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType of Source\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper arm circumference measurement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTextbook\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalorie requirement calculation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTextbook\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalculation of fluid requirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTextbook\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFulfilment of nutrition during illness in cancer children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eText / eBook\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement of nausea or vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement of fever and neutropenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucositis management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement of cognitive disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and symptoms of acute lymphoblastic leukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy in children with acute lymphoblastic leukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal article\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eFurthermore, the application material was consulted with pediatric haemato-oncology experts, pediatric health experts, pediatric nursing experts, psychologists, and information technology experts. The experts who were respondents at the content validation stage of the application have experience in their fields so that the reviews provided by these experts can be scientifically justified. Generally, the experts involved in the content design of this application are male (4, 80%) and have doctoral education (3, 60%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of experts on content validation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExpertise\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime of assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoctoral, Subspecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePediatric Hematology-oncology (Consultant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster, Specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChild Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePediatric Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInformation Technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicated that the increase in the total validity index occurred at the end by the experts from 0.75 to 0.97. We had improved the content of the application material through their suggestions and inputs submitted by the experts. The results of the revised application content were consulted again until it was declared appropriate by the experts. Experts provide essential input on almost all application content menu items, including demographic data, the addition of infection and bleeding to symptoms due to chemotherapy, the use of tools and methods for filling in children's body data, symptom management due to chemotherapy, and information about leukemia and chemotherapy in the form of animated videos. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showed an overview of the feedback provided by the experts. After the developers built the application, the researchers conducted a trial with ten users.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent validity according to experts (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eFirst Assessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eLast Assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ef\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI-CVI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ef\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eI-CVI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInput demographic data as needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eData input 15 symptoms due to chemotherapy using the SSPedi tools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInput body temperature, weight, height, and UAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInput data for children's daily activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow to calculate a child's calorie needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of nausea or vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition and fluid management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucositis management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of physical activity and rest (sleep)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of fever and neutropenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of relaxation activities, hypnosis, and positive thoughts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication according to doctor's prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily, weekly, monthly chart depiction as needed in monitoring patient's health status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute lymphoblastic leukemia information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChemotherapy information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal mean score (S-CVI) (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.75 (0.358)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.97 (0.058)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSSPedi, symptom screening in pediatric; UAC, upper arm circumference; I-CVI, item-content validity index; S-CVI, scale-content validity index; SD, standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecommendations for the content of the material in the application\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpert\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuggestions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eData input 15 symptoms due to chemotherapy using the SSPedi tools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Added signs of infection and bleeding in the Symptoms menu.\u003c/p\u003e \u003cp\u003e\u0026bull; Displays a description of each symptom operationally.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInput body temperature, weight, height, and upper arm circumference (UAC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Using standardized nutritional status parameters and appropriate measuring tools in measuring children's nutritional status.\u003c/p\u003e \u003cp\u003e\u0026bull; Added upper arm circumference measurement step.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2, 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInput data for children's daily activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; There is a warning sign if the data is not filled in.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 2, 3, 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow to calculate a child's calorie needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Using the REE formula according to FAO/WHO/UNU.\u003c/p\u003e \u003cp\u003e\u0026bull; Implementation of applicable calorie and fluid needs for families.\u003c/p\u003e \u003cp\u003e\u0026bull; Calorie and fluid requirement formulas are obtained from data input by the user.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 2, 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of nausea or vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Added management of dehydration due to vomiting or mucositis.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition and fluid management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Adding menu recommendations according to patient needs and ready-to-use products available on the market.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 2, 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucositis management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Create a symptom algorithm that can be treated at home or must be immediately taken to the hospital.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of physical activity and rest (sleep)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Adding material on identifying danger signs that cause fatigue, such as anemia, hypoglycemia, or electrolyte disturbances due to dehydration so that management takes the form of immediately taking them to the hospital.\u003c/p\u003e \u003cp\u003e\u0026bull; Adding data on signs and symptoms that are easily recognizable by parents for decreased physiological status (not laboratory results).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1, 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of fever and neutropenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Immediately take to the hospital if fever or neutropenia.\u003c/p\u003e \u003cp\u003e\u0026bull; Added anal fissure management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement of relaxation activities, hypnosis, and positive thoughts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Relaxation management is practiced in the form of video examples.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication according to doctor's prescription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Add an explanation of the type of drug that should be taken, the timing and risk of drug interactions with other foods/drinks/drugs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily, weekly, monthly chart depiction as needed in monitoring patient's health status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; What does the presentation of a graph?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute lymphoblastic leukemia information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Added explanation of invasive procedures.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChemotherapy information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; It uses layman's terminology and is easy to understand.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eREE, resting energy expenditure; FAO/WHO/UNU, food agriculture organization/world health organization/united nations university\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e Of the 12 parents who met, ten people were willing to participate in the trial of the CAC application. Almost all respondents were female (90%) and aged 20\u0026ndash;40 years (90%). Most respondents' education level was intermediate (50%), and they generally worked as housewives (80%). Respondents had children with an average age of 8.75 (2\u0026ndash;13 years) and were male (80%), undergoing chemotherapy in the induction phase (80%) and diagnosed with acute lymphoblastic leukemia less than three months (50%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of usability test respondents (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003cp\u003e20\u0026ndash;40\u003c/p\u003e \u003cp\u003eMore than 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003cp\u003eHigh education (Academy/Bachelor/Postgraduate)\u003c/p\u003e \u003cp\u003eMiddle education (High school)\u003c/p\u003e \u003cp\u003ePrimary education (Elementary/Junior school)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e50\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003cp\u003eWorking (Civil servants)\u003c/p\u003e \u003cp\u003eNot working (Housewife)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild's age (year) (median, min-max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8.75 (2\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s gender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase of chemotherapy\u003c/p\u003e \u003cp\u003eInduction\u003c/p\u003e \u003cp\u003eConsolidation\u003c/p\u003e \u003cp\u003eMaintenance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong-time diagnosed with ALL\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e \u003cp\u003e3\u0026ndash;6 months\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 months \u0026ndash; 1 year\u003c/p\u003e \u003cp\u003eA year \u0026ndash; 3 years\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eAlmost all respondents could complete the tasks given in the trial well, taking about 15\u0026ndash;20 minutes. However, there was one respondent who experienced problems in using the application due to cellular network interference. The average total respondents' satisfaction with the CAC application was 4.28 (0.32), indicating that the respondents were satisfied in terms of material coverage, application authenticity, curiosity, material clarity and language use, and application appearance (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAverage respondents' satisfaction with the use of the Chemo Assist for Children (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery dissatisfied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDissatisfied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEnough satisfied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA. Material coverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Fill in the application according to the child\u0026rsquo;s needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Fill in the application according to the doctor's recommendation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB. Novelty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Application presentation according to the times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC. Encourage curiosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Application helps in the identification of symptoms due to chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Applications encourage the management of symptoms due to chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD. Clarity of material and language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. The app's learning method is easy to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. The app's symptom management is easy to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. The language is easy to understand and clearly read\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. The terms in the app are understandable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Sentence descriptions or app commands are continuous and easy to follow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE. Attractiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. App features easy to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. The size of the text reads well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Very interesting pictures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. The activity flow is clear and interesting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Very attractive color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.28 (0.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eMost of the respondents gave a good impression of the CAC mHealth application. The application contains information that is easy to understand and provides benefits during the treatment of children. The following are comments from respondents:\u003c/p\u003e \u003cp\u003e\"This application has increased our knowledge and helped us in dealing with our problems, especially in handling children's health during the treatment/chemotherapy period. In the future, hopefully, this application will be easier for users to use.\" (R1)\u003c/p\u003e \u003cp\u003e\"The app is good and easy to understand.\" (R2)\u003c/p\u003e \u003cp\u003e\"Quite understandable.\" (R4)\u003c/p\u003e \u003cp\u003e\"Good and helpful.\" (R5)\u003c/p\u003e \u003cp\u003e\"The application is easy to understand and easy to enter data.\" (R10)\u003c/p\u003e \u003cp\u003eIn addition to general comments, participants also gave specific suggestions for further improvement of the application, as follows:\u003c/p\u003e \u003cp\u003e\"The application is easy to understand; there are only signal problems when using it.\" (R1)\u003c/p\u003e \u003cp\u003e\"The symptom question no. 1 focus more on the patient's condition; No. 5 added details in the form of physical conditions, not only physical appearance.\" (R2)\u003c/p\u003e \u003cp\u003e\"Pease activate for a doctor's consultation while we are at home. For information, please increase the content that makes children enthusiastic about covering, for example, children/adolescents who are drug-free/recovered.\" (R10)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, an approach was the user-centered design used to design, implement, and evaluate the CAC mobile health application. This application allows users to identify and manage symptom data due to chemotherapy in children with ALL in one place. Besides, it also records body temperature and anthropometric status of children as indicators of monitoring possible fever or infection and decreasing or improving nutritional quality. This application feature can encourage users to be more involved in their own child's health care by implementing chemotherapy-induced symptom management recommendations and ultimately improving health care quality. In addition, information features in 12-minute animated video format can provide insight into children's disease and treatment and motivation to undergo chemotherapy treatment regularly. Using this mobile app to flexibly manage chemotherapy-induced symptom data can also fill the information gap that currently exists between clinical visits. Mobile-based education effectively increased mothers' knowledge and decisions about managing children when choking [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, a critical review by Aldiss et al. (2015) found that using supportive technology for children and young people with a chronic condition improved the knowledge of disease and psychosocial aspects.\u003c/p\u003e \u003cp\u003eThe CAC mHealth application was designed and developed based on the exploration of the role of parents in the management of chemotherapy-induced symptoms and the need for health application media for children with ALL and supplemented by a literature review of current studies. There are seven application modules: patient demographic data, primary health data, regulation of caloric and fluid requirements, symptom identification with \u003cem\u003eSymptom Screening in Pediatrics\u003c/em\u003e (SSPedi) tools [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], symptom management due to chemotherapy, information, and consultation implemented into a mobile application. These modules make it easy for users to manage the health data of children with ALL.\u003c/p\u003e \u003cp\u003eThis CAC mHealth application is designed to be easy to use and user-friendly for both parents and children. Individual pages in the CAC mobile application are designed to be simple and have a specific purpose, such as entering children's chemotherapy data and identifying chemotherapy symptoms. Therefore, the usability of this application is high, and the participants are satisfied with the application. Ten parents with very diverse social, educational, and ethnic backgrounds tested the CAC mobile health application. In this way, we could get varied input and accommodate the needs expressed by users with various characteristics. The CAC mHealth application users were involved throughout the application trial implementation process. During the procedure, users actively contribute by providing ideas and feedback on the prototyping version in usability tests. Suggestions and feedback from users at the pilot stage have been incorporated into the current version of the CAC mHealth application. In general, respondents felt satisfied and felt that the application provided information, assistance, and solutions during chemotherapy treatment and treatment. Overall, the mHealth application was easy to understand and use.\u003c/p\u003e \u003cp\u003eThis app includes strong security measures to protect user data. In this CAC mHealth application, users must register their account with a private password before opening the menus. All data entered by a user are protected using an encrypted token that is unique to each user. The data entered by the user are saved after the application retrieves the data for display on the local device, and only authorized users can enter, view, or modify the data in the application.\u003c/p\u003e \u003cp\u003eThe application\u0026rsquo;s scalability is determined by the capacity of the secure remote server. Currently, the application utilizes server \u003cem\u003eshared hosting\u003c/em\u003e, which is reliable with high-security features and unlimited storage capacity. The CAC mHealth application presently uses the development tool \u003cem\u003eFlutter\u003c/em\u003e, which can be used for both Android and iOS-based mobile operating systems.\u003c/p\u003e \u003cp\u003eWith the availability of this CAC mobile app, users will be able to easily manage all of their health data in one place, including data during treatment and those generated between their typical clinical visits. These data are often not available to medical professionals. As a result, the information gap will be filled. Healthcare providers can obtain more reliable and comprehensive patient data, which can help them better understand the ineffectiveness of specific therapies. Health care providers can utilize information in their decision-making, leading to an increase in the quality of the health services provided.\u003c/p\u003e \u003cp\u003eThe application implementation design has also integrated several solutions for the barriers to adopting CAC. As obtained from the exploration findings, there are concerns about \u003cem\u003ecybercrime\u003c/em\u003e and the possibility of internet signal/network constraints. Several mHealth security threats include malware infections, hackers, mobile phone theft, human users, and data theft by third parties such as insurance companies and intelligence departments [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The application has used strong security measures with password criteria of at least eight characters with a combination of upper- and lower-case letters. This feature will help the CAC mHealth application achieve higher adoption rates.\u003c/p\u003e \u003cp\u003eMeanwhile, to overcome internet network problems, this CAC mHealth application is designed to be used when an internet connection is unavailable, or the network is in inadequate condition. Some users do not always have a strong network or internet signal, so that any data that the users' input is stored in advance on the mobile device or \u003cem\u003eSmartphone.\u003c/em\u003e Then when users have a strong network, these data are automatically entered and uploaded into the application system. This action allows users not to need to repeat data entry. This finding aligns with the review [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] that one of the barriers to using mHealth applications is internet connectivity.\u003c/p\u003e \u003cp\u003eThis CAC mHealth app is designed to be extendable, and therefore, it will be easier to add new features according to user needs and feedback. This research aimed not to create mobile applications to meet everyone's needs but to build an mHealth application with a specialized purpose and provide the CAC mHealth application to specific users. After users use it for a certain period, they will better understand ​​what further improvements may be needed.\u003c/p\u003e \u003cp\u003eThere were some limitations of our study that deserve note. The usability test instrument is currently a questionnaire made by researchers to assess respondents' satisfaction with using the application from five aspects: material coverage and accuracy, recency, encouraging curiosity, clarity of material and language, and attractiveness of the application. This approach may miss some data in the collection, such as future application usage issues and obstacles encountered while using the application. Accordingly, these concerns can be addressed more in-depth through follow-up interviews in the future. However, the researchers encourage respondents to continue to provide comments and suggestions to obtain feedback on changes that need to be made to the application. The usability test should be done in a room, such as a laboratory, so respondents are in an air-conditioned, comfortable situation and environment. However, this study was conducted in a childcare facility, which could interfere with application testing.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImplications for further research\u003c/h2\u003e \u003cp\u003eFuture research needs to determine the efficacy and effectiveness of using the CAC mHealth application in clinical and community settings. The collection of qualitative data in evaluating user experience, benefits and challenges felt by users, significant and less important features of the mHealth application is also vital to improve the application's performance and quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImplications for health services\u003c/h2\u003e \u003cp\u003eThe presence of the CAC mHealth application for children with ALL can fill in the gaps in data that were not evaluated while patients are out of the hospital. The availability of recommendations and information on symptom management due to chemotherapy in the CAC mobile application can further increase independence and empower parents and children. In addition, the application can accommodate communication between parents, children, and health practitioners in recognizing and dealing with symptoms that arise during chemotherapy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe CAC mHealth application was developed based on user needs and validated by experts to be functional and easy to use. Chemo Assist for Children is a mobile-based health application option that supports parents of children with leukemia undergoing chemotherapy treatment. The support presented through the application is expected to overcome various problems that arise from physical, psychological, and social aspects.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emHealth\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMobile health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChemo assist for children\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute lymphoblastic leukemia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort message service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent validity index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eI-CVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eItem-Content validity index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eS-CVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScale-level.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eApp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eApplication\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSPedi\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSymptom screening in pediatrics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUpper arm circumference.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to all the participants in Dr. M. Djamil Hospital Padang and Dr. Sardjito Hospital Yogyakarta for their participation and cooperation during this study. We also thank experts Bambang Ardianto, MD, MSc, Ph.D, Kristia Hermawan, MD, MPH, Yantri Maputra, M.Ed, Ph.D, Yuliana Hanaratri, BSN, MAN, and Ahmad Syafruddin Indrapiyatna, M.Eng, Ph.D, who have provided time, knowledge, and suggestions to improve the content of application. We would like to thank Research and Publication Affairs, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, who helped with the translation of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.N: wrote, designed the study, collected the data, and edited the manuscript. L.Z: designed the study. F.H and E.S: wrote and analyzed the data. E.S.H: supervised and reviewed the manuscript. All authors commented read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Grant from Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was reviewed and approved by the Ethical Commission of Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (Reg No. KE/FK1007/EC/2020) and\u0026nbsp;the Health Research Ethics Commission Dr. M. Djamil Hospital Padang (262/KEPK/2020). All the study methods were conducted in accordance to 7 (seven) WHO 2011 standards. Informed consent was obtained from parents/guardians of the participants whose age was below 16.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Pediatrics and Maternity Nursing, Faculty of Nursing, Universitas Andalas, Padang, Indonesia [email protected].\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eStudent of Doctoral Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada,\u0026nbsp;Yogyakarta, Indonesia.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia [email protected]; [email protected]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eDepartment of Pediatric-Maternity Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia [email protected]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003eDepartment of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKeene N. 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Perbandingan Kesintasan Tiga Tahun pada Anak Leukemia Limfoblastik Akut antara Protokol Pengobatan 2006 dan 2013. Indones J Cancer 2017;11:111\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.33371/ijoc.v11i3.515\u003c/span\u003e\u003cspan address=\"10.33371/ijoc.v11i3.515\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"symptoms of chemotherapy, mobile health, literature review, user-centered design","lastPublishedDoi":"10.21203/rs.3.rs-1705083/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1705083/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe mobile health (mHealth) application encourages parents and pediatric patients to be involved in caring for their child's health condition by providing the ability to identify and manage chemotherapy-induced symptoms in their child actively. Several monitoring systems available today are diverse in terms of features and system basis. This study aimed to develop and trial the Chemo Assist for Children (CAC) mHealth application for symptom management due to chemotherapy in children with acute lymphoblastic leukemia (ALL).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this study, the development of the CAC application went through four phases. The initial phase was conducting a literature study for application content. The application design phase involved five experts to validate application content. In the implementation phase, the application was piloted on ten parents with ALL children undergoing chemotherapy at two teaching hospitals, Indonesia. At the evaluation stage, the CAC application was improved according to the test results. The data were obtained descriptively from the validation and application testing using the average and total item scores.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePhase 1 obtained 17 reference sources in textbooks and research journal articles to design the mHealth application content. Phase 2 received the value of the content validity of all statements was 0.96, which means that the application material is declared valid. In phase 3, the average total usability test score was 4.28. Finally, an evaluation phase was applied continuously to produce a valid, accessible, and appropriate application for users.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe CAC mHealth application developed can meet the needs of technology users to identify symptoms and manage symptoms due to chemotherapy in children with ALL. The CAC mHealth application can accommodate data not recorded at out-of-hospital care, increase the independence of symptom management, and improve communication between parents of children with ALL and health workers.\u003c/p\u003e","manuscriptTitle":"Chemo assist for children mobile health application to manage symptoms of chemotherapy in acute leukemia in Indonesia: A user-centered design approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-07-25 17:25:28","doi":"10.21203/rs.3.rs-1705083/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-09-22T12:56:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-09-21T23:39:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8bc213b1-857e-446b-924a-9b0246e33ab5","date":"2022-09-16T08:39:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-09-10T04:52:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17fe27fc-55aa-40b9-b55f-4410f83958a4","date":"2022-09-09T11:27:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8effcecd-6c2c-4f34-9608-e208bd18d73a","date":"2022-08-11T18:47:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-07-25T11:20:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-07-25T11:12:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-07-18T08:32:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-07-18T08:29:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2022-05-29T14:49:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee0199e1-698a-43b2-8b0d-aa624bb89699","owner":[],"postedDate":"July 25th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T21:33:21+00:00","versionOfRecord":{"articleIdentity":"rs-1705083","link":"https://doi.org/10.1186/s12887-023-04076-0","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2023-05-30 21:01:56","publishedOnDateReadable":"May 30th, 2023"},"versionCreatedAt":"2022-07-25 17:25:28","video":"","vorDoi":"10.1186/s12887-023-04076-0","vorDoiUrl":"https://doi.org/10.1186/s12887-023-04076-0","workflowStages":[]},"version":"v1","identity":"rs-1705083","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1705083","identity":"rs-1705083","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}