A digital platform – CFHealthHub – was created to provide the technical components of the complex intervention to support adherence to treatment in PWCF. CFHealthHub provided the front-end user-facing components of the intervention (a website and mobile app) and the back-end server infrastructure for secure receipt and storage of adherence data. The technical development was defined by two high-level phases: (1) technical scoping and configuration of the infrastructure and (2) development of the digital components of the BCI.
The digital platform was developed iteratively over an 18-month period, with the first phase conducted with 27 participants from August 2015 to April 2016, followed by a two-centre feasibility study conducted with 64 participants across two CF centres in 2016–2017. The digital platform was finalised and became feature complete for the full-scale RCT launch in October 2017. The first phase of the technical development involved high-level requirements capture for the project. The top priority identified was to enable the display of objective adherence data to the interventionists and PWCF through the CFHealthHub website. Discussions with the nebuliser supplier led to the configuration of a secure data-transfer mechanism, enabling nebuliser devices to submit data in real-time to the study server, hosted at the University of Manchester (Manchester, UK). To display the adherence data in CFHealthHub it was necessary to develop a manual entry point for the prescription information through the CFHealthHub website. The website was developed to display the objective adherence data in a variety of graphical and tabular formats.
After the website was designed to display the objective adherence data, an intensive co-design process was launched to refine the display of data and to incorporate, develop and refine the BCI components. This involved multiple project stakeholders reviewing successive prototypes and wireframes of designs, and iterative website software releases. Input from the PPI panel and from the qualitative research contributed to the design and refinement process. Development of the mobile app drew heavily on the earlier website development reviews, but designs were tailored for smaller screen sizes. Mobile-specific engagement strategies (e.g. push notifications to encourage engagement with the CFHealthHub digital platform) were also incorporated.
The technical architecture of the digital component of the intervention is shown in Figure 2.
FIGURE 2 Technical architecture of the digital component of the intervention. (Figure not reproduced here; see the original article.)
The software development was conducted by the mobile health (mHealth) team at the Health eResearch Centre, University of Manchester, with design expertise provided by user experience (UX) company Keep It Usable (Manchester, UK). Later phases of the design work were completed in-house at the Health eResearch Centre.
For more details on WP 1, see Appendix 1.