129 Patient’s and parents’ perspective on PROM implementation saturation was considered attained when no new themes emerged during the analyses of the focus groups. Regarding the questionnaire, SPSS was used for descriptive statistics (percentages) to provide insight into the experiences of patients and parents with the use of the KLIK PROM portal. Open questions of the evaluation questionnaires were analyzed qualitatively by MvM and LT. This was done by clustering the answers of both patients and parents into main themes following the thematic analysis in psychology [34]. Results Participants Figure 2 shows the study and participant flowchart of this study. In total, 8 patients (three focus groups) and 17 parents (three focus groups) participated in six focus groups. Regarding the questionnaire, 31 patients (response rate: 21.8%) and 130 parents (response rate: 19.6%) participated. One patient and 5 parents participated in the focus groups and completed the questionnaire. Table 1 shows the sociodemographic characteristics of all participants. Focus groups Data saturation was attained as no new themes emerged after analyzing the focus groups. Table 2 (patients) and 3 (parents) depict the most important positive experiences with KLIK and points of improvement for KLIK and corresponding examples of statements. Themes are ranked based on the number of times mentioned (most often to fewest times) by patients and parents during the focus groups. Patients In all focus groups, patients came up with a broad range of experiences with KLIK, both positive, negative and mixed. Themes that were unanimously rated as positive were that the KLIK website has an attractive layout (due to the use of colors and pictures), that KLIK provides insight into their daily functioning and that KLIK improves the conversation content during the consultation, where a broader range of topics is discussed. Furthermore, patients indicated that the consultation is more efficient when using KLIK and that they are happy about how secure the KLIK website is and how their data remains anonymous. There were five themes on which patients disagreed. Some patients rated the content of PROMs positively, as they cover all important topics and are clear, while other patients indicated that the questions in the PROMs are difficult to understand, repetitive and not relevant for every patient. 5
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