103 4 Supporting stoma patients’ self-efficacy with a mobile application - a focus group interview stud To date, healthcare is on the lookout for the smart use of digital solutions in times of limited care provider availability and -resource. A well-designed mobile app has the potential to support healthcare, contributing to several aspects, such as information provision, communication between patients or between patients and their healthcare provider, and perioperative guidance.2 Research indicates that a Chinese app improved patient outcomes for those with a stoma, while a Turkish app did not.13,26 However, both apps had limited functionality that did not fully align with patients’ desires described in this study, with the Chinese app primarily focused on appointment scheduling, chat communication with stoma nurses, and photo uploading, while the Turkish app offered information and contact details for Turkish stoma care units. The clinical effectiveness of an app is reliant on proper design and development. To ensure usability, we conducted a quantitative study12 and this qualitative research on stoma care, studying patients' specific needs and desired functionalities. It's crucial to involve the target group and stakeholders actively in the development process to guarantee usability. Additionally, recognizing patients' varying levels of digital literacy is important, as not all may have the necessary proficiency with mobile devices.12 As such, the app should cater to this as much as possible and provide support for patients who need help in using it. Although not reported in literature, a strong opinion, role or verbalism of a sole participant in a focus group may influence others in the same group - or even prevent others from verbalising their thoughts.27 Such risk was mitigated by strong focus on creating a comfortable atmosphere on forehand, a group leader aware of this and asking all participants for their opinions during the interviews. We did not notice any limited expressions of the participants. In addition, the setup of the participants was different in every interview, as it was not possible to organise interviews with the same participants. This could have led to different dynamics between the participants in the interviews and, ultimately, to different outcomes. It is important to note that participating patients may not be a good representative of the ‘average’ patient. Most likely, our participants were more actively involved in their own stoma care, or perhaps better educated or skilled as they were members of patient associations. Purposive sampling was used to minimize this limitation. Finally, the last three interviews were conducted online because of Dutch COVID-19 restrictions. Based on previous studies showed virtual focus groups may result in participants being more relaxed and involved in the group discussion.28 However, in our study, we experienced that discussions in online meetings were less fluent because of connectivity or audibility problems.
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