Proper wound management minimizes adverse developments in open skin wounds, making the dissemination of information vital for good wound management. Booklets can be a reliable source of such information but have many limitations as printed copies. To address this, smartphone applications can easily aggregate coloured information from multiple booklets, serving as a better alternative. For this purpose, we created the Wound Education app to consolidate wound care information from multiple clinical booklets from the Welsh Wound Innovation Centre. The application was developed for both Android and iOS smartphones and displays a list of different wound conditions to the user. The information is also cached to allow for off-line access. Also included is a feature to direct the user to their nearest dermatologist. The Wound Education app is a freely available application on both the Google Play store and Apple app stores, aimed to empower patients to take greater charge of their own wound care.
Open skin wounds are susceptible to infection, making wound management particularly important (Edwards & Harding, 2004). Improper care can result in chronic persistent wounds (Rahim et al., 2017), contributed by long waiting times (Schulz, 2017; Suneja et al., 2001) or having to travel great distances to medical institutions (Schulz, 2017). In developing countries, delayed diagnosis often further adds to the problem (Shah & Shah, 2017). The crux of these problems stem from a lack of timely access to validated clinical information, and the solution may present itself in the prevalence of smartphones (Taylor & Silver, 2019). From displacing lab equipment (Gan & Poon, 2016) in research labs to clinical uses (Gan, Koshy, Nguyen, & Haw, 2016), mobile apps can improve the dissemination of reliable scientific/clinical information to the general public. In the same vein, the much-needed information on wound care management would also be disseminated better to the patients and carers.
While convenient to bring early intervention self-care knowledge to users, the accuracy of the content of such apps are crucial to reap the needed benefits. Hospitals today typically utilize printed booklets which has the benefit of being curated by the medical professionals of the institutions (Sium, Giuliani, & Papadakos, 2017). However, hardcopy booklets are prone to misplacement, being dirtied, and can only contain limited amounts of information without trading off logistics associated with prints. These print logistics incur cost amongst other challenges (Di Noia, Schwinn, Dastur, & Schinke, 2003), and are less environmentally friendly compared to digitalized E-booklets. By leveraging on mobile apps, the same information and more in colour, is available at the tap of the finger. Connected to the unlimited capacity of the internet, the content can be easily and conveniently updated, present much more information than a pamphlet, and even be suitable for the visually challenged through zoom functions for easier viewing. Overall, this is a cost effective and environmentally friendly solution.
In view of the above, the Wound Education app, developed for both the Android OS and iOS mobile operating systems, was created to present the following information from multiple wound care booklets: the variants of wounds and methods of self-care in the area of wound appearances, likely causes, early signs, individuals at risk, recovery time, advice on daily activities, wound management, and preventive measures.
The application was developed in Android Studio version 3.1 for the Android OS platform while XCode 9.4 was used for the iOS version. The application retrieves the list of wounds from a database through a Representational State Transfer (REST) Application Programming Interface (API). The content of the app was taken from booklets by Welsh Wound Innovation Centre used in Cardiff University Hospital, UK.
The mobile app data is stored online in a database and provides two different pathways for loading the data. With internet connectivity, the app would retrieve the most recent data from the database while caching it in the device. In the absence of an active network connection, the application will retrieve the data from the cache for display instead (Figure 1).
Figure 1. Flowchart of the processes that occur as a user attempts to access a specific wound page from the list.
Medical information in the mobile application was provided by the Welsh Wound Innovation Centre and used with permission.
Our patient-centric Wound Education app includes information about Arterial leg ulcer, hidradenitis suppurativa, pilonidal sinus, venous leg ulcer, etc. from the Welsh Wound Innovation Centre (WWIC). The advisory for each wound includes directions on wound care and precautionary measures to mitigate wound exacerbation. In the case of arterial leg ulcers, advisories include preventing dry skin by using moisturizers and encouraging exercise for increased blood flow. Other different wound types are depicted in Figure 2. Accessing the items triggers a WebView to load a corresponding HTML page that covers essential details of the various conditions (Figure 2).
Figure 2. The user interface of the Wound Education application. A) The list of the different wound types is shown using relevant images in the application. B) An example page showing the overview of the content. C) Example of an information page.
The essential information and advice on self-care provided in the application are summarized in Table 1.
Table 1. Summary of the information provided.
|What is (wound name)?||A description of the wound.|
|How is it caused?||How the wound is developed.|
|What are the early signs of (wound name)?||Symptoms of the wound.|
|Who is at risk?||Identification of individuals at risk due to diets or habits.|
|What treatment will I receive?||Outlines the treatment options.|
|How long will it take to heal?||Approximated recovery duration for patients to monitor and seek help when necessary.|
|Can I shower or bathe?||Advisory on daily activities that can be performed and those that should be avoided.|
|Will it occur again?||Cautions on the risk of relapse.|
|What can I do to aid healing and prevent recurrence?||Highlights the practices for facilitating healing and preventing recurrence.|
Should the users feel they require professional assessment, they may locate their nearest dermatologists on the integrated map feature (Refer to Figure 3).
Figure 3. The various features of the map function. A) Map displaying the dermatology clinics closest to the user. B) The list of dermatology institutions available in the vicinity.
Rather than being exposed to unreliable sources of medical information on the Internet, the Wound Education app provides an accredited source of wound management information. This empowers users and their carers to take charge of their own wound care without burdening already stretched professional medical services. Coupled with other clinical aid apps that allow users to monitor their wounds (e.g. the APD Skin Monitoring app, (Wu, Yong, Federico, & Gan, 2019)), there are clear possibilities to reduce user cost (medical, travel, etc) as well as hassles and waiting times.
Such benefits are reaffirmed in a review of 41 articles that reported enriching patient care and medical education to outweigh the costs of material development (Valle, Godby, Paul, Smith, & Coustasse, 2017). Given that apps were also found to be beneficial to improve clinical proficiency (Gaglani & Topol, 2014) and increase the productivity of pharmacists (Aungst, 2013), there is reason to expect benefits for patients.
Content addition and modification updates do not affect the structure of the application, allowing for easier updates and additions. There is no action required on the user in these cases. At present, the cache or offline access feature is only available in the Android version. Future updates to the iOS version will implement this feature for iPhone/iPad users.
The Wound Education app is a native application on both Android and iOS platforms that provides coloured clinical information about wounds to users to enable users to take greater charge of their own wounds. It is freely available on the Google and Apple app stores.
The Wound Education app is freely available on both Google Play store and Apple app store.
This app is provided free by APD SKEG Pte Ltd and the Global Wound Services, Limited.
The work described here forms part of the industrial attachment programme for KJYY, KYWY, and is the final year project of KF in fulfilment of the requirements of the Diploma in Information Technology by Temasek Polytechnic, Singapore.
JH is CEO of Global Wound Services Limited, however, there is no conflict of interest as the app is provided free based on content freely available to patients.
KJYY drafted the manuscript and modified the Android version of the app and HTML pages. KF and KYWY created the Android and iOS versions of the app, respectively. KH and JH provided the information on the wounds.
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