To design the App, the prototyping model, also known as the evolutionary model, was used. The reason for choosing this model was that it can be used to identify the needs of users of the system evolutionarily. For this purpose, we started with a list of basic and incomplete requirements by sampling and presenting it to the users. By this, all necessary information was extracted. The work began with gathering needs. After forming a panel of experts in the field of teaching NDT in children with CP, the general goals of the software were determined. The considered needs were identified and the sections that should be defined were briefly documented. The focus of this form of design was on the dimensions of the software that were tangible and visible to the users. The result of this quick design was a primary example. The obtained sample was then reviewed and corrected and this repetition was done until a complete sample was obtained. The stages of the research process in this study were:
Step 1: Educational needs assessment and expert panel
To assess the Educational needs for NDT, a questionnaire to determine the importance of the approach, the need for retraining, acceptance of educational content based on movies in students, educational content, and barriers to use educational books witch teaching NDT were provided. Then the sampling population contains 30 students in the 5th semester of bachelor's degrees in occupational therapy was chosen.
By using the opinions of occupational therapists and physiotherapists working in the field of children with CP (faculty members of the occupational therapy and physiotherapy departments who have a history of teaching this approach) (14), the areas and cases required for application and educational items in software were extracted. In this study, to explain the areas and determine the requirements for application, a panel of experts was held with the presence of 5 faculty members (3 occupational therapists and 2 physical therapists) who have a history of teaching NDT. With the permission of the invited experts, the content of the interviews during panel was recorded and then written word by word. The obtained data, are repeated at the same time during panel to get a general understanding from interviews and later, the coding process was done. From the extracted codes, concepts related to domains and required items for developing application were obtained.
Step 2: Designing the functions and software features
During several panels of expert meetings, the prototype, and programmed items which made in prototype were reviewed several times respectively, to obtain the final software version. One of the goals and protocols of the research in this phase was a brief and comprehensive answer to the following questions:
- What is the purpose of software? - Has it ever been done? - Does anyone need it?
Also, the sections that increase the value of the software (contact us section, results analysis section in a certain interval, etc.) were considered (Table 1).
Table 1
Designing levels and their explanations
designing level
|
Title of level
|
Explanation
|
1
|
Recognize competitors
|
The available software features are checked with the desired software in the designing process.
|
2
|
Create "prototyping"
|
The purpose of visual design prototyping is software implementation requirements.
|
3
|
Review the important points
|
such as:
- Is access to the main menu of the software clear?
- Are all the desired activities specified by the software?
- Is the path between software pages clear?
- is it necessary to go back to reach each section?
- Are there any options for the user that are not embedded in the software?
|
The application in this project is based on Android and is compatible with versions 4.3 to 12. The initial application version of the software was provided online.
Step 3: Design and evaluate the software prototype
This phase of the study was done with the aim of software design based on the opinions of occupational therapists and physical therapists and also based on the information obtained from the software prototype. To design the program, Android software was implemented using Java language and in the Basic4Android programming environment. The APK tool was also used to identify possible malfunctions in the program.
Step 4: Evaluation of usability, final evaluation of software and its effect on students' knowledge
This step was performed to evaluate the usability of the software based on the opinions of occupational therapy students and to evaluate the effect of using this educational software on the level of knowledge of 5th-semester occupational therapy students about the Neurodevelopmental Treatment approach. For this purpose; in this study, 30 occupational therapy students in the 5th semester of their bachelor’s course were chosen.
The following parts show the process of study level by level and separately.
Step 1: To achieve the educational requirements for the NDT, a focus group consisting of five experts in the field of teaching this method was held. According to the needs assessment questionnaire that was collected from the students in this study which was taken after panel of experts, the results showed that about half of the students believe that the NDT is used for the daily treatment of children with CP. More than 80 percent of students stated that they used NDT videos if they needed to learn and restudy. At the same time, more than 80% of the participants referred to the resources and books of the NDT for little training instructions. Eighty percent of the participants, stated that the reason why therapists did not refer to the books is the lack of quick access to resources and boredom of referral. Therefore, for designing and developing educational software for the NDT approach, this information was considered a need for students.
After a qualitative review, the content presented by experts was determined as the main elements required to be used and placed in the software and was focused on the content production process. These items include the following:
(1) Theoretical training includes: the basics of child motor development, neuroanatomical knowledge, neurophysiology, emotions and motivation, neonatal reflexes, postural evaluation and reflexes
(2) Practical training to evaluate the child based on NDT
(3) Practical training of techniques used by NDT to facilitate normal motor development and social participation
Second and third steps: designing software features and evaluating the prototype
According to the purpose of this study, after holding a panel the expert session, the process of making and editing educational videos of NDT was performed with the cooperation of occupational therapists, parents, and children with CP, adapted to Iranian culture.
Step2 and step3: Then, by prototyping, the various sections and elements used in the program, including the main menu, items, the path between the pages and placing the options were provided. During the process of preparing educational videos, basic software samples were made and its problems were solved. After performing this step and receiving confirmation from the relevant professors, the final videos were evaluated. After uploading the videos, the fourth stage of the study began. Screenshots of the application pages by the time of initializing the software are shown in Figure 1.
The back end of software
PHP language and MySQL database were used to back up this software. Although the number of users of this software was limited, all the tables used in the project were indexed, so the software could have a higher loading speed.
In the web services used to connect the database to the application, developers tried to use a minimum number of queries to direct less load to the server, and if a large number of users operate software simultaneously, there will be no disruption in the program execution process.
User authentication
Regarding the users, considering that only a certain group of people were allowed to use the software, the list of users is already defined in the system and each of these people who referred to the software can verify their mobile number via SMS for using the software. For this purpose, we applied the services of the "SMS.ir "system and web services provided by this collection, and by using the fast SMS sending module, we reduced the activation code sending to the minimum possible time.
Step 4: To evaluate the level of knowledge and level of user satisfaction from developed software, occupational therapy students of the University of Social Welfare and Rehabilitation Sciences (USWR) who were passing the 5th semester of occupational therapy bachelor’s course were used. From 32 available students, 15 were selected for the intervention group and 15 for the control group. At the beginning of the study, 2 students withdrew from the program and the final population was reduced to 30, which were divided into intervention and control groups. After completing the study, the software was given to the control group and after using the software for two weeks, all participants answered the user satisfaction interaction questionnaire (QUIS).
To assess level of knowledge of students, the intervention group and control group answered valid and reliable knowledge questionnaire (15) at the first of the study. Then intervention group used educational content of the app for two weeks while studying NDT course at university. The control group just used NDT curse educational content. After two weeks, the knowledge questionnaire was answered by both groups of the study to assess knowledge increasing and differences between 2 groups of intervention.
The results of statistical analysis have been done after data gathering. At First, the Kolmogorov-Smirnov test was used to examine the data distribution. According to the results of this test, the data distribution did not follow the normal pattern, so non-parametric tests were used for analytical statistics. The results of the Wilcoxon test to compare the mean scores of knowledge within the group and the results of the Mann-Whitney test to compare the scores of knowledge between the intervention and control groups are reported.