A national platform for advancing self-care processes for the most common illnesses and conditions: designing, evaluating, and implementing

Abstract

Background

Effective self-care practices are crucial for maintaining health and well-being, as inadequate self-care can lead to increased health risks and decreased overall quality of life. To address these issues, one promising approach involves leveraging progressive web app (PWA) platforms to educate and empower individuals with necessary self-care services. This study aims to design, implement, and evaluate a national self-care PWA platform, aiming to enhance accessibility and effectiveness in promoting health and self-care practices. The platform designed to improve self-care processes can be utilized by mothers, children, adolescents, youth, adults, and patients with emotional and mental disorders.

Methods

This study was conducted in three phases. In the first phase, during 35 meetings with 19 health care providers including physicians and another group of professionals, the most common illnesses and conditions that require self-care were identified. Platform capabilities were then assessed based on stakeholder opinions. Subsequently, during 15 meetings 19 health care providers identified a comprehensive list of conditions benefiting from dedicated decision aids to enhance individuals’ self-care processes. In the second phase, a progressive web app platform was designed based on these common illnesses and conditions and capabilities and subsequently evaluated. To usability evaluation the platform, 26 evaluators utilized the system for two weeks. The QUIS 5.5 questionnaire was employed for evaluation, and the results were analyzed using SPSS 23. In the final phase, the system was implemented at the Smart University of Medical Sciences (SMUMS), affiliated with the Ministry of Health and Medical Education in Iran.

Results

Based on the most common illnesses and conditions (n = 87) and identified capabilities, the national self-care platform was designed with eight sections catering to ‘Maternal and child health services,’ ‘Mothers,’ ‘Infants,’ ‘Teenagers,’ ‘Adults,’ ‘Elderly,’ ‘Health of All Age Groups,’ ‘Patients with Mental and Emotional Health Disorders,’ and ‘General Information’ for user education. Furthermore, the platform features 54 decision aids (DA), teleconsultation services, and a self-care magazine (Access link: https://khodmoragheb.ir/). These features were integrated to provide comprehensive support and resources for self-care. A mean exceeding 7 was attained across all evaluated dimensions, indicating that evaluators generally agreed the platform performed well.

Conclusion

The designed national self-care platform offers a promising solution for managing healthcare challenges. This innovative approach addresses the specific needs of individuals and extends its reach to Persian-speaking patients worldwide, fostering a global impact. By embracing self-care practices on an international scale, this platform contributes to a more inclusive and accessible healthcare landscape for individuals in Iran, Afghanistan, Tajikistan, and beyond.

Introduction

At present, half of the global population, totaling 3.6 billion people, faces a lack of access to crucial health services [1]. Moreover, 100 million individuals are pushed into poverty due to the financial burden of healthcare expenses. Additionally, underserved and marginalized populations frequently encounter barriers to accessing quality health information, services, and products, coupled with stigma and discrimination within healthcare. The use of irregular and non-standard products, incorrect or unclear health information, or lack of access to health workers and/or health facilities to guide or manage side effects or complications are other potential challenges that people usually face [2]. To address these issues, the World Health Organization (WHO) recommends the adoption of self-care interventions for every country and economic context. This strategic approach is deemed essential for advancing universal health coverage, fostering overall well-being, ensuring global safety, and addressing the needs of vulnerable populations [2].

Self-care refers to the capacity of individuals, families, and communities to enhance health, prevent diseases, sustain well-being, and manage illness and disability, whether or not they have the assistance of a health worker [1]. It encompasses the decisions and actions individuals undertake to uphold and enhance their health, address minor ailments, and manage chronic conditions. While many individuals address minor ailments independently, a slight shift towards increased reliance on self-care, as opposed to professional care, could result in substantial savings in healthcare expenditures [3]. Self-care processes can be provided to people through mobile or web-based platforms [4, 5]. A self-care platform encompasses a wealth of benefits that contribute to individuals’ overall well-being and healthcare efficiency. By promoting empowerment, these platforms encourage users to actively participate in managing their health, fostering a sense of control and autonomy [5]. Accessibility is another key advantage, as self-care platforms provide a wealth of information and resources at users’ fingertips, enabling them to make informed decisions irrespective of time or location. The cost-effectiveness of such platforms is notable, as they reduce unnecessary physician visits for minor ailments, consequently lowering healthcare expenditures. Moreover, the global reach of self-care platforms extends health education and practices to diverse populations, transcending geographical boundaries. As efficient educational tools, these platforms equip users with knowledge about preventive measures, symptoms, and appropriate self-management strategies [5, 6].

In general, systems such as the Integrated Health System (SIB) for electronic health records, the Iran Electronic Health Record System (SEPAS) [7], Hospital Information Systems (HIS) like Tirazhe and Rayavaran [7], the Electronic Referral System (EasyMED) [8], electronic prescribing system (such as Iran Health Insurance Organization (IHIO) and Social Security Organization (SSO)), and other similar systems are already implemented in Iran [9]. However, a comprehensive self-care platform has not yet been designed in this country. Moreover, to the best of our knowledge, no study has been undertaken in the realm of designing, evaluating, and implementing a national platform for advancing self-care processes. While some studies have focused on developing self-care applications or web-based platforms tailored to specific groups such as pregnant mothers [5], heart patients [10], diabetics [6, 11], and others, there remains a gap in comprehensive research dedicated to a national self-care platform. As mentioned, the WHO emphasizes implementing self-care interventions globally to advance universal health coverage, enhance well-being, promote global safety, and support vulnerable populations [2]. Hence, the objective of this study is to design, implement, and evaluate a National Self-Care Platform that encompasses individuals of all age groups, including mothers and babies, children, teenagers, adults, the elderly, as well as those dealing with mental and emotional health disorders.

Materials and methods

This study was conducted in three phases. The first phase involved identifying the most common illnesses and conditions that require self-care, determining decision aid (DA) requirements, and identifying the capabilities necessary for designing the platform. The second phase involved designing a progressive self-care web app platform based on the most common illnesses and conditions and the identified capabilities. Subsequently, the platform was evaluated, and in the last phase, the system was implemented through the Smart University of Medical Sciences (SMUMS), affiliated with the Ministry of Health and Medical Education in Iran. These phases will be elaborated upon as follows (Fig. 1).

Fig. 1

Study conduction phases diagram

First phase: identifying the most common illnesses and conditions that require self-care and the capabilities needed for designing the platform

In this phase, we initially focused on identifying prevalent illnesses and conditions requiring self-care, along with the essential requirements for designing a national platform. The target population comprised experts in self-care and healthcare systems, drawn from the most distinguished faculty members of Iran’s medical universities. The sampling strategy employed was convenience sampling, a non-probability technique where participants are selected based on easy accessibility rather than random selection, including all available samples [12, 13]. A list of eligible experts was provided by the Smart University of Medical Sciences, containing the email addresses of faculty members in disciplines directly relevant to self-care and healthcare systems. The sample size was determined by the availability and willingness of experts to participate in the study. An initial pool of 30 experts was invited via email to participate, based on their recognized expertise. The inclusion criteria required that participants be actively involved in relevant academic or healthcare system roles, with substantial experience in self-care initiatives or health system design. The exclusion criteria included a lack of willingness to participate and a failure to respond to the invitation. Out of the 30 experts, 19 accepted the invitation and contributed to the study.

Then, we conducted a series of five consensus-building meetings with these19 healthcare providers (general practitioner, endocrinologists, psychiatrist, gynecology and obstetrics, neonatal medicine, pediatric infectious diseases, internal diseases, emergency medicine), posing a single question: “What are the most common illnesses and conditions?” From these discussions, we generated a list of common illnesses (Appendix A). Subsequently, this list underwent rigorous review in 30 sessions both online and face-to-face with the same panel of 19 healthcare providers. This iterative process resulted in a refined and final selection of illnesses and conditions. Throughout these sessions, physicians not only contributed to compiling the list but also provided insights into necessary self-care processes for each condition, ensuring a comprehensive understanding of their respective self-care requirements.

After identifying the most common illnesses and conditions, we engaged in a collaborative process with key stakeholders to identify the platform capabilities. This step involved consultations with the same 19 experts who participated in the first step, as well as technology experts, government officials, and potential end-users, including all age groups such as mothers and babies, children, teenagers, adults, and the elderly.Through online meetings, we sought to gather diverse perspectives, refine our understanding of the target audience, and ensure alignment with the current healthcare landscape. In these meetings, we also asked stakeholders to introduce us to the necessary capabilities for platform design. Finally, capabilities such as DA, teleconsultation services, and a self-care magazine were approved.

It should be noted that healthcare professionals aimed to improve patient outcomes and streamline self-care processes by providing accurate, evidence-based information and supporting patient autonomy, expecting the platform to be user-friendly and enhance adherence. Technology experts focused on developing a robust, scalable, and secure platform, integrating advanced technologies like AI and IoT, and collaborating with healthcare professionals to meet clinical needs. Government officials sought public health improvement and efficient healthcare delivery, aiming for widespread platform adoption to reduce healthcare costs and improve population health, expecting the platform to be accessible, reliable, and compliant with regulations. Potential end-users, including individuals across all age groups, desired accurate, personalized health information and convenient self-care tools to manage their health conditions effectively, and expected the platform to be easy to use, informative, and supportive of their self-care efforts.

Moreover, we consulted with the same 19 experts who participated in the first step in 15 sessions, both online and in-person, to compile a comprehensive list of common illnesses that would benefit from dedicated decision aids for enhanced self-care. Additionally, we requested physicians to enlighten us about the decision-making processes associated with any illnesses and conditions. Following this, we conducted a thorough literature review, including the Ministry of Health and Medical Education in Iran and WHO self-care guidelines for the identified conditions [14], to ensure evidence-based decision aid development. This literature review ensured our decision aids (DAs) were evidence-based and aligned with field advancements. We then identified 54 specific illnesses for our design phase, creating corresponding flowcharts to outline clinical pathways within the Decision Aids system. These flowcharts use binary yes/no questions at key decision points, guiding users based on their inputted clinical parameters to recommended actions, often resulting in treatment recommendations.

We meticulously followed a step-by-step process to create clinical flowcharts. Initially, we reviewed the clinical processes related to designing decision aids for 54 common illnesses and conditions, aiming to identify crucial decision points, recommendations, treatment options, and essential clinical variables. We then extracted major decision points and treatment options to outline primary pathways within the flowchart. Clear inputs such as specific symptoms and signs were defined to guide patients logically. The initial draft of the flowchart was mapped out, connecting decision points based on coded inputs to ensure alignment with guideline-recommended treatments. We refined the flowchart to incorporate all relevant decision logic and validated it thoroughly against the original guideline to ensure accuracy and completeness, addressing any omissions or logic gaps. Following validation, the flowchart was encoded into an executable format for the clinical decision support platform.

It should be noted that in this phase, regarding the mobile application used for recording sessions, we employed the “Voice Recorder Pro” application to record and document discussions in both face-to-face meetings and online meetings using Google Chrome’s Skyroom Tab Recorder. Additionally, during all the meetings, we solely asked healthcare providers and stakeholders for the names of the diseases and inquired about the required capabilities. Subsequently, we considered all the identified diseases and necessary capabilities for system design without imposing any exclusion or inclusion criteria.

Second phase: design and evaluate a national self-care platform

During the project, two proficient software engineers skilled in ASP.NET and C# programming languages were engaged. They also demonstrated extensive expertise in database design principles. The platform prototype was meticulously developed using ASP.NET and C# within the Visual Studio 2019 environment, with Microsoft SQL Server 2017 employed for database design.

The prototype was then subjected to usability evaluation. For the usability evaluation, we obtained a list of 35 phone numbers of medical informatics experts from the Medical Informatics Association of Iran. The target population consisted of these medical informatics experts. Subsequently, in the form of convenience sampling, all experts were invited to participate in the study, and invitations were sent to all 35 individuals. Ultimately, 30 people responded to our invitation, and, following the inclusion and exclusion criteria, 26 were included in the study. The following are the inclusion and exclusion criteria:

Inclusion criteria:

• Express informed consent to participate in the study.

• Absence of acute cognitive and mental disorders.

• Possess specialized knowledge and experience in usability evaluation methodologies.

Exclusion criterion:

• Unwillingness to continue in participation in study.

The usability evaluation was conducted with medical informatics experts because these professionals have completed four evaluation courses during their academic training, ensuring their thorough familiarity with usability evaluation methodologies. Additionally, in Iran, medical informatics specialists are mandated to assess the usability of their designed digital systems, further cementing their expertise in this domain. Therefore, their involvement guarantees a profound understanding of usability principles and the ability to provide detailed, expert feedback. This level of expertise enables them to identify and articulate subtle usability issues that may not be evident to end users, thereby contributing to a more comprehensive and rigorous evaluation of the platform.

Next, the platform link and mobile phone installation instructions were provided to the evaluators, who used the platform for two weeks before discontinuing its usage. Feedback on the tool’s usability and satisfaction was then collected using the standardized Questionnaire for User Interface Satisfaction (QUIS). This study reaffirmed QUIS validity, with reliability confirmed through Cronbach’s alpha (0.92), consistent with previous research [15]. The questionnaire results were analyzed using SPSS 23 in the form of mean and standard deviation (SD). Mean scores of 0 to 3 were categorized as poor, 3.1 to 6 as intermediate, and 6.1 to 9 as good [16].

Third phase: implementation and performance evaluation a national self-care platform

After resolving previous phase issues, the updated platform was implemented at Smart University of Medical Sciences, part of the Ministry of Health and Medical Education in Iran. A dedicated team of two software engineers and two physicians managed the project from a well-equipped room, facilitating seamless collaboration and effective project management. Post-implementation, an ongoing evaluation monitored the platform’s performance, user engagement, and usability. Real-time data collection, user feedback analysis, and continuous improvements were employed to enhance effectiveness. Twenty-six usability testers from the earlier phase were invited to report bugs via the platform’s ‘Bug Report’ feature (a detailed description of the target population and sampling strategy for selecting testers was provided in the second phase). Additionally, a comprehensive training program was developed for healthcare professionals, administrators, and end-users to ensure a smooth national platform rollout, covering usage, features, and best practices to maximize benefits.

Moreover, our marketing strategy for effectively introducing the website to Persian-speaking individuals globally revolved around targeted actions rather than mere statements. First, we planned to leverage digital marketing channels such as search engine optimization (SEO), social media platforms, and online advertising to reach our target audience effectively. This included creating localized content in Persian that resonated with cultural nuances and addressed specific healthcare needs prevalent among Persian-speaking communities worldwide. Additionally, partnerships with healthcare organizations, influencers, and community leaders within these demographics helped amplify our outreach efforts. Through these strategies, we aimed to establish a strong online presence and build trust among Persian-speaking users seeking reliable self-care resources.

Addtionally, to enhance accessibility among underserved and marginalized populations, we implemented a multifaceted approach. This included face-to-face advertisements and community outreach sessions in rural areas to directly engage community members, educating them on the platform’s benefits for self-care. We also distributed localized printed materials like bulletins and brochures in community centers and healthcare facilities. Personal communication via phone calls and interactions with community leaders built trust and addressed concerns. Additionally, “training of trainers” programs empowered local healthcare workers and leaders to promote platform adoption and support within their communities, ensuring sustainable impact and scalability.

Ethical considerations

The ethics committee of Smart University of Medical Sciences provided the code of ethics under number IR.SMUMS.REC.1402.020. Prior to participating in the study, informed consent was acquired from all individuals. Participation was entirely voluntary, allowing participants the freedom to withdraw from the study at any point.

Results

The results of each phase are detailed below, outlining key findings and insights obtained during the study.

First phase: identifying the most common illnesses and conditions that require self-care and the capabilities needed for designing the platform

The Table 1 shows the demographic information of the physicians in phase 1. According to this table, 68.38% of the participants were women. Also, most of the participants had 1–10 years of work experience.

Table 1 Healthcare providers’ demographics

Table 2 displays the most common illnesses and conditions that necessitate self-care. Drawing from insights gathered from focus group discussions, a comprehensive list encompassing 87 prevalent illnesses and conditions was identified (Table 2).

Table 2 The most common illnesses and conditions that require self-care

As per stakeholders, it is essential to design decision aids for enhancing self-care. Additionally, we should consider features such as teleconsultation and a self-care magazine (Table 3). According to the opinions of physicians, it was necessary for us to design decision aids to enhance self-care processes for 54 common illnesses and conditions (Table 3).

Table 3 Self-care platform capabilities

Second phase: design and evaluate a national self-care platform

The designed platform will be accessible through the link: https://khodmoragheb.ir/. Users can visit this link to access the platform and its features. The main page of this platform is shown in Fig. 2.

Fig. 2

Main page of selfcare platform

The self-care platform was designed in two sections: “self-care processes education” and “platform capabilities”. In the following, both parts are explained.

Part 1: self-care processes education

The education section included eight main groups " maternal and child”, “Mothers”, “Infant”, “Teenagers”, “Elderly”, “Mental and emotional health”, “Health of all age groups”, and “General health information”. This section also included 87 common illnesses and conditions. In this section, based on these illnesses and conditions all self-care processes are taught to people in the form of video, text and audio (Table 1).

The ‘maternal and child’ theme, with 15 sub-themes, is designed to support new mothers and families in addressing common health issues from birth to one year old. The self-care training covers crucial topics like umbilical cord care, newborn jaundice, breastfeeding, diaper rash, baby cries, watery eyes, rhinorrhea, baby cough, skin changes, sleep patterns, circumcision, growth and development, immunization, teething, and defecation. This training aims to provide mothers with essential knowledge and skills for navigating and managing health concerns during the first year of their baby’s life (Fig. 3).

Fig. 3

Maternal and child health services theme

The self-care tutorials offered under the “Mother” theme are specifically tailored to address a range of postpartum concerns and promote the well-being of new mothers. These tutorials cover important topics such as managing lochia (postpartum bleeding), addressing postpartum fever, caring for episiotomy, vaginal wounds, and tears, alleviating postpartum pain, managing breast pain, dealing with constipation, understanding and addressing postpartum depression, guidance on birth control and sexual health, and relief from leg pain and cramps. These tutorials aim to empower mothers with practical knowledge and self-care strategies, facilitating their ability to navigate and overcome various postpartum challenges and promoting a healthy and comfortable postpartum experience.

The ‘Infant’ theme is specifically designed to cater to the needs of parents and caregivers, offering valuable information and guidance on prevalent childhood issues. This thematic section delves into a range of common challenges faced by infants, including but not limited to fever, cold, sore throat, earache, vomiting, diarrhea, constipation, and toilet training. By providing a comprehensive overview, the theme aims to equip parents and caregivers with the knowledge needed to navigate and address these common childhood concerns, promoting the well-being and health of infants.

In the ‘Teenagers’ theme, the goal is to provide a nuanced exploration of critical health aspects relevant to adolescents (Fig. 4). Through the strategic subdivision into two sub-themes, Acne and Menstruation, the purpose is twofold. Firstly, the “Acne” sub-theme delves into the multifaceted world of skincare for teenagers, addressing the common issue of acne. By offering in-depth insights into the causes, prevention strategies, and effective management of acne, the aim is to empower teenagers with practical knowledge to navigate this aspect of their physical well-being confidently. Secondly, the “Menstruation” sub-theme acknowledges the unique challenges and experiences associated with adolescence, particularly concerning menstrual health. This section is designed to provide comprehensive information on menstruation, encompassing topics such as menstrual hygiene, understanding menstrual cycles, and addressing common concerns.

Fig. 4

Teenager’s theme

In the ‘Elderly’ theme provides targeted training on common health concerns for seniors, including fever, cough, cold and flu, sore throat, earache, nausea and vomiting, diarrhea, constipation, urinary problems, and male sexual disorders. these modules aim to equip seniors with the knowledge to manage these issues effectively, tailored to their specific needs. the goal is to enhance their overall well-being, empower them with self-care strategies, and foster a proactive approach to health management in later years.

In the theme ‘Mental and Emotional Health’, the overarching purpose is to offer comprehensive training aimed at empowering individuals in the control and management of various aspects related to mental well-being. This theme covers a spectrum of critical topics, including depression, substance use disorder, psychotic illness, anxiety disorders, domestic violence, sleep problems, and memory problems and dementia. The trainings provided within this theme serve a dual purpose. Firstly, they aim to increase awareness and understanding of mental disorders, encouraging individuals to recognize and address these conditions in themselves and others. Secondly, the training modules offer practical strategies and coping mechanisms for managing complex emotions and navigating challenges associated with mental health.

In the “General Health Information” theme, the overarching purpose is to provide a broad spectrum of training sessions that empower individuals with essential knowledge on various health-related topics. These trainings cover a wide range of common issues such as fever, cold, and more, emphasizing not only the universality of these experiences but also the importance of knowing how to recover quickly. The diverse topics within this theme address both preventative measures and practical steps for managing health challenges. From basic practices like washing hands to more specialized areas such as anticonvulsants, antihistamines, and antibiotics, the goal is to equip individuals with the information needed to make informed health decisions.

Additionally, the theme delves into critical aspects of general health, including high blood pressure, influenza, viral infections, heart disease, stroke, immunization, disease prevention and detection, dieting, weight loss, diabetes, sports, cancer prevention and detection, visual impairment, smoking, and sexually transmitted diseases. The purpose here is not only to provide information but also to foster a proactive approach to health, encouraging individuals to take charge of their well-being through prevention, healthy practices, and early detection. Ultimately, the “General Health Information” theme aims to empower individuals to make informed choices that contribute to their overall health and well-being.

Part 2: self-care platform capabilities

According to the opinions of physicians and other stakeholders, features such as 54 decision aids, Teleconsultation, and a self-care magazine were considered for the self-care platform. The following section describes these features in detail (Table 2). To design each decision aid, as mentioned, we drew a flowchart. Below are two examples of these flowcharts (Figs. 5 and 6).

Fig. 5

Urinary problems diagnosis. ^*Note: Refer to Appendix B to see recommendations A, B, C, and D

Fig. 6

Sore throat diagnosis in children

In order to diagnose and predict common ailments, the platform incorporates a robust knowledge base and a clinical decision support core. Users can utilize this feature by registering their information and symptoms on the platform, enabling them to receive a diagnosis for their condition. The platform provides information about the levels and severity of the identified illness, offering users valuable insights into their health status. Additionally, the platform goes beyond diagnosis and offers personalized recommendations, home remedies, and self-care guidelines tailored to the specific ailment. This comprehensive approach not only informs users about their health condition but also empowers them with actionable steps for managing and improving their well-being. Moreover, recognizing the importance of professional medical intervention, the platform is equipped to refer users to appropriate medical centers when necessary. This ensures a seamless transition from self-diagnosis to expert medical care, reinforcing the collaboration between users and the required clinical teams for more effective healthcare management.

As an example, in the diagnosis of a child’s sore throat (Fig. 7), the mother is first asked if the child’s fever is more than 38.5 degrees Celsius orally. If the answer is “yes,” the mother is suggested to go to the medical center, and antipyretics are recommended. If the answer is “no,” the mother will be asked the following five questions:

• ▪ Does the child have unusual drooling? Or.

• ▪ Is the chin protruding? Or.

• ▪ Does the child have severe swallowing problems? Or.

• ▪ Does the child have trouble breathing? Or.

• ▪ Does the child seem extremely unwell?

If the answer is “yes,” the mother is advised to “go to the hospital now.” If she chooses “no,” she will be asked again if her child has a severe sore throat and swollen lymph nodes without cough or cold symptoms. If the answer is “yes,” the mother is advised to “go to the hospital now.” Afterward, she is instructed to read the home recommendations provided on the platform. These recommendations include:

• If your child has a fever along with a sore throat, refer to the fever section.

• You can give your child acetaminophen or ibuprofen for pain and discomfort. Avoid giving aspirin to anyone under 20 years old. View the image gallery.

• Give your child plenty of warm liquids to help soothe the sore throat.

• Numbing compounds can reduce the pain caused by a sore throat. A saltwater gargle (dissolve half or 1 teaspoon of salt in 250 ml of warm water) can relieve a sore throat to some extent and can be repeated several times a day. Younger children may not be able to gargle properly, and if they are likely to swallow the saline solution, reduce the amount of salt to half to a quarter teaspoon. If it is too painful to gargle or the child chokes, stop. You can get the numbing solution from pharmacies, usually containing phenol and a flavoring agent. It has been observed that if these sprays are used before meals, the child eats better.

• Give one teaspoon of honey three times a day to children older than 1 year. Do not give honey to children under 1 year old.

• If your child is old enough to suck on candy, give them a lollipop. Almost all types of candies are equally effective.

• Give your child plenty of fluids. In the first few days, it may be easier for your baby to eat soft foods or soup.

• Frequent hand washing can prevent the spread of the disease.

Finally, after 48 h, the mother is asked:

• ▪ Have the symptoms worsened? Or.

• ▪ Has there been a rash?

If the answer is “yes,” it is suggested to “refer to the health center.” If the answer is “no,” it is recommended to continue self-care processes at home until the child is fully recovered.”

Fig. 7

Diagnosis of a child’s sore throat

In the Teleconsultation section, a practical solution has been implemented to enhance user accessibility and facilitate direct communication. Within this section, a comprehensive list of phone numbers belonging to various specialists is provided. This curated directory allows users to easily contact and connect with healthcare professionals based on their specific needs or medical conditions.

In the Self-care magazine, a valuable resource has been established for users by curating the latest information on self-care. This information originates from a variety of reputable outlets, such as articles and clinical guidelines. The aim is to empower users with up-to-date insights and knowledge related to self-care practices. Information from both expert articles and evidence-based clinical guidelines is incorporated to ensure that users have access to a well-rounded and informative collection of materials. This section functions as an educational hub, providing users with a comprehensive source of information to support self-care processes, encouraging informed decision-making and proactive health management.

Usability evaluation of the self-care platform

Table 4 displays the demographic information of the participants, indicating that the majority fell within the 31–41 age range and possessed 1–10 years of work experience.

Table 4 Demographic information of evaluators

Tables 5 and 6 showcase the outcomes of the usability assessment conducted with QUIS. Table 5 presents evaluator opinions on assessing the self-care platform, inclusive of mean and standard deviation values derived from data analysis. Across all evaluated dimensions, a mean exceeding 6 was attained, indicating a general consensus among evaluators that the platform performed well. Detailed information regarding each of these aspects is available in Table 6.

Table 5 Evaluation the self-care system usability and user satisfaction

Table 6 Evaluation results for different aspects of the system

It should be noted that in the performance evaluation section, the evaluators did not report any problems.

Third phase: implementation and performance evaluation a national self-care platform

Inaugurated on March 17, 2023, at the Smart University of Medical Sciences, affiliated with the Ministry of Health and Medical Education in Iran, the nationally designed self-care platform has embarked on its operational journey. This multifaceted self-care initiative, functioning seamlessly as an online tool, is poised to make significant strides in bolstering public health and individual self-care against prevalent diseases, ailments, and disorders. Simultaneously, it seeks to elevate the decision-making processes for individuals involved. Beyond its local origins, the platform is globally accessible to Persian-speaking patients, transcending geographical boundaries and providing self-care services to individuals, regardless of their location.

Discussion

The study outlines the development and evaluation of a national self-care progressive web app (PWA) platform aimed at addressing health challenges through encouraging and educating individuals. The platform, designed based on insights gathered from a total of 50 meetings with 19 health care providers, identified common illnesses and conditions, along with stakeholder opinions. It features eight sections catering to various age groups and health conditions, incorporating 54 decision aids, teleconsultation services, and a self-care magazine.

Self-care processes in platforms

The findings of our study align with previous research that emphasizes the importance of technology-driven solutions in healthcare. Several studies, such as the work of Göransson et al. [17], and Park et al. [6], have explored the development and assessment of digital platforms to enhance self-care practices. The platform designed in Göransson et al.‘s study [17] aimed to provide self-care services to older persons. This platform included self-care services such as managing one’s mental state, cultivating connections and participating in social events, attending to physical abilities and issues, and sustaining holistic self-care. Park et al.‘s platform [6] offers self-care for diabetes patients, covering mental well-being, social engagement, physical concerns, and overall self-care. Divided into three parts, it employs IoT technology to automatically track daily activities impacting glucose levels, transmitting data to a web server via a smartphone. This establishes a clear link between the patient’s lifestyle and glucose measurements, presented through a user-friendly self-care application. Athilingam et al. [18], developed a mobile self-care platform for past patients, featuring automated alerts and feedback for daily assessments of weight, blood pressure, and heart failure symptoms, exercise guidance, medication alerts, real-time vital signs monitoring with a wearable device, evidence-based audio-enabled HF education, and performance trend visualization through a module called Stats. In comparison, our national self-care platform encompasses diverse sections catering to different age groups and health conditions, offering 54 decision aids, teleconsultation services, and a self-care magazine. The platform’s comprehensive design and inclusive approach distinguish it, addressing specific needs and extending its impact to Persian-speaking patients globally, fostering a more accessible healthcare landscape.

Decision aids

The integration of decision aids into self-care platforms has been a pivotal focus in our study, aligning with the broader literature on their positive impact. As noted in the findings of our study, 54 decision aids were integrated into the national self-care platform to enhance self-care and treatment processes. Parmanto et al. [19], explored the implementation of decision aids in a mobile health application to support individuals in managing specific health conditions. Their findings underscored the significance of decision aids in empowering users to make informed choices about their health. This aligns with our approach of incorporating 54 decision aids within our national self-care platform to enhance individuals’ self-care processes. Clifford et al. [20], stated that decision aids provide users with comprehensive information, helping them make informed decisions about their health. This is crucial in self-care, where individuals often need to evaluate various options and understand the potential outcomes of their choices. Informed decision-making contributes to a more active and engaged approach to personal health management [20]. Informed decision-making, as highlighted by their research, promotes an active and engaged approach to personal health management, thereby enhancing the effectiveness of self-care processes.

McCaffery et al. [21], also concluded that decision aids can contribute to improving health literacy among their users by examining the role of decision aids in enhancing people’s health. Health literacy is the ability to obtain, process, and understand health information to make appropriate decisions. Decision aids simplify complex medical information, making it more accessible to individuals and thereby enhancing their overall health literacy. Moreover, decision aids empower individuals to take control of their health. Providing users with tools to navigate through health-related decisions fosters a sense of autonomy. Empowered individuals are more likely to engage in proactive self-care practices, leading to better health outcomes and an increased sense of personal responsibility for one’s well-being [22]. Papandreou et al. [23], also investigated the role of CDSS in diet adherence during early pregnancy and concluded that the use of CDSS during pregnancy improves diet adherence and reduces psychological distress. The integration of 54 decision aids into our national self-care platform reflects a concerted effort to enhance the self-care and treatment processes of individuals, aligning with the empowering insights drawn from other studies [21,22,23]. Decision aids play a crucial role in promoting informed decision-making, improving health literacy, and empowering users to actively manage their health. To optimize the impact of decision aids in self-care platforms, it is advisable to customize these tools to individual needs, maintain current and accurate information, ensure user-friendly interfaces, and establish seamless integration with healthcare providers. By adopting these strategies, self-care platforms can truly empower individuals, foster a proactive approach to health management, and contribute to better overall well-being.

Teleconsultation services

The inclusion of teleconsultation services in our national self-care platform represents a key finding in our manuscript, highlighting a progressive approach to healthcare delivery. The incorporation of teleconsultation services into our platform aligns with the insights from Verma et al.‘s study [24]. They created a telemedicine system for brain function teleconsultation, resulting in a “digital assistant” that delegates history-taking and physical exams from urban physicians to rural nurses or health workers. The digital assistant aims to guide, not diagnose, helping remote healthcare providers collect comprehensive patient information. This data is shared with distant physicians, enhancing teleconsultations and healthcare delivery in underserved areas. By adopting this collaborative approach, our platform not only enhances accessibility but also ensures the dissemination of quality healthcare to even the remotest communities. This strategy proves instrumental in addressing the distinctive healthcare needs of diverse populations, marking a significant step towards equitable healthcare distribution. Lopez-Villegas et al. [25]. Also concluded with the implementation of a teleconsultation in a hospital emergency department that teleconsultation contributes to timely interventions, as individuals can seek medical advice promptly, potentially mitigating the progression of health issues.

The integration of teleconsultation services into our platform signifies a significant stride towards modernizing healthcare delivery. By incorporating teleconsultation, our platform facilitates remote medical interactions, allowing individuals to consult with healthcare professionals from the comfort of their homes. This not only addresses the challenges of accessibility but also caters to the evolving needs of diverse populations. Teleconsultation is not merely a convenience; it stands as a transformative force in healthcare, providing benefits such as enhanced patient access to medical expertise, reduced travel burden, and timely interventions.

Study implication

The development, evaluation, and implementation of the national self-care progressive web app (PWA) platform hold significant implications across several domains, highlighting its potential impact and future prospects.

Public health impact

The introduction of the national self-care platform addresses critical gaps in healthcare accessibility and effectiveness. By providing tailored self-care resources for a diverse range of users, including mothers, children, adolescents, adults, and individuals with mental and emotional health disorders, the platform empowers users to actively manage their health. This proactive approach not only enhances individual well-being but also contributes to public health by potentially reducing healthcare burdens associated with preventable illnesses and chronic conditions.

Cost-effectiveness

Implementing a comprehensive self-care platform can potentially alleviate healthcare costs by promoting early intervention and prevention strategies. By offering teleconsultation services and decision aids, the platform supports timely healthcare access, reducing unnecessary visits to healthcare facilities and optimizing resource allocation.

Accessibility and equity improvements

The platform’s design prioritizes inclusivity, aiming to bridge gaps in healthcare access across diverse demographic and geographic contexts. By offering content in Persian and accommodating cultural nuances, the platform enhances accessibility for Persian-speaking populations globally, promoting health equity and reducing disparities in healthcare delivery.

User empowerment

Through its user-friendly interface and educational resources, the platform empowers individuals to make informed decisions about their health. By fostering health literacy and self-efficacy, users can actively participate in their healthcare journey, leading to improved health outcomes and enhanced quality of life.

Future development prospects

As digital healthcare evolves, future developments of the platform could incorporate advanced technologies such as artificial intelligence (AI) and machine learning (ML). These advancements could enable predictive analytics, personalized health recommendations, and real-time health monitoring capabilities, further enhancing the platform’s utility and effectiveness.

Therefore, the national self-care platform represents a pivotal advancement in healthcare innovation, offering scalable solutions to enhance individual health management and promote a more accessible healthcare landscape. Continued research and collaboration across multidisciplinary fields will be crucial in maximizing the platform’s potential to improve health outcomes and quality of life on a global scale.

Study limitations

Our study has several limitations that warrant consideration. Firstly, the sample size of 26 expert medical informatics evaluators may limit the generalizability of our findings. While these participants provided valuable insights into the usability of the platform, a larger and more diverse group could offer broader perspectives and enhance the applicability of our results across different user demographics and settings. Furthermore, the short evaluation period of two weeks may not fully capture the long-term user experience or potential changes in user behavior over time. Future studies with extended follow-up periods could provide a more comprehensive understanding of how users interact with the platform over extended periods.

Additionally, it is important to acknowledge the potential impact of cultural and language factors on the platform’s usability and effectiveness, particularly given its global target audience. Variations in cultural norms, language proficiency, and healthcare practices may influence how users perceive and engage with the platform, which could affect its overall effectiveness and adoption. Lastly, our study primarily focused on usability aspects, and further research is needed to explore the platform’s impact on users’ self-care behaviors and health outcomes. Future studies, such as randomized controlled trials or longitudinal studies, would be valuable in assessing the platform’s effectiveness in improving self-care practices and enhancing health outcomes among diverse populations.

Conclusion

In conclusion, our study successfully designed, implemented, and evaluated a national self-care progressive web app platform, offering a robust solution to critical healthcare challenges. The versatile system, with eight dedicated sections addressing diverse demographics and health concerns, integrates 54 CDSS, teleconsultation services, and a self-care magazine, significantly enhancing overall functionality and user resourcefulness. Furthermore, the national self-care platform goes beyond individual health needs, offering significant global impact potential. Its unique ability to address the specific requirements of Persian-speaking populations worldwide positions it as a valuable asset in the international healthcare landscape, benefitting Persian-speaking communities globally, not just in Iran.

The seamless integration of technology, educational content, and personalized healthcare resources transforms this platform into a powerful tool for advancing overall health and mitigating health risks on a broader scale. By fostering accessibility, inclusivity, and personalized care, the national self-care platform stands at the forefront of healthcare innovation, promising lasting positive effects on the health and well-being of diverse populations worldwide.