Table 1.

Five-Phase, User-Centered Approach to Develop HEARTPrep^©.

Phase	Partners	Parent participants	Methods	Deliverables
Phase I: Establishing partnerships Duration: variablea	Parent: • Mother of child with CHD Clinicians: • 2 fetal cardiologists • Perinatal nurse coordinator Design and technology: • CHDI: director, designer, analyst, software engineers, quality assurance engineers, editor from Nemours KidsHealth • REACH: director of technology and methodology core	• No participants or data collection in Phase I	• Weekly meetings dedicated to HEARTPrep© development • Frequent communication via Microsoft Teams and email to promote collaboration	Partnerships to: • Facilitate stakeholder input on HEARTPrep© • Provide design and technological expertise to develop HEARTPrep© • Leverage existing functionality within NCH (Nemours app)
Phase II: Creating content Duration: 8 months	• Parent and clinician partners provided input on content (videos, articles, resources) • Medical editor refined written content to be easily understood by families	Video filming: • 7 mothers, 6 fathers whose child received prenatal CHD dx • 2 Hispanic/Latino, 5 Black, 6 NHW • Payment = $100	• Parents participated in 1-hour recorded virtual interviews via Skype to provide content for HEARTPrep© videos	• HEARTPrep© content (videos, articles, resources) ready for prototype development
Phase III: Developing prototype and testable intervention Duration: 8 months	• Designer developed HEARTPrep© prototype • Analysts, software engineers, and quality assurance engineers developed testable HEARTPrep© intervention	Prototype review: • 2 mothers whose child received prenatal CHD dx in past year • 2 NHW; age: 30-34 years • Payment = $50	• Mothers gave feedback on HEARTPrep© prototype • Feedback informed development of testable HEARTPrep© intervention	• Testable HEARTPrep© intervention ready for think-aloud testing
Phase IV: Conducting think-aloud testing Duration: 4 months	• Analyst, software engineers, and quality assurance engineers refined HEARTPrep© based on participant feedback	• 5 mothers whose child received prenatal CHD dx in past year • 1 pregnant, 1 in hospital with infant, 3 at home after cardiac surgery • 1 Hispanic/Latino, 2 Black, 2 NHW; age: 23-42 years • Payment = $50	• Mothers navigated through HEARTPrep© and said out loud what they were thinking and doing • All communications recorded, transcribed, and analyzed for common themes • Results informed refinements to HEARTPrep©	• Refined HEARTPrep© intervention ready for beta testing
Phase V: Completing beta testing Duration: 4 months	• Analyst, software engineers, and quality assurance engineers refined HEARTPrep© based on participant feedback	• 10 mothers expecting a baby with CHD • 2 Black, 8 non-Hispanic White; Age: 21-37 years • Payment = telehealth ($10), survey ($25), interview ($50)	• Expectant mothers participated in HEARTPrep© • Provided feedback via survey and qualitative interview • Usability data obtained from Nemours app	• Fully refined HEARTPrep© intervention ready for efficacy testing

Note. CHD, congenital heart disease; CHDI, Center for Health Delivery Innovation; REACH, Research Expanding Access to Child Health Center; NCH, Nemours Children's Health; Dx, diagnosis; NHW, non-Hispanic White.

^a Partnerships developed over variable time frames, building on prior research and clinical collaborations.