Table 4.

Community Feedback on the Design of the ELF device and ELF Tracker app

West Eugene Focus Groups (n = 18)
Issue	Suggestion(s) if applicable	Changes to the application
Application interface:
How do you trigger the test from the opening page?	Add a label … something like “click here to start”	The instruction page opens first
The log of data is confusing	Keep the data log, but it should not be the opening page	The instruction page is now the main page
Why does it say “asthma”?	This makes it seem like only asthmatics can use the device.	Replaced with “Spirometer Transmission Status”
Data transmission:
How do you know your data was successfully transmitted?	It would be helpful if the grey button changed to green.	Grey button changed to a red button. When the test is completed the user clicks the red button, which turns yellow as data is transmitted and then green when data is successfully sent.
Usability of the device:
The text is not in Spanish	Include a Spanish version of the app	Spanish text is included alongside the English text
Push notifications are too passive		Notifications programmed into the cell phone alarm
Keeping track of spirometry tests	Include a counter on the cell phone
How to use the spirometer	Put an instructional video on the phone	Written instructions currently available
[In Eugene] you simply don't wear orange (wristband; color of rival school)	Have different colors	Wristbands now available in 5 colors

Carroll County focus group (n = 7)
Issue	Suggestion(s) if applicable	Changes made
Application interface:
The button stays green when you are done. I was going to sit here and wait for it to go back to red.	It should go back to red, since that means the test is done.	The starting button is now blue, which changes to yellow (transmission), then green (successful transmission), and changes back to blue when test is complete.
Why is the text on the colored buttons the same?	The wording for the yellow button should say “transmitting” and the wording for the green button should say “test complete”	The text has been updated to state the progress of the data transmission.
How do I contact [the study coordinator] if I need help?	Include the study coordinator's phone number on the instruction page	The phone number for the study coordinator is now listed as an icon on the cell phone home page (and identified in an user's guide), as well as in all instructions.
Data transmission:
Cell phone reception out here is not good.	You have to have [specific cell provider] out here!	Note: The phones were using the local provider that had the best coverage but should be considered for studies in different regions.
When you're out of service the phone will shut down to preserve battery life and transmit data later?	Provide a car charger	Future studies will include optional car chargers
It took a long time for the spirometer to display results	Write in the instructions that it can take up to 10 seconds for the spirometer to display data	Instructions updated to clarify that there may be a lag time between when the test finishes, and when results are displayed
Usability of the device:
How do you reset the spirometer to take another test?	On the app, add “Step 5: click the right arrow on the spirometer to reset.”	See below for changes to written instructions
Simplify terminology	Change the instructions to read “breath in (inspire) and breath out (expire)”	See below for changes to written instructions
Tracking spirometry tests	Include a progress bar	A progress bar was added to show how many tests have been completed.
ELF Tracker instructions:
Terminology not consistent, not sure what to do if a mistake is made	Include a trouble-shooting guide, and an instruction sheet to show how to use the cell-phone, geared towards new cell-phone users.	“The ELF Tracker: A Users Guide” was created showing step-by-step instructions on how to navigate the cell phone, as well as how to use the app and how to set and change the scheduled spirometry reminders.