“ENF NA DOSE CERTA” APP: ASSESSMENT OF CONTENT, APPEARANCE, AND USABILITY BY NURSING CARE PROVIDERSABSTRACT
Objective: to assess the content, appearance, and usability of the “Enf na Dose Certa” app for the prevention of medication errors by nursing care providers.
Method: a methodological study conducted between December 2024 and January 2025, involving 32 nursing care providers using an electronic form. The Educational Health Content Validation Instrument, the Educational Technology in Health Appearance Validation Instrument, and the System Usability Scale were used to assess usability. The content validity index, the appearance validity index, and the overall usability score were used for analysis.
Results: evaluation by nursing care providers revealed ratings classified as excellent: 99% for content, 88% for appearance, and 84.37 points for usability. All usability characteristics obtained mean scores classified as excellent, indicating that the app is easy to learn and remember, satisfying, and efficient, with low inconsistency.
Conclusion: the “Enf na Dose Certa” demonstrated strong ratings from the target audience, with the potential to contribute to clinical nursing practice, particularly in reducing medication errors in adults and older adults, and is available free of charge on the Google Play Store.
DESCRIPTORS:
Mobile applications; Nursing team; Medication errors; Evaluation study; Educational technology
RESUMO
Objetivo: avaliar o conteúdo, a aparência e a usabilidade do aplicativo “Enf na dose certa” para prevenção de erros de medicação por profissionais de enfermagem.
Método: estudo metodológico, desenvolvido entre dezembro de 2024 a janeiro de 2025, com 32 profissionais de enfermagem, utilizando um formulário eletrônico. Para a avaliação de usabilidade foi utilizado o Instrumento de Validação de Conteúdo Educativo em Saúde, o Instrumento para Validação de Aparência de Tecnologias Educacionais em Saúde e a Escala de Usabilidade de Sistemas. Para a análise utilizou-se o índice de validade de conteúdo, o índice de validade da aparência e o escore global de usabilidade.
Resultados: a avaliação dos profissionais revelou índices classificados como excelentes: 99% no conteúdo, 88% na aparência e 84,37 pontos na usabilidade. Quanto às características da usabilidade, todas obtiveram o escore médio classificado como excelente, indicando que o aplicativo possui facilidade de conhecimento e memorização do sistema, satisfação e eficiência, além de baixa inconsistência.
Conclusão: o “Enf na Dose Certa” mostrou-se como uma tecnologia bem avaliada pelo público-alvo, com potencial para contribuir na prática clínica da enfermagem, especialmente na redução de erros de medicação em adultos e idosos e está disponível de forma gratuita na Google Play Store.
DESCRITORES:
Aplicativos móveis; Equipe de enfermagem; Erros de medicação; Estudo de avaliação; Tecnologia educacional
RESUMEN
Objetivo: evaluar el contenido, la apariencia y la usabilidad de la aplicación “Enf na dose certa” para la prevención de errores de medicación por profesionales de enfermería.
Método: estudio metodológico, desarrollado entre diciembre de 2024 y enero de 2025, con 32 profesionales de enfermería, mediante un formulario electrónico. Para la evaluación de la usabilidad se utilizaron el Instrumento de Validação de Conteúdo Educativo em Saúde, el Instrumento para Validação de Aparência de Tecnologias Educacionais em Saúde e la Escala de Usabilidade de Sistemas. Para el análisis se emplearon el índice de validez de contenido, el índice de validez de apariencia y la puntuación global de usabilidad.
Resultados: la evaluación de los profesionales reveló índices clasificados como excelentes: 99% en el contenido, 88% en la apariencia y 84,37 puntos en la usabilidad. En cuanto a las características de la usabilidad, todas obtuvieron una puntuación media clasificada como excelente, lo que indica que la aplicación presenta facilidad de aprendizaje y memorización del sistema, satisfacción y eficiencia, además de baja inconsistencia.
Conclusión: el “Enf na Dose Certa” demostró ser una tecnología bien evaluada por el público destinatario, con potencial para contribuir a la práctica clínica de enfermería, especialmente en la reducción de errores de medicación en adultos y adultos mayores, y está disponible de forma gratuita en la Google Play Store.
DESCRIPTORES:
Aplicaciones móviles; Equipo de enfermería; Errores de medicación; Estudio de evaluación; Tecnología educacional
INTRODUCTION
The Agência Nacional de Vigilância Sanitária (ANVISA) defines medication errors (MEs) as incidents arising from failures in the use and prescription of medications, which may result in harm to the patient. Medication errors are preventable and represent a public health problem that requires intervention1. The cost of managing such incidents places a burden on the healthcare sector and can result in substantial losses. According to an investigation conducted at a public hospital within the ANVISA Sentinel Hospital Network, the cost per occurrence, which leads to increased hospital length of stay, ranges from approximately 31 Brazilian reais to more than 21,000 reais in a single severe event2.
The most common medication errors are related to illegible prescriptions, improper drug dispensing, and incorrect administration, exposing patients to risks ranging from allergic reactions to death3. The nursing team is responsible for critical steps, including medication scheduling, dispensing, preparation, and administration, and its role is therefore crucial in preventing these errors. Accordingly, it is essential that nursing care providers remain aware of the different types of errors and how to prevent them4.
In this context, Information and Communication Technologies (ICT) can serve as strategies to mitigate medication error incidents by facilitating knowledge dissemination in nursing and implementing solutions through continuing education5. Mobile applications stand out among ICT for their immediate accessibility and usability in any context, making them valuable tools for healthcare providers who require reliable, readily accessible information in their work process6.
It should be emphasized that the smartphone is one of the main means of internet access in the daily lives of Brazilians, which includes the frequent use of mobile applications. However, despite the variety of mobile applications available7, not all are accessible on digital platforms or address the proposed subject matter. Moreover, many are not targeted at nursing care providers, as most Educational Technologies (ET) are intended for patients and their caregivers8.
The “Enf na Dose Certa” mobile app is an ICT tool developed for use in clinical nursing practice, conceived as an ET designed to prevent medication errors in adults and older adults through the continuing education of nursing care providers. This ET was developed and validated with excellent indices among experts. Among its topics, the “Enf na Dose Certa” app includes several interactive sections covering professional safety, infection prevention, error prevention, medication calculation, routes of administration, diluents, medication scheduling and verification, medication preparation, and nursing team training9.
App validation was carried out with a group of experts; it is therefore essential to evaluate the app among the nursing care providers involved in clinical practice, namely those who will actually use it in their professional routines, including both technical-level and higher-education-level professionals. For this reason, the technological characteristics of the app, particularly its usability for this audience, are especially important, as these are the users who will interact with it daily10.
It is essential to understand how nursing care providers evaluate the “Enf na Dose Certa” app, as they constitute the target audience for whom this ET is designed. Assessing the app’s content, appearance, and usability can contribute significantly to its improvement, enabling it to become an efficient and effective ET for supporting nursing care providers in preventing medication errors through expanded knowledge and reinforced safety layers for reducing adverse events11. Evaluating a mobile app aims to analyze its content and functionalities to verify their alignment with the objectives established from the outset of its development; it is further worth noting that usability is a central element of the user experience, as it encompasses efficiency, effectiveness, and satisfaction when interacting with the app, all of which are key determinants of its acceptance and adoption12.
In this regard, the perspective of the target audience for whom the “Enf na Dose Certa” app was designed is essential to ensure that the ET is useful and practical in clinical care, meeting content and usability needs while providing a visually appealing interface. The participation of nursing care providers in this evaluation process is particularly relevant for identifying gaps and necessary adjustments so that the ET fully meets the needs of its intended audience. Furthermore, making a free app available with quick access from any location can bring significant benefits to both professionals and patients, as this accessibility and its use during clinical practice have the potential to promote patient safety, improve care quality, and reduce medication errors.
Accordingly, this study aims to assess the content, appearance, and usability of the “Enf na Dose Certa” app for the prevention of medication errors by nursing care providers.
METHODS
This is a methodological study, a subset of a larger project entitled “Construção e validação de um aplicativo para enfermagem sobre terapia medicamentosa em adultos e idosos,” which evaluated the “Enf na Dose Certa” app (Figure 1) among nursing care providers, developed in two stages: assessment of the app’s content, appearance, and usability by the target audience, and adaptation of the technology based on the target audience’s suggestions.
Data collection was conducted in a virtual environment from December 2024 to January 2025, using an electronic form built in Google Forms. The following inclusion criteria were established for participant eligibility: nursing team professionals from various regions of Brazil who worked with adult and older adult patients. Those who worked exclusively in administrative activities and did not perform medication administration were excluded.
The recommended composition of 30 to 40 professionals was adopted for the target audience sample13, who were invited to participate in the study through the dissemination of a research invitation on WhatsApp and Instagram. Participant recruitment was conducted by convenience sampling using the snowball technique. This technique consists of a referral chain initiated by the researchers, in which each participant sequentially recruits others to participate in the study14.
An invitation was sent via WhatsApp and Instagram to contacts with close ties to the research team to establish the referral chain; thereafter, participants themselves forwarded it to their contacts until the predefined sample was obtained. The invitation contained a link to a Google form. Upon accessing it, the participant encountered the Informed Consent Form (ICF) available for reading and download. After agreeing to participate by selecting the option “I have read the ICE and agree,” participants were directed to the data collection form. Those who did not agree to participate were directed to a final thank-you page.
The first part of the form included questions to characterize the target audience (age, sex, educational level, profession, and state) and a link to download the app. The second part of the form contained the instruments for assessing the content, appearance, and usability of the “Enf na Dose Certa” app, along with a space for comments and/or suggestions. The form designed for the target audience took an average of 20 minutes to complete.
The first stage, which involved the target audience’s evaluation of the app, comprised the assessment of the content, appearance, and usability of the “Enf na Dose Certa” app. Content was assessed using the Educational Health Content Validation Instrument (IVCES), a tool designed for the evaluation of written educational materials. This instrument has high reliability, with ICC > .80 (p < .05), and comprises 18 items distributed across three categories: objectives (purposes, goals, or aims), structure/presentation (organization, structure, strategy, coherence, and sufficiency), and relevance (significance, impact, motivation, and interest). Responses are provided on a Likert-type scale, where 0 = disagree, 1 = partially agree, and 2 = fully agree15.
The appearance of the mobile app was assessed using the Educational Technology in Health Appearance Validation Instrument (IVATES), which aims to evaluate how images support content comprehension. This instrument has demonstrated excellent internal validity, with CVI = .93, and comprises 12 items that analyze the app’s appearance, classified as negative or positive using a Likert-type scale (strongly disagree, disagree, partially disagree, agree, and strongly agree), ranging from 1 to 5 points16.
Usability was assessed using the System Usability Scale (SUS), Brazilian version, which aims to evaluate how easy it is for the user to interact with a given system. This scale is a Brazilian Portuguese translation of the System Usability Scale (SUS) and has a Cronbach’s alpha reliability of 0.76. It contains items with both positive and negative ratings using a Likert-type scale, where 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree17.
Target audience characterization data were analyzed using the Statistical Package for the Social Sciences for Windows (SPSS) software, version 20.0. This analysis was conducted using descriptive statistics, including simple frequencies, measures of central tendency (mean and median), and measures of dispersion (standard deviation), allowing for a characterization of the target audience that participated in the app evaluation.
Content analysis was performed using the Content Validity Index (CVI). The literature recommends that the CVI be ≥ 80% (.80). Each item of the IVCES was to be answered using a Likert-type scale. The CVI for each item was calculated by dividing the number of “partially agree” and “fully agree” responses by the total number of responses. Items that achieved 80% or greater agreement among participants were considered valid. Items that did not demonstrate acceptable validity were required to undergo revision or exclusion. The global CVI was calculated by summing the CVI of each item and dividing by the total number of items15.
Appearance assessment was performed using the Appearance Validity Index (AVI). The literature recommends that the total AVI exceed .90. The AVI for each item was calculated by dividing the number of evaluators who responded “agree” or “fully agree” by the total number of evaluators. The total AVI was then calculated by summing the AVI of all items and dividing by the total number of items in the IVATES. The AVI is classified as excellent if ≥ .78; an AVI between .60 and .77 indicates the need for adjustments to improve the app’s appearance, and an AVI < .60 is considered poor, indicating that the app would need to be redesigned16.
Usability was analyzed using the SUS, Brazilian version. First, scores for even-numbered items were calculated, with each individual score obtained by subtracting the response value from five points. Next, scores for odd-numbered items were calculated, with each individual score obtained by subtracting one point from the value given by the evaluator. The resulting values were then summed and multiplied by 2.5, yielding the final score. Results were classified as follows: worst imaginable when the score ranges from 0 to 20.5; poor, from 21 to 38.5; moderate, from 39 to 52.5; good, from 53 to 73.5; excellent, from 74 to 85.5; and best imaginable, from 86 to 100 points17.
The usability characteristics (system learnability, system efficiency, inconsistencies, memorability, and user satisfaction) were calculated from the score of each participant’s responses to the items in each domain, multiplied by 25 for a scale of zero to 100. The mean score for each item was calculated by summing the points assigned by all participants and dividing by the total number of respondents. Subsequently, the mean SUS score was calculated for the items comprising each characteristic analyzed. For the mean of each item, the sum of the responses assigned to that item was divided by the total number of corresponding items. The Scale items comprising the ‘learnability’ characteristic are 3, 4, 7, and 10. For the ‘system efficiency’ characteristic, the items are 5, 6, and 8. Only item 6 comprises the ‘inconsistencies’ characteristic, and similarly, only item 2 comprises the ‘memorability’ characteristic. The ‘user satisfaction’ characteristic is composed of items 1, 4, and 9.
In the second stage, which involved adapting the technology based on the target audience’s suggestions, an analytical framework was created to systematize the observations made by nursing care providers regarding content, appearance, and usability. This framework was discussed in a meeting with the research team, in which each suggestion was evaluated for its relevance and practical feasibility of implementation.
This study was submitted to and approved by the Research Ethics Committee, in compliance with Resolution 466/2012 of the National Health Council. During the preparation of this article, the authors used ChatGPT OpenAI® version 4.0 to reduce the word count of the text. Following the use of this tool, the authors reviewed and edited the content in accordance with the scientific method and assume full responsibility for the content and integrity of the publication.
RESULTS
The sample was therefore composed of 32 (100.0%) nursing care providers, of whom 18 (56.25%) were registered nurses and 14 (43.75%) were nursing technicians, with a mean age of 35 years, ranging from 23 to 55 years of age. Among these professionals, 29 (90.62%) were women and 3 (9.37%) were men. Most participants resided in the state of Rio de Janeiro (29, 90.62%), followed by Minas Gerais (3, 9.37%).
The professionals assessed the content of the mobile app and assigned a global CVI of .99, confirming content validity (Table 1). Only item 15, pertaining to appropriate text size, received a CVI of .96, with all other items achieving the maximum score.
Nursing care providers offered several suggestions, among which the inclusion of a topic on hypodermoclysis and a dose calculator stood out; both will be incorporated into the next version of the app to expand the content offered. Other suggestions included correcting specific typographical errors and adjusting the font size in one particular topic, requests that were addressed to improve text readability. Finally, inclusion of content on types of precautions and examples of associated infections was proposed; however, this suggestion was not implemented, as it falls outside the app’s central theme.
The professionals’ assessment of the mobile app’s appearance yielded a total AVI of .88, classified as excellent with respect to appearance validity (Table 2). Item indices ranged from .84 to .90. Item 12, which evaluates whether the illustrations support changes in the target audience’s behaviors and attitudes, received the lowest score, at .84.
Increasing the image size was suggested; however, this modification was not feasible due to technical limitations, given that the visual resources already available include a zoom functionality.
The usability assessment by the target audience yielded a mean SUS score of 84.37, a result considered excellent for the “Enf na Dose Certa” app (Table 3). Individual scores among participants ranged from 60.0 to 100.0. Three nursing care providers who participated in the study assigned the maximum score to the app.
All usability characteristics obtained mean scores classified as excellent, indicating that the app has strong learnability and memorability, user satisfaction, and efficiency, in addition to low inconsistency (Table 4).
The overall evaluation of the app by the target audience was considered excellent, with satisfactory indices.
DISCUSSION
The “Enf na Dose Certa” app received positive evaluations regarding its content, appearance, and usability from nursing care providers who constitute the target audience for which this ET was designed. It also demonstrated its value as an important tool for use in continuing education on the prevention of medication therapy errors in clinical practice with adults and older adults, with concise, well-structured, and relevant content, an attractive visual layout, and excellent usability.
In their daily practice, nursing care providers are directly involved in medication preparation and administration, which contributes to the provision of quality care and the reduction of errors during these steps. Furthermore, one study identified that the use of mobile apps can facilitate rapid access to updated information, thereby reducing incorrect actions in clinical care18, which reinforces the relevance of the present study.
Although numerous apps exist, some still lack the methodological rigor needed for adequate evaluation19-20. It has been observed that some studies aimed at developing technologies such as apps do not include an evaluation step among the target audience that will benefit from and use the proposed technology, presenting only expert validation21, a limitation that was addressed in the present study.
In this study, the IVCES was used as a content evaluation tool and demonstrated excellent performance, consistent with the findings of a study evaluating an app for nursing students, in which all items obtained a CVI of 1.00, with the exception of one item related to “layout and presentation,” which obtained .9522. The “Enf na Dose Certa” app achieved the maximum CVI on all items, except for the one related to appropriate text size; however, it still attained an index higher than that reported in the comparison study.
Although nursing care providers were not the target audience, a study that developed an app for medication dosing in neonatal and pediatric services used instruments that assessed content, appearance, and usability in a manner similar to the present study. In the appearance analysis, which was evaluated by computer systems engineers, the items received positive ratings, although some reservations arose regarding the app’s interface23. Similarly, despite the “Enf na Dose Certa” app’s satisfactory mean AVI, there remains a need for continuous improvement to ensure an organized and attractive design capable of meeting the target audience’s expectations.
Regarding usability, a study on an app for the outpatient monitoring of patients using peripherally inserted central catheters, conducted with the target audience, yielded a mean SUS score of 82.7, achieving an excellent classification24, as did the app in the present study. Other studies published in the literature have also used the SUS to assess the usability of mobile apps among target audience users, such as the “Avazum” and “Sepse em Foco” apps25-26, which obtained mean SUS scores of 78.28 and 83.18, respectively. These scores are consistent with those found in the evaluation of the “Enf na Dose Certa” by the target audience, which obtained higher SUS scores, although still within the excellent classification for usability.
Regarding usability characteristics, system learnability had the highest mean in the “Enf na Dose Certa” app. This result, however, may vary in the literature depending on the specific attributes of each app. Consistent with this finding, the “Nasci Bem” app27, which achieved a mean SUS score of 94, classified as best imaginable, also had learnability as the characteristic most highly rated by its target audience. In the “ROBOVID” app28, the mean SUS score was 87.3, also higher than that observed in the present study and equally classified as best imaginable; however, the characteristic with the highest mean was memorability, diverging from the pattern identified in the present study.
In the evaluation process, nursing care providers offered suggestions considered relevant, all of which were duly accepted or justified. Qualitative analysis of these contributions reinforces the importance of evaluator participation in the development process of educational technology, consistent with the validation study of a multimedia app for foot care in people with diabetes, which also incorporated participants’ recommendations into the final product10. Similarly, the study that developed, validated, and evaluated an app for humanized care practices for newborns at routine birth risk incorporated participants’ suggestions, promoting the improvement of the technological resource27.
The “Enf na Dose Certa” app has an innovative character in the subject area chosen relative to its target audience and demonstrated excellent evaluations among nursing care providers in terms of content, appearance, and usability, highlighting its potential as an ET for preventing medication errors. This type of tool holds broad potential by adopting the strategy of integrating technology with clinical practice29. The content, which is clear and aligned with safe medication administration practices, fosters meaningful learning and can be used in both initial training and continuing health education.
The app features an attractive design and intuitive interface, promotes engagement, and facilitates use in daily professional practice, while its well-rated usability indicates smooth navigation and accessible information that optimize the user’s time. It is worth noting that apps used as ET offer visual resources and up-to-date scientific content in a practical and accessible format at the user’s fingertips, fostering professional engagement30. These combined aspects reinforce the app’s capacity to support safe decision-making and strengthen the patient safety culture, making it a strategic resource for reducing failures related to medication therapy.
One possible limitation of this study relates to the use of non-probability convenience sampling, associated with the snowball technique and the virtual environment, which may have influenced the participant profile and concentrated responses among professionals who are more engaged or familiar with digital technologies. However, although this may have restricted the participation of individuals with less internet access or lower technological proficiency, it allowed for broader geographic reach and ensured the participation of professionals working in different care settings, without compromising the relevance of the contributions obtained for app validation. At the time of data collection, the “Enf na Dose Certa” app was not indexed in the virtual app stores for Android and iOS and, since it was not readily available, participants expressed hesitation and encountered difficulties in following the steps to access the app via a link on their smartphones.
CONCLUSION
The “Enf na Dose Certa” app was evaluated in terms of its appearance, content, and usability, demonstrating that it satisfactorily meets the expectations of nursing care providers, reflecting the methodological rigor of its development, as well as the high relevance and quality of the ET.
The app stands out for its clear and relevant objectives, consistent information organized and aligned with best practices and scientific evidence, as well as its promotion of meaningful learning and practical applicability for the target audience. Likewise, its appearance reveals an attractive, harmonious, and functional visual design, with graphic elements that facilitate content comprehension, promote user engagement, and make navigation intuitive and pleasant. Among the usability characteristics, the most notable were the ease of use when accessed for the first time and the speed in completing the established tasks.
The use of the “Enf na Dose Certa” app as a tool for preventing medication errors has the potential to positively transform clinical practice by providing technological and educational support, as a continuing education tool, enabling nursing care providers to deliver safer, high-quality care to adults and older adults.
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NOTES
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ORIGIN OF THE ARTICLE
Extracted from the Undergraduate Thesis - “Enf na Dose Certa” App: assessment of content, appearance, and usability by nursing care providers, presented to the Nursing Program of the Universidade Federal Fluminense, Campus Rio das Ostras, in 2025.
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FUNDING INFORMATION
Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ). Grant number: E-26/260.339/2022.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Research Ethics Committee of the Universidade Federal Fluminense, Opinion No. 5.725.119/2022, Certificate of Presentation for Ethical Consideration 60748122.8.0000.8160.
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TRANSLATED BY
Martin Webster.
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DATA AVAILABILITY
All data supporting the results of this study were published in the article itself.
Edited by
All data supporting the results of this study were published in the article itself.
