PROTOTYPE OF A MOBILE APPLICATION FOR HEALTHCARE PROFESSIONALS MANAGING NONSPECIFIC CHRONIC LOW BACK PAIN: A HEURISTIC EVALUATIONABSTRACT
Objective: to describe the usability validation process of a mobile application prototype for healthcare professionals with nonspecific chronic low back pain.
Method: this is a methodological usability validation study with descriptive analysis, conducted with eight expert judges during November and December 2023. Participants were selected through the Lattes Platform. The evaluation was based on Jakob Nielsen’s heuristics, with problems classified according to their severity and grouped into thematic categories.
Results: the evaluation identified twelve violated heuristics and 45 usability problems. Regarding severity, 16 (34.7%) were purely aesthetic issues, 16 (34.7%) were minor issues, eight (17.9%) were major issues, and three (6.5%) were severe problems. Judges suggested instructional adjustments, improvements in navigation, visual standardization, interactive support, and audio enhancement.
Conclusion: the heuristic analyses provided essential insights for redesigning the interface, navigation, and functionality of the prototype. The results reinforce the importance of successive validation steps in the development of digital health technologies, especially those aimed at self-care in occupational contexts.
DESCRIPTORS:
Low Back Pain; Self-Management; Wireless Technology; Heuristic; Validation Study
RESUMO
Objetivo: descrever o processo de validação de usabilidade do protótipo de aplicativo móvel para profissionais de saúde com dor lombar crônica inespecífica.
Método: trata-se de um estudo metodológico de validação de usabilidade, com análise descritiva, conduzido com oito juízes especialistas, nos meses de novembro e dezembro de 2023. Os participantes foram selecionados por meio da Plataforma Lattes. A avaliação baseou-se em Heurísticas de Jakob Nielsen, sendo os problemas classificados segundo sua gravidade e agrupados em categorias temáticas.
Resultados: a avaliação resultou em doze heurísticas violadas e 45 problemas de usabilidade. Quanto à gravidade, foram identificados 16 (34,7%) problemas apenas estéticos, 16 (34,7%) problemas de menor gravidade, oito (17,9%) problemas de maior gravidade e três (6,5%) problemas graves. Juízes sugeriram ajustes instrucionais, melhorias na navegação, padronização visual, suporte interativo e aprimoramento de áudio.
Conclusão: as análises heurísticas forneceram subsídios fundamentais para a reformulação da interface, navegação e funcionalidade do protótipo. Os resultados reforçam a importância de validações sucessivas no desenvolvimento de tecnologias digitais em saúde, especialmente para o autocuidado em contextos ocupacionais.
DESCRITORES:
Dor Lombar; Autogestão; Tecnologia Sem Fio; Heurística; Estudo de Validação
RESUMEN
Objetivo: describir el proceso de validación de usabilidad del prototipo de una aplicación móvil para profesionales de la salud con dolor lumbar crónico inespecífico.
Método: se trata de un estudio metodológico de validación de usabilidad, con análisis descriptivo, realizado con ocho jueces especialistas durante los meses de noviembre y diciembre de 2023. Los participantes fueron seleccionados mediante la Plataforma Lattes. La evaluación se basó en las heurísticas de Jakob Nielsen, clasificándose los problemas según su gravedad y agrupándolos en categorías temáticas.
Resultados: la evaluación identificó doce heurísticas violadas y 45 problemas de usabilidad. En cuanto a la gravedad, se encontraron 16 (34,7%) problemas meramente estéticos, 16 (34,7%) problemas de menor gravedad, ocho (17,9%) problemas de mayor gravedad y tres (6,5%) problemas graves. Los jueces sugirieron ajustes instruccionales, mejoras en la navegación, estandarización visual, soporte interactivo y optimización del audio.
Conclusión: los análisis heurísticos proporcionaron insumos fundamentales para la reformulación de la interfaz, la navegación y la funcionalidad del prototipo. Los resultados refuerzan la importancia de realizar validaciones sucesivas en el desarrollo de tecnologías digitales en salud, especialmente aquellas destinadas al autocuidado en contextos ocupacionales.
DESCRIPTORES:
Dolor Lumbar; Autogestión; Tecnología Inalámbrica; Heurística; Estudio de Validación
INTRODUCTION
Chronic low back pain (CLBP) is a prevalent and multifactorial condition with significant physical, psychological, social, and economic impact, affecting individuals from adolescence to older age, with early onset in many cases. According to the Global Burden of Disease 2019, it is one of the leading causes of disability among individuals aged 10 to 49 years1. The high occurrence of spinal disorders results in substantial repercussions for the healthcare system2. International guidelines recommend self-management with a biopsychosocial focus, including exercise, education, psychosocial interventions, and a multidisciplinary approach that involves active patient participation in decision-making, symptom monitoring, and management of physical and psychosocial needs1-4. However, adherence to therapeutic options remains low2
Most cases of chronic low back pain are classified as nonspecific, as the exact cause is usually not identified. When it persists, management becomes more complex. However, there is concern about the excessive use of examinations and low‑evidence treatments, which may cause additional harm. In this context, self‑management strategies emerge as viable alternatives, especially in light of economic challenges and barriers to healthcare access3.
Low back pain is a major global health problem and the leading cause of disability worldwide, primarily affecting individuals of working age. Its impact has increased due to population aging and rising healthcare costs, highlighting the need for innovative, accessible, and scalable strategies for self‑management of the condition4.
Mobile applications (apps) can support self‑management through education, symptom tracking, exercises, and outcome monitoring, facilitating shared decision‑making between patients and healthcare professionals2. These apps have the potential to replace traditional educational materials and supervise therapeutic exercises, demonstrating moderate to high effectiveness in promoting adherence3.
Despite growing interest in digital technologies for health management, low back pain apps are still underused and often present limitations in resources aimed at self‑management and behavior change. In this context, evaluating the quality and potential of these apps is essential to guide their use and improve low back pain management in primary care4.
Evaluating apps is crucial for improving the quality of information through metrics that measure their strengths and weaknesses5. Usability assessment is essential to ensure acceptance and usefulness before making a product available to users6.
The term heuristic refers to a practical rule used in the early stages of design because it represents an efficient cost‑benefit analysis that, although it does not replace user research, helps identify product issues and reduces the time and cost of later interactive evaluations7-8. Heuristic Evaluation is a simple, low‑cost method that uses experts to identify usability problems based on Nielsen’s principles8-9. Applying it during the development phase can therefore reduce failures and costs8.
In health apps, specific challenges affect usability. The direct‑to‑consumer model often neglects the contribution of clinical informatics specialists, resulting in evaluations based solely on consumers that do not reflect clinical utility or actual usability. Additionally, many developers lack resources for usability studies prior to launch and are pressured to enter the market quickly. Insufficient regulation worsens the problem, exposing consumers to apps with high user ratings but low clinical utility, poor usability, and potential risks10.
Unlike apps focused exclusively on exercise, the Autocuidado Lombar prototype was developed based on a biopsychosocial approach and integrates educational content, biomechanical and breathing exercises, self‑monitoring strategies, and self‑care goals. Moreover, it was specifically designed for healthcare professionals with nonspecific chronic low back pain, a population frequently exposed to physical and occupational overload11. Thus, this study contributes scientifically by describing the heuristic validation process of a digital health technology in occupational health, while also providing practical insights for improving usability and guiding the development of future digital self‑care interventions. Therefore, the objective is to describe the usability validation process of a mobile app prototype for healthcare professionals with nonspecific CLBP.
METHOD
This is a methodological usability validation study with descriptive analysis. The validation was carried out by expert judges based on Jakob Nielsen’s heuristics12, identifying interface problems and proposing improvements. This validation took place in the second version of the prototype, after content validation, aiming to refine the final version. The app was developed based on a systematic literature review (SLR) and a technological prospection of apps (Figure 1).
It followed the stages of the Systematic Instructional Design (SID) - the ADDIE model (analysis, design, development, implementation, and evaluation), which separates conception (analysis, design, and development phases) from execution (implementation and evaluation phases) in a cyclical and continuous process13. The prototype app was developed in 2023 and grounded in a checklist for supporting chronic pain self‑management and in the concepts of Pierre Lévy14-15. The conceptual self‑care model used in the creation of the prototype was structured around two central and complementary axes: the theoretical axis and the methodological axis, both linked to the development of self‑care skills. The theoretical axis supports self‑care through physical, psychological, and social dimensions, reflecting the biopsychosocial nature of low back pain. It also incorporates concepts of collective intelligence, virtualization, cyberspace, and the internet, highlighting the role of digital technologies in supporting care, information exchange, and shared knowledge construction. The methodological axis comprises the stages of analysis, design, development, implementation, and evaluation, characterizing a systematic process of prototype creation and validation. Within this context, the evaluation stage - conducted through heuristic evaluation by specialists - is considered fundamental to the technology validation process. This stage made it possible to identify usability problems, analyze interface adequacy, and propose improvements related to navigation, information organization, content clarity, and user interaction with the app.
The main menu includes education on chronic pain and low back pain, a diary for recording, storing, and tracking pain, brief messages through reminders, goal planning, an exercise plan, and strategies for pain crises, as well as specific guidance on patient positioning and breathing, relaxation, and meditation methods.
The validation took place during November and December 2023, using an intentional non‑probabilistic sample. Participants were selected through the Lattes Platform and a referral chain of potential participants, initially invited by the researchers and later through recommendations from the individuals themselves. The search used the terms “Nielsen’s heuristics” OR “human-computer interaction” and “applications” OR “usability,” considering experience in software engineering, usability, heuristics, or interface design, regardless of academic degree. Although five evaluators can identify between 74% and 87% of usability problems10,16, the study followed the ABNT ISO/IEC 25062:2011 standard, which recommends a minimum sample of eight participants17. Specialists in Human-Computer Interaction and/or Usability were included, while professionals who did not complete the form correctly or did not own Android smartphones were excluded.
The evaluation process took place in two stages: sending an invitation letter by email with information about the study, the Informed Consent Form (ICF), and, after it was signed, a link providing access to the app in Android Application Package (APK) format and to an electronic usability‑evaluation form. The judges assessed the prototype based on Jakob Nielsen’s ten heuristics and on the severity of the problems, suggesting improvements: system visibility (H1), match between the system and the real world (H2), user control and freedom (H3), consistency and standards (H4), error prevention (H5), recognition rather than recall (H6), flexibility and efficiency of use (H7), aesthetic and minimalist design (H8), helping users recognize, diagnose, and recover from errors (H9), and providing help and documentation (H10). Additionally, three heuristics specific to touchscreen devices were incorporated-low human/device interaction (H11), physical interaction and ergonomics (H12), and legibility and layout (H13)-adopted based on methodological recommendations referenced by previous authors and used in the literature17
The data collection instrument was a semi‑structured electronic form created in Google Forms, containing instructions about the validation process and both open and closed questions. The form addressed the professionals’ profiles (academic degree, years since graduation, area of expertise, and scientific production) and usability aspects, such as violated heuristics, severity level, description and location of the problems, as well as suggested solutions. The problems were classified according to the established severity scale: 0 = Not considered a usability problem at all; 1 = Cosmetic problem only: does not need to be fixed unless extra time is available; 2 = Minor usability problem: fixing this issue should have low priority; 3 = Major usability problem: important to fix and should be given high priority; 4 = Usability catastrophe: must be fixed before the product is released12.
Scores closer to 0 indicate a more usable system6. Repeated problems - identified by different evaluators but related to the same interface aspect and the same heuristic - were counted only once in the overall analysis to avoid overestimating the frequency of similar issues. This approach allowed for a more precise and representative interpretation of the findings, without altering the severity classification assigned by the experts.
The validation data were organized in a Microsoft Excel® spreadsheet, with the judges identified as J1 through J8. The analysis included the specialists’ comments and the assessment of heuristic severity. Quantitative data were used to analyze the violated heuristics and the severity of the problems, while the evaluators’ descriptive comments supported the identification and description of usability issues and suggested improvements. A descriptive analysis of frequencies, means, and standard deviation (SD) was performed. The variables were extracted from the data collection instruments: academic degree, years since graduation, years of experience in the field, professional background, purpose of smartphone use, most frequently used device in daily life, and usability‑related items.
The overall severity mean was calculated by summing all scores assigned by the judges, including evaluations marked as “no severity” (0), providing a broad view of severity perception by accounting for those who considered the situation as “no severity.” The weighted severity mean was calculated by summing scores from 1 to 4, excluding zeros, and dividing by the total number of judges who identified the violation. This calculation focuses on the perception of severity among judges who recognized the problem, highlighting areas that require prioritized corrections or interventions. The intensity scale considered was: 0-0.5 (severity 0); 0.6-1.5 (severity 1); 1.6-2.5 (severity 2); 2.6-3.5 (severity 3); and 3.6-4 (severity 4)18.
The study was approved by the Research Ethics Committee of the Federal University of Santa Catarina, in accordance with Resolution No. 466/2012 of the National Health Council.
RESULTS
Eight judges participated in the study, which identified 45 usability problems across the 67 screens of the prototype. The most frequently violated heuristics were “User control and freedom” (H3), with thirteen (28.9%) problems, and “Flexibility and efficiency of use” (H7), with six (13.3%) problems. Catastrophic problems were found in H3 and H9. The least violated heuristics were H1, H8, H9, H10, H12, and H13, with H12 showing no violations.
One participant primarily used a smartphone, while seven preferred a computer. The main purposes for smartphone use included: four (50%) making and receiving calls; seven (87.5%) accessing social media; three (37.5%) using it for games and entertainment; and seven (87.5%) using instant messaging services and for professional purposes.
In sociodemographic terms, 75% of the judges were male and 25% female, with ages ranging from 27 to 52 years; most (87.5%) were between 27 and 40 years old, with a mean age of 35.1 years (SD 7.5). Regarding profession, four (50%) were professors, one (12.5%) was a Control and Automation Engineer, one (12.5%) was a Systems Development Manager, and one (12.5%) was self‑employed (a master’s student in Information Science). In terms of educational background, three (37.5%) held undergraduate degrees, three (37.5%) held master’s degrees, and two (25%) held doctorates. Concerning experience, two professionals (25%) had worked for 1 to 5 years, two (25%) for 6 to 10 years, and four (50%) for more than 10 years. Areas of specialization included: five (62.5%) in Software Engineering, seven (87.5%) in Human-Computer Interaction, five (62.5%) in Nielsen’s Heuristics, four (50%) in Interface Design, and six (75%) in Usability.
The judges’ comments reflected both positive and negative aspects of the prototype. Problems were identified related to navigation, app stability, visual clarity, information organization, error recovery, user support, and accessibility of functions. Usability and personalization improvements were also suggested, including adjustments to navigation flow, inclusion of shortcuts, and enhancement of user support features (Chart 1).
In H2, the judges identified content considered relevant for guiding the user. In heuristic H6, the judges praised the functionality of the “back” arrow, present both in the app and in the Android system, as an efficient navigation feature. In heuristic H8, the judges considered the aesthetics and organization of information appropriate, highlighting a consistent visual identity and a design that avoids overwhelming the user. Despite the extensive list of information in areas such as the “Diary,” the reduced number of mandatory fields simplifies use, minimizing the severity of the issue. Overall, the design was evaluated as functional, pleasant, and balanced between aesthetics and usability (J4, severity 1; J8, severity 0).
Regarding severity, 16 (34.7%) problems were classified as purely aesthetic, 16 (34.7%) as minor problems, eight (17.9%) as major problems, and three (6.5%) as severe problems. Aesthetic and low‑severity issues predominated, while severe problems were less frequent. The overall severity mean was 0.63, and the weighted mean was 1.62 (Table 1). The severity scale, number, and percentage of problems are shown in Figure 2.
The heuristic evaluation made it possible to identify problems related to the adequacy of images and audio, terminology, navigation flow, visual identity, menu organization, error recovery, system feedback, report generation, and user permissions. The most frequent issues involved the absence of shortcuts and return buttons, interaction with non‑actionable elements, and difficulties related to audio, images, and navigation.
The recommendations included inserting animated GIFs into the exercise sections, reviewing audio files with more accessible language, improving biomechanical and breathing training sessions, enhancing navigation flow, adding shortcuts, adjusting report generation, providing feedback at the end of exercises, and strengthening user‑support features. Although the suggestions were considered relevant for improving the prototype, not all could be incorporated at this stage due to funding limitations, development time constraints, and the absence of a new evaluation round after the proposed modifications. Nevertheless, the findings supported recommendations for future versions of the app.
DISCUSSION
The participation of multiprofessional judges represented a strength of the study, as it incorporated different technical and conceptual perspectives. The literature recommends three to five specialists in heuristic evaluations, a number considered sufficient to identify most usability problems10. In addition, the quality of the evaluation depends on the evaluators’ experience in usability, human-computer interaction, and interface design, which favors early identification of problems and reduces costs and rework, especially in the system’s pre‑implementation phase8-9,19.
Most of the problems identified in the usability test were of low severity and cosmetic in nature, resulting in generally positive evaluations. Even so, identifying these issues was essential, as it provided a concrete foundation for improving the tool.
The heuristic evaluation of the Autocuidado Lombar prototype identified problems mainly related to interface clarity, user control, and interaction support, including aspects such as terminology, navigation flow, visual standardization, missing feedback, and menu organization. Despite the diversity of categories involved, the average severity of the problems was considered low, indicating that most issues are easy to correct. The weighted severity (level 2) therefore provides a strategic basis for guiding incremental improvements and prioritizing interventions with greater impact on the user experience.
Visual interface, colors and legibility
The prototype was developed based on the DIS, aiming for a simple and intuitive interface, blue tones, a white background, and essential functionalities with accessible information to encourage behavior changes related to self‑care. However, usability in mobile devices poses challenges due to limitations in screen size, processing, and wireless communication, requiring specific and easy‑to‑use interfaces20-21. The interface layout directly influences user efficiency and experience, and should organize information clearly, with intuitive icons and emphasis on essential content to reduce cognitive load and facilitate understanding20.
The heuristics “Visibility of system status,” “Physical interaction and ergonomics,” and “Legibility and layout” were positively evaluated, indicating accessible buttons, good legibility, and appropriate design. Clear and easy‑to‑learn interfaces improve user experience, satisfaction, retention, and help achieve goals, reinforcing the app’s potential as a self‑care support tool7.
Despite this, problems related to visual standardization were identified, particularly regarding colors and the clarity of some interface elements. The “Consistency and standards” heuristic revealed difficulties associated with color standardization and visual organization. Similar results are described in the literature, which highlights compatibility and standardization as critical aspects of usability. Maintaining consistent patterns of colors, symbols, terminology, content, and layout throughout the system contributes to user familiarity and more predictable interaction10. The lack of color standardization in the Self‑efficacy section was also identified as an issue, reinforcing the importance of a consistent visual identity to reduce cognitive load and increase user confidence22.
Navigation, user control and system organization
The most frequent problems were concentrated in the heuristics “User control and freedom” and “Match between the system and the real world,” corroborating findings in the literature that identify these dimensions as critical in digital health systems, especially when terminology is unfamiliar to users. The match between the system and the real world highlights the importance of leveraging users’ prior knowledge, facilitating learning and recall7,10. The main difficulties involved navigation flow, absence of shortcuts, menu organization, and user control over actions.
In the heuristic “Recognition rather than recall,” problems were detected related to excessive memorization demands and difficulty recognizing available functions. This principle aims to reduce users’ mental and physical effort when interacting with systems, minimizing the need for memory‑based actions to complete tasks16. While recognition depends on visual familiarity, recall requires greater cognitive load. Unclear icons compromise recognition of available actions, increasing mental effort and resulting in confusion, frustration, and task abandonment9. Similarly, in the heuristic “Flexibility and efficiency of use,” the absence of shortcuts was the most frequently cited problem. Studies indicate that shortcuts and quick‑access features increase the speed, accuracy, and efficiency of interaction16. Although less frequent, problems related to “Flexibility and efficiency of use” and “User control and freedom” were considered among the most severe, highlighting the importance of systems that provide user autonomy, reducing cognitive load, errors, and mental and physical effort during task execution22.
In digital health technologies, failures related to navigation, user control, and error recovery can reduce users’ speed, accuracy, and autonomy, increasing cognitive load, errors, and mental and physical effort during system use, ultimately compromising adherence16,22. Although the present study did not assess direct clinical risks, critical usability problems may negatively affect user experience and limit the potential use of the technology in care contexts.
Limitations were also reported regarding report generation and insufficient emphasis on certain functionalities, which may cause confusion among users and hinder proper task completion. This involves implementing help resources within the system, improving instructional guidance, and generating reports that can be shared with healthcare professionals.
Language, feedback and user support
Issues related to the use of technical language in the app were identified. The use of familiar terms facilitates communication and interaction with digital systems, even when the target audience consists of healthcare professionals. Studies advise avoiding excessively complex terminology, regardless of the user profile23. Thus, it is recommended to avoid overly technical language and revise the texts used in the app.
The heuristic “Help users recognize, diagnose, and recover from errors” highlighted the importance of clear mechanisms for preventing and recovering from failures. Usability studies point to recurring difficulties users face in identifying and correcting errors6,22,24. Strategies such as clear labels, removal of ambiguous elements, prevention of duplicate entries, and indication of mandatory fields help avoid errors, guide users, and increase usability and satisfaction with the system22.
The absence of help resources or tutorials was perceived as a gap, although not considered problematic by all judges. The presence of support is important, as its absence may generate doubts and hinder interaction, especially in ambiguous situations16,25. A previous study also identified problems related to the lack of tutorials and system standardization19. In this sense, the inclusion of tutorials, explanatory pop‑ups, and other user‑support mechanisms is recommended.
The inclusion of motivational phrases, reward systems, and gamification elements was identified as a promising strategy to increase engagement. Gamification is widely used in interventions aimed at physical conditioning and the management of chronic diseases, promoting motivation, adherence, and positive interactions7,23. In this regard, improving user feedback can strengthen the connection with the app and encourage continuous use.
Self‑care and monitoring functionalities
Although the heuristic evaluation indicated an excess of information and input fields in the Diary, this functionality was designed to support self‑monitoring of pain and the generation of more comprehensive reports. Digital self‑management tools associated with symptom monitoring have been linked to better health outcomes. Patients who monitored and reflected on their pain, activities, and medication use may have reduced the psychological aspects of chronic pain26. Thus, the aim was to balance the collection of relevant information for monitoring low back pain with the usability of the appl.
This analysis focused on the usability of the app, without assessing its clinical effectiveness. Although usability is essential, effective app for managing low back pain must also promote self‑management and behavior change. mHealth interventions are promising strategies in digital health, capable of supporting self‑management and encouraging healthy habits, despite challenges related to engagement, adherence, and scientific grounding. Therefore, it is recommended that such technologies be simple, personalized, user‑friendly, and evidence‑based27. Moreover, effective technologies for chronic disease self‑management require robust design, rigorous testing, appropriate commercialization strategies, and regulation10.
The distinguishing feature of the prototype lies in the integration of educational resources, biomechanical and breathing exercises, pain self‑monitoring, and self‑care strategies into a single technology aimed at healthcare professionals with nonspecific chronic low back pain. The integration of digital health strategies increases patient engagement and supports active participation in self‑care. Additionally, studies on digital interventions for chronic musculoskeletal conditions highlight the importance of technological tools to support more effective management of these chronic conditions27.
The updating of app must be continuous, involving improvements, corrections, and adaptations to keep pace with constant technological changes. Likewise, the adoption of innovative technologies in healthcare requires not only technical adequacy but also ongoing investment in professional training to ensure their proper and effective use28.
The study’s limitations include the use of different devices by the judges, which may have influenced aspects such as navigation and legibility, although this diversity brings the evaluation closer to real‑world usage conditions. Additionally, the prototype was developed only for Android, and its usability was not assessed with the target audience. Some functionalities not yet implemented, such as the motivational messaging system, also could not be analyzed. The evaluations were conducted individually, in a single round, considering information saturation and practical limitations related to time, resources, and evaluator availability. Finally, the absence of specific funding restricted the implementation of more advanced functionalities in the prototype.
Although the literature recommends three to five specialists for heuristic evaluations9-10, the present study included eight evaluators, expanding the diversity of technical perspectives. As this was a preliminary validation stage conducted by experts, the findings do not fully represent the experience of the target audience in real contexts, reinforcing the need for future studies with end users. The prototype was designed for healthcare professionals with nonspecific chronic low back pain, a group particularly vulnerable to occupational demands related to musculoskeletal pain. It is also noteworthy that the prototype had previously undergone face and semantic validation with end users, whereas this stage focused on heuristic usability evaluation by specialists29.
Furthermore, the prototype shows potential for use in different care contexts. Usability validation is essential to ensure clarity, coherence, and functionality of the technology, whose effectiveness depends on personalization, professional support, and complementary use alongside continuous care. In this context, self‑management app can help reduce the burden of care, reinforcing the importance of simple and easy‑to‑interact digital tools30.
CONCLUSION
The usability evaluation made it possible to identify correctable issues and aspects of the application's interface that can be improved. The judges’ contributions highlighted weaknesses related to navigation, clarity of information, and system interaction, in addition to pointing out relevant suggestions for refining the technology. However, due to funding limitations, development time constraints, and the absence of a new validation stage, the suggested modifications were not incorporated at this phase of the study and remain as recommendations for future versions of the prototype. For subsequent studies, it is recommended to assess usability with end users and to investigate the clinical effects and cost‑effectiveness of the technology. The findings reinforce the relevance of systematic validation processes in the development of digital health technologies, especially in occupational contexts and in supporting self‑care among healthcare professionals with nonspecific chronic low back pain.
ACKNOWLEDGMENT
To the Graduate Program in Nursing at the Universidade Federal de Santa Catarina, and especially to the expert judges, for the valuable contributions offered to improve the mobile application, and to the developers, for the excellent work carried out.
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