To develop and test the ePRO tool, we have drawn on the principles of design research, which suggest an iterative approach where designs are progressively adjusted and refined based on emerging design principles, evolving needs, and end-user feedback. We iteratively engaged in end-user codevelopment of the tool through a mutliphased approach:

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• Phase 1: Needs Assessment - We conducted a user-needs assessment in which focus groups were conducted with patients and caregivers, as well as interviews with content experts and providers. Findings were published in 2015. 

• Phase 2: Tool Development - We used findings from Phase 1 to develop a prototype, which was tested with three working groups: (1) patient and caregiver working group, (2) primary health care provider working group, and (3)
  expert and research team working group. The working groups assessed the feasibility and usability of the first prototype, and another round of redesign was conducted based on user and expert feedback.

• Phase 3: Usability Pilot -  We conducted a usability pilot to determine the utility, functionality, and usability of the ePRO tool. Findings from this study informed further modification to the tool to improve usability. 

• Phase 4: Exploratory Trial - We conducted exploratory trials to uncover determinants (or mechanisms) to inform content theory that underpins this complex intervention before designing our full evaluation plan.

• Phase 5: Full Evaluation, Scale, and Spread - Phase 5 full evaluation is done data collection and undergoing analysis.

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