<![CDATA[Background: Expert appraisal can identify issues before digital health systems are evaluated with intended users. However, less attention is given to how expert feedback is translated into subsequent design decisions. Objective: This study examined how multidisciplinary expert appraisal informed design decisions for a user-centered digital tuberculosis treatment support and monitoring system before field evaluation. Methods: Five purposively selected experts representing information technology, public health, tuberculosis program management, and frontline tuberculosis care appraised an alpha prototype using a 26-item structured evaluation form and open-ended feedback. Ratings were analyzed descriptively, and expert feedback was synthesized into design issues and traced to documented design decisions and implementation status. Development dispositions were organized as Retain, Refine, Defer, or Field-test. Results: The prototype received favorable appraisal, with an overall mean score of 4.63/5 and domain means ranging from 4.56 to 4.72. Despite these ratings, experts identified concerns related to medication-documentation integrity, information quality, privacy, accessibility, programmatic alignment, interoperability, monitoring, and implementation readiness. Core user-informed functions were largely retained, while actionable concerns prompted targeted refinements, including direct camera capture, privacy-sensitive photo guidance, interface-readability improvements, and refinement of monitoring information. Other recommendations were deferred or partially implemented, while questions concerning limited digital ability and context-dependent conditions were carried forward for field evaluation. Conclusion: Multidisciplinary expert appraisal supported selective refinement rather than fundamental redesign and identified design considerations not apparent from favorable ratings alone. Expert appraisal may therefore serve as a complementary checkpoint between user-centered development and field evaluation, distinguishing actionable refinements from issues requiring further development or evaluation with intended users.]]>
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