Usability of Commercially Available Mobile Applications for Diverse Patients

Journal of General Internal Medicine, Jul 2016

BACKGROUND Mobile applications or ‘apps’ intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications. OBJECTIVE The objective of this study was to investigate the usability of existing mobile health applications (“apps”) for diabetes, depression, and caregiving, in order to facilitate development and tailoring of patient-facing apps for diverse populations. DESIGN Usability testing, a mixed-methods approach that includes interviewing and direct observation of participant technology use, was conducted with participants (n = 9 caregivers; n = 10 patients with depression; and n = 10 patients with diabetes) on a total of 11 of the most popular health apps (four diabetes apps, four depression apps, and three caregiver apps) on both iPad and Android tablets. PARTICIPANTS The participants were diverse: 15 (58 %) African Americans, seven (27 %) Whites, two (8 %) Asians, two (8 %) Latinos with either diabetes, depression, or who were caregivers. MAIN MEASURES Participants were given condition-specific tasks, such as entering a blood glucose value into a diabetes app. Participant interviews were video recorded and were coded using standard methods to evaluate attempts and completions of tasks. We performed inductive coding of participant comments to identify emergent themes. KEY RESULTS Participants completed 79 of 185 (43 %) tasks across 11 apps without assistance. Three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management. CONCLUSIONS App developers should employ participatory design strategies in order to have an impact on chronic conditions such as diabetes and depression that disproportionately affect vulnerable populations. While patients express interest in using technologies for self-management, current tools are not consistently usable for diverse patients.

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Usability of Commercially Available Mobile Applications for Diverse Patients

Usability of Commercially Available Mobile Applications for Diverse Patients Urmimala Sarkar 1 2 8 9 10 Gato I. Gourley 10 Courtney R. Lyles 1 2 8 9 10 Lina Tieu 1 2 8 9 10 Cassidy Clarity 1 2 8 9 10 Lisa Newmark 0 7 10 Karandeep Singh 10 David W. Bates 10 0 Information Systems, Partners HealthCare System , Wellesley, MA , USA 1 DGIM at SFGH , San Francisco, CA , USA 2 Center for Vulnerable Populations at San Francisco General Hospital, University of California , San Francisco, CA , USA 3 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health , Boston, MA , USA 4 Harvard Medical School , Boston, MA , USA 5 Division of General Internal Medicine, Brigham and Women's Hospital , Boston, MA , USA 6 Department of Learning Health Sciences, University of Michigan Medical School , Ann Arbor, MI , USA 7 Candidate for BA in Public Health and Molecular Cell Biology 2016, University of California , Berkeley, CA , USA 8 Research Assistant, Division of General Internal Medicine, Brigham and Women's Hospital , Boston, MA , USA 9 Candidate for BS in Chemistry 2016, San Francisco State University , CA , USA 10 Contributors: Contributions to this paper were made by Juan Castillo 11 Department of Internal Medicine, University of Washington , WA , USA 12 A.B. Harvard University, San Francisco Department of Public Health 13 Candidate for BA in Public Health 2017, University of California , Berkeley, CA , USA BACKGROUND: Mobile applications or 'apps' intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for lowincome, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications. OBJECTIVE: The objective of this study was to investigate the usability of existing mobile health applications (“apps”) for diabetes, depression, and caregiving, in order to facilitate development and tailoring of patient-facing apps for diverse populations. DESIGN: Usability testing, a mixed-methods approach that includes interviewing and direct observation of participant technology use, was conducted with participants (n = 9 caregivers; n = 10 patients with depression; and n = 10 patients with diabetes) on a total of 11 of the most popular health apps (four diabetes apps, four depression apps, and three caregiver apps) on both iPad and Android tablets. PARTICIPANTS: The participants were diverse: 15 (58 %) African Americans, seven (27 %) Whites, two (8 %) Asians, two (8 %) Latinos with either diabetes, depression, or who were caregivers. MAIN MEASURES: Participants were given conditionspecific tasks, such as entering a blood glucose value into a diabetes app. Participant interviews were video recorded and were coded using standard methods to evaluate attempts and completions of tasks. We performed inductive coding of participant comments to identify emergent themes. KEY RESULTS: Participants completed 79 of 185 (43 %) tasks across 11 apps without assistance. Three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management. informatics; computers; handheld; chronic diseases; patient engagement; J Gen Intern Med 31(12); 1417-26 DOI; 10; 1007/s11606-016-3771-6 © Society of General Internal Medicine 2016 INTRODUCTION Mobile technology applications, or “apps,” have been widely promoted as a strategy to improve health through enhanced self-management of chronic conditions for patients and families.1 There is a movement toward harnessing patient-generated data through apps to track personalized trends in health behaviors such as diet, exercise, medication adherence, or other healthcare-related tasks in order to improve daily behaviors and ultimately health outcomes.2 Healthcare systems are becoming increasingly interested in using apps to integrate patient-generated data such as home blood glucose or blood pressure, into the electronic health record, in order to improve treatment plans.3 Most importantly, patients, including lowincome and non-English speaking populations, perceive that mobile technology could help with self-management.4 Many have suggested that mobile technology has potential to reduce health disparities.5–7 There is evidence that racial/ ethnic minorities in the US are just as likely as whites to use mobile phones and smartphones.8–10 Additionally, smartphone use is increasing among low-income populations.11,12 Therefore, even though many low-income chronic disease patients do not have access to these technologies today, developing effective self-management support tools on mobile platforms is still critical, because we expect their use to continue to expand. Experts have suggested that because mobile technology is ubiquitous, apps can lower barriers to engaging in positive health behaviors and (...truncated)


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Urmimala Sarkar MD, MPH, Gato I. Gourley MSc, Courtney R. Lyles PhD, Lina Tieu MPH, Cassidy Clarity BA, Lisa Newmark BA, Karandeep Singh MD, MMSc, David W. Bates MD, MSc. Usability of Commercially Available Mobile Applications for Diverse Patients, Journal of General Internal Medicine, 2016, pp. 1417-1426, Volume 31, Issue 12, DOI: 10.1007/s11606-016-3771-6