Investigating usability of mobile health applications in Bangladesh

Usability evaluation of the Agente Escuta application: translational research

PURPOSE

To evaluate the usability and satisfaction of users with the interface of the 'Agente Escuta' application, in addition to identifying problems and possibilities for improvement.

METHODS

Descriptive exploratory translational study, characterized by a usability test with a quantitative and qualitative approach, subdivided into three stages: (I) prior evaluation of usability by 10 judges, including students, primary care professionals, professors and researchers in Information Technology and Speech Therapy; (II) evaluation of the application by the target audience, that is, community health agents from six municipalities in Rio Grande do Norte; (III) evaluation of the satisfaction of the agents who used the application in their work routine. The System Usability Scale and the Net Promoter Score were used, in addition to a qualitative evaluation of the opinions.

RESULTS

Usability was rated as excellent by judges, regardless of category. In the evaluation by community health agents, usability was considered good and there was no effect of the city of origin. It was found that the perception of the judges and the target audience were different, with a lower score for the participants in the second stage. However, most would give positive publicity to the product. The heuristic with the highest score was ease of memorization and participants in the third stage were interested in continuing to use the tool in practice, even after the end of the study.

CONCLUSION

The Agente Escuta prototype showed good usability and satisfaction and aspects that could be improved in future solutions were identified.

Exploring usability problems of mHealth applications developed for cervical cancer: An empirical study

Objectives

Nowadays, mobile health applications are developed to raise awareness and facilitate screening and treatment of cervical cancer, while a very few studies have been conducted focusing on the measurement and assurance of usability and exploring the acceptable user experience of such applications. Usability issues become a crucial concern for such cervical-cancer-related applications because users with diverse backgrounds in terms of education, information technology literacy, and geographic reasons are required to access those applications. The objective of this research is to evaluate the usability of mobile health applications developed for cervical cancer patients.

Methods

Two evaluation studies were conducted following the expert evaluation and a questionnaire-based user study. A total of four cervical-cancer-related applications that are focusing on the Awareness and Diagnosis theme were selected and each of the applications was evaluated by four usability experts. Then, a user study (n = 80) based on the Goal Question Metric was conducted to reveal the usability problems of four selected applications. Finally, findings of both evaluations were aggregated and analyzed.

Results

Both approaches showed that all applications suffer from several usability problems while "Cervical Cancer Guide" performs better and "Cervical Cancer Tracker" showed the least in performance from the usability perspective. Again, the Goal Question Metric performs noticeably better in assessing the learnability of the applications, while the analytical heuristic evaluation performs better in identifying the issues that cause user annoyance.

Conclusion

The methodology adopted and the usability problems revealed through this study can be well utilized by the information technology professionals or user interface designers for designing, evaluating, and developing the cervical-cancer-related applications with enhanced usability and user experience.

Dr. Smartphone, can you support my trauma? An informatics analysis study of App Store apps for trauma- and stressor-related disorders

Background

Psychological trauma is prevalent in developed countries, with prevalence rates and treatment needs exceeding health system capacity. As telemedicine and out-of-patient care are promoted, there has been an expansion of digital apps to compliment therapeutic stages in psychological trauma. To date there are no reviews that have compared these apps and their clinical utility. This study aims to identify the availability of trauma- and stressor-related mhealth apps, assess their functionality, and review their therapeutic abilities.

Methodology

The authors conducted a systematic search using an iPhone 13 Pro in the Australian IOS App Store to extract trauma- and stressor-related apps that resulted from the search criteria. A cross-adaptation of the Mobile App Rating Scale (MARS) and the Comprehensive App Evaluation Model (CAEM) were used as a framework to produce the mTrauma App Evaluation Conceptual Model and Informatics Framework. App content descriptors were analysed based on their general characteristics, usability, therapeutic focus, clinical utility, data integration. Following an applicability in concordance with psychological trauma-informed delivery.

Results

A total of 234 apps resulting from the search strategy were screened, with 81 apps that met the inclusion criteria. The majority of apps were marketed to 4+ to 17+ years of age, categorised as 'health and fitness', with the highest target markets observed for adolescents, children, parents, clinicians, and clients. A total of 43 apps (53.1%) contained a trauma-informed specified section, and 37 (45.7%) incorporated a section useful to support trauma-related symptoms. A significant number of apps there was an absence of therapeutic utility (in 32 apps (39.5%)). Most apps were supporting post-traumatic stress disorder-informed, cognitive behavioural therapy and eye movement desensitisation and reprocessing. Provision of psychoeducation, courses, guided sessions, trainings, self-reflection/journaling, symptom management and progress tracking were highly present.

Conclusions

Trauma-informed mobile apps are available in the App Store, expanding in its target market reach and usability, with an increase of creative psychotherapies being introduced alongside conventional modalities. However, based on the app descriptors, the scarcity of evidenced-based testimonials and therapeutic applicability remains questionable for clinical validity. Although mhealth tools are marketed as trauma-related, current available apps employ a multifunctional approach to general psychological symptomatology, through to associated comorbid conditions and emphasizes on passive activity. For higher uptake on user engagement, clinical application and validity, trauma-apps require curated specification to fulfil its role as complimentary psychological treatment.

A scale to measure the perceived quality of mHealth by elderly patients with hypertension in China

BACKGROUND

The elderly population in China is growing, with hypertension being the most prevalent chronic disease in older adults. Despite the rapid penetration and efficient management effect of mobile health on hypertension healthcare, elderly patients are often less adopted and continue to use mobile health services. Quality perception significantly affects an individual's satisfaction and continued intention to use mobile health services. The evaluation of the significant factors affecting mobile health quality perception by elderly individuals remains largely unexplored. The aim of this study was to develop and validate an evaluation scale to measure the perceived quality of mobile health applications for hypertension and determine the underlying influencing factors.

METHODS

A cross-sectional survey was conducted between November 2018 and October 2019. A quality evaluation scale with three factors and seven indicators was developed based on the Information Systems Success model. Data was analyzed using structural equations modelling (SEM) and one-way analysis of variance (ANOVA). All tests were two-sided and statistically significant at P < 0.05.

RESULTS

The proposed mobile health application quality evaluation scale from the perspective of the elderly was shown to be a hierarchical, multidimensional construct with valid reliability, convergent validity and discriminant validity, which consists of three factors and seven indicators. The SEM results suggested that information quality and service quality had a significant impact on the satisfaction of elderly individual's with mobile health applications for hypertension management. The results also suggest that the elderly individuals had a low evaluation of mobile medical service quality(4.06 ± 0.70), while the score of information quality was the highest, with an average score of 4.36(SD 0.83) out of 5. Male patients were shown to more readily accept mobile health applications, with their perception of system quality being 0.27 higher than female ones (95% CI 0.00 ~ 0.52; P < .05). Patients with 1-5 years hypertension histories assessed the system (95% CI 0.03 ~ 0.63; P < .05), information (95% CI 0.11 ~ 0.65; P < .05), and service quality (95% CI 0.00 ~ 0.47; P < .05) higher than those with hypertension histories > 10 years. Elderly patients who regularly visited primary hospitals assessed the information quality 0.13 higher (95% CI -0.08 ~ 0.34; P < .05) than those visited tertiary hospitals.

CONCLUSIONS

These findings have significant implications for theoretical and practical research on mobile health application quality evaluation, which will be helpful for policymakers and mobile health providers in improving the context and utilisation of mobile health to include elderly users. More mobile health applications attributes, such as timely information and interactive services that meet the characteristics of elderly patients with different mental and health demands need to be considered. Deeply embedding mobile health into primary health services is recommended to help increase the perceived quality of mobile health, and ensure the continuous use.

Understanding the determinants of adoption of mHealth services among older women’s perspective in Bangladesh

Purpose

The purpose of this study was to explore the factors affecting adoption of mHealth services among the older women in Bangladesh. As this portion of the total population is rapidly increasing in Dhaka City.

Design/methodology/approach

Using the technology acceptance model as a theoretical framework, this study introduces perceived reliability, price value and technology anxiety as new factor reflecting the user’s reliability, beliefs and monetary concerns in the acceptance of mHealth services. A structured survey was conducted to collect the required data from convenience sampling of 271 mHealth end users from Dhaka city in Bangladesh.

Findings

The study confirmed that perceived usefulness, perceived reliability; price value and technology anxiety had a significant impact on mHealth adoption. Ease of use did not influence on the adoption of mHealth services.

Originality/value

To the best of the authors’ knowledge, this study is one of the first to investigate the determinant of mHealth adoption among older Women. Moreover, the insights from this study could benefit mHealth services providers and policymakers in implementing more effective marketing strategies to increase the acceptability of mHealth services.

Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

BACKGROUND

Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited.

OBJECTIVE

The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any.

METHODS

A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records.

RESULTS

In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use.

CONCLUSIONS

The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.

An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample

BACKGROUND

The mental health burden is high and rising among Bangladeshi university students. Understanding barriers to mental healthcare and how barriers impact mental health outcomes may inform the development of targeted interventions to decrease barriers and improve access to care.

AIMS

This study identifies barriers to mental healthcare and their association with mental health outcomes in a Bangladeshi university student sample.

METHODS

We conducted a cross-sectional survey (n = 350) on stigma-related, attitudinal, and instrumental barriers to accessing mental healthcare among Bangladeshi university students. We examined the association between stigma and non-stigma (i.e., attitudinal and instrumental) barriers with four mental health outcomes: suicidal ideation, depression, high perceived stress, and wellness.

RESULTS

Attitudinal barriers were the most reported barriers. Stigma-related barriers were significant for individuals who had experienced suicidal ideation (aOR = 2.97, p = 0.001), not for individuals with depression. Non-stigma-related barriers were significant for individuals who had experienced depression (aOR = 2.80, p = 0.011).

CONCLUSIONS

The current work advances our understanding of how to improve access to mental healthcare among university students in Bangladesh. Stigma-related barriers were particularly salient for individuals who experienced suicidal ideation. Further study is needed on how stigma may impact access to care distinctly for different mental health problems among Bangladeshi university students.

Application of artificial intelligence in medical technologies: A systematic review of main trends

Objective

Artificial intelligence (AI) has been increasingly applied in various fields of science and technology. In line with the current research, medicine involves an increasing number of artificial intelligence technologies. The introduction of rapid AI can lead to positive and negative effects. This is a multilateral analytical literature review aimed at identifying the main branches and trends in the use of using artificial intelligence in medical technologies.

Methods

The total number of literature sources reviewed is n = 89, and they are analyzed based on the literature reporting evidence-based guideline PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for a systematic review.

Results

As a result, from the initially selected 198 references, 155 references were obtained from the databases and the remaining 43 sources were found on open internet as direct links to publications. Finally, 89 literature sources were evaluated after exclusion of unsuitable references based on the duplicated and generalized information without focusing on the users.

Conclusions

This article is identifying the current state of artificial intelligence in medicine and prospects for future use. The findings of this review will be useful for healthcare and AI professionals for improving the circulation and use of medical AI from design to implementation stage.

The Perception of Health Professionals in Bangladesh toward the Digitalization of the Health Sector

Bangladesh is undertaking a major transformation towards digitalization in every sector, and healthcare is no exception. Digitalization of the health sector is expected to improve healthcare services while reducing human effort and ensuring the satisfaction of patients and health professionals. However, for practical and successful digitalization, it is necessary to understand the perceptions of health professionals. Therefore, we conducted a cross-sectional survey in Bangladesh to investigate health professionals' perceptions in relation to various socio-demographic variables such as age, gender, location, profession and institution. We also evaluated their competencies, as digital health-related competencies are required for digitalization. Additionally, we identified major digitalization challenges. Quantitative survey data were analyzed with Python Pandas, and qualitative data were classified using Valence-Aware Dictionary and Sentiment Reasoner (VADER). This study found significant relationships between age χ2(12,N=701)=82.02,p<0.001; location χ2(4,N=701)=18.78,p<0.001; and profession χ2(16,N=701)=71.02,p<0.001; with technical competency. These variables also have similar influences on psychological competency. According to VADER, 88.1% (583/701) of respondents have a positive outlook toward digitalization. The internal consistency of the survey was confirmed by Cronbach's alpha score (0.746). This study assisted in developing a better understanding of how professionals perceive digitalization, categorizes professionals based on competency, and prioritizes the major digitalization challenges.

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran

BACKGROUND

Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL.

METHODS

An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7).

RESULTS

The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL.

CONCLUSION

The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

System Usability Scale Benchmarking for Digital Health Apps: Meta-analysis

Background

The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS was not specifically designed to evaluate mobile apps, or in particular digital health apps (DHAs).

Objective

The aim of this study was to examine whether the widely used SUS distribution for benchmarking (mean 68, SD 12.5) can be used to reliably assess the usability of DHAs.

Methods

A search of the literature was performed using the ACM Digital Library, IEEE Xplore, CORE, PubMed, and Google Scholar databases to identify SUS scores related to the usability of DHAs for meta-analysis. This study included papers that published the SUS scores of the evaluated DHAs from 2011 to 2021 to get a 10-year representation. In total, 117 SUS scores for 114 DHAs were identified. R Studio and the R programming language were used to model the DHA SUS distribution, with a 1-sample, 2-tailed t test used to compare this distribution with the standard SUS distribution.

Results

The mean SUS score when all the collected apps were included was 76.64 (SD 15.12); however, this distribution exhibited asymmetrical skewness (–0.52) and was not normally distributed according to Shapiro-Wilk test (P=.002). The mean SUS score for “physical activity” apps was 83.28 (SD 12.39) and drove the skewness. Hence, the mean SUS score for all collected apps excluding “physical activity” apps was 68.05 (SD 14.05). A 1-sample, 2-tailed t test indicated that this health app SUS distribution was not statistically significantly different from the standard SUS distribution (P=.98).

Conclusions

This study concludes that the SUS and the widely accepted benchmark of a mean SUS score of 68 (SD 12.5) are suitable for evaluating the usability of DHAs. We speculate as to why physical activity apps received higher SUS scores than expected. A template for reporting mean SUS scores to facilitate meta-analysis is proposed, together with future work that could be done to further examine the SUS benchmark scores for DHAs.

Revisiting health promotion settings: An innovative model from Sri Lanka to integrate healthy settings using mHealth

The health promotion settings approach has been recognised as an effective method of health promotion in the recent era, and mobile health (mHealth) is a highly evolving field in the health sector. The health promotion settings are shifting the focus away from the individuals and moving towards a more holistic model of health promotion. We identified five settings in Sri Lanka to promote a mHealth model, including villages, schools, preschools, workplaces, and hospitals. The specified model using mHealth helps monitor the activities at various levels of healthcare, including regional, district and national levels. The model also maps the location of the healthy settings, which provide a visual picture to the policymakers, helpful in planning and decision-making.

Evaluation of community health worker's performance at home-based newborn assessment supported by mHealth in rural Bangladesh

BACKGROUND

In low to middle-income countries where home births are common and neonatal postnatal care is limited, community health worker (CHW) home visits can extend the capability of health systems to reach vulnerable newborns in the postnatal period. CHW assessment of newborn danger signs supported by mHealth have the potential to improve the quality of danger sign assessments and reduce CHW training requirements. We aim to estimate the validity (sensitivity, specificity, positive and negative predictive value) of CHW assessment of newborn infants aided by mHealth compared to physician assessment.

METHODS

In this prospective study, ten CHWs received five days of theoretical and hands-on training on the physical assessment of newborns including ten danger signs. CHWs assessed 273 newborn infants for danger signs within 48 h of birth and then consecutively for three days. A physician repeated 20% (n = 148) of the assessments conducted by CHWs. Both CHWs and the physician evaluated newborns for ten danger signs and decided on referral. We used the physician's danger sign identification and referral decision as the gold standard to validate CHWs' identification of danger signs and referral decisions.

RESULTS

The referrals made by the CHWs had high sensitivity (93.3%), specificity (96.2%), and almost perfect agreement (K = 0.80) with the referrals made by the physician. CHW identification of all the danger signs except hypothermia showed moderate to high sensitivity (66.7-100%) compared to physician assessments. All the danger signs assessments except hypothermia showed moderate to high positive predictive value (PPV) (50-100%) and excellent negative predictive value (NPV) (99-100%). Specificity was high (99-100%) for all ten danger signs.

CONCLUSION

CHW's identification of neonatal danger signs aided by mHealth showed moderate to high validity in comparison to physician assessments. mHealth platforms may reduce CHW training requirements and while maintaining quality CHW physical assessment performance extending the ability of health systems to provide neonatal postnatal care in low-resource communities.

TRIAL REGISTRATION

clinicaltrials.gov NCT03933423 , January 05, 2019.

Factors Affecting the Perceived Usability of the COVID-19 Contact-Tracing Application "Thai Chana" during the Early COVID-19 Omicron Period

Thai Chana is one of the mobile applications for COVID-19 disease-control tracking, especially among the Thais. The purpose of this study was to determine factors affecting the perceived usability of Thai Chana by integrating protection motivation theory, the extended technology acceptance model, and the system usability scale. In all, 800 Thais participated and filled an online questionnaire with 56 questions during the early COVID-19 omicron period (15 December 2021 to 14 January 2022). Structural equation modeling (SEM) showed that the understanding of COVID-19 has significant effects on perceived severity and perceived vulnerability, which subsequently leads to perceived usefulness. In addition, perceived usefulness and perceived ease of use have significant direct effects on attitude, which subsequently leads to the intention to use, actual use, and perceived usability. This study is one of the first studies that have analyzed the mobile application for COVID-19 disease-control tracking. The significant and substantial findings can be used for a theoretical foundation, particularly in designing a new mobile application for disease-control tracking worldwide. Finally, protection motivation theory, the extended technology acceptance model, and the system usability scale can be used for evaluating other disease-control tracking mobile applications worldwide.

Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study

Background

Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low.

Objective

The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH.

Methods

This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH.

Results

Social influence (adjusted odds ratio [aOR] 1.68, 95% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non–stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95% CI 1.10-3.80; P=.02).

Conclusions

Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health.

Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality

Background

Cardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption.

Objective

The aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors.

Methods

The knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion.

Results

This app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits.

Conclusions

The app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies.

Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications

Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies.

Aliviado Mobile App for Hospice Providers: A Usability Study

CONTEXT

Evaluation of usability and mobile health content is critical for ensuring effective implementation of technology utilizing interventions tailored to the needs of hospice care providers for people living with dementia in community-based settings.

OBJECTIVES

To evaluate the usability, content, and "readiness to launch" of the Aliviado mobile health app for interdisciplinary team members participating in the Hospice Advanced Dementia Symptom Management and Quality of Life.

METHODS

Usability of the Aliviado app was assessed in 86 respondents with an adapted IBM Computer Usability Satisfaction Questionnaire following Hospice Advanced Dementia Symptom Management and Quality of Life training and implementation of the mobile app.

RESULTS

More than half of users receiving training employed the mobile app in practice. Users reported use as: Daily-6.3%, Weekly-39.6%, monthly-54.2%. The highest measured attributes were usefulness, value, and effectiveness. Over 90% deemed the app "ready to launch" with no or minimal problems.

CONCLUSION

This study shows that a newly-developed mobile app is usable and can be successfully adopted for care of people living with dementia.

Understanding the sociodemographic factors associated with intention to receive SMS messages for health information in a rural area of Bangladesh

Background

The use of digital interventions for managing chronic diseases is significantly increasing. The aim of this study was to estimate the proportion of ownership of a mobile phone, and factors associated with the ability to read and access SMS delivered health information, and willingness to pay for it among people with hypertension in a rural area in Bangladesh.

Methods

Data were collected from 307 participants aged 30 to 75 years with hypertension from a rural area in Bangladesh from December 2020 to January 2021. Outcome measures included ownership of a mobile phone, ability to read SMS, willingness to receive and pay for health information by SMS. Associated factors included age, gender, level of education, occupation, and socioeconomic status. We used regression analysis to identify variables associated with the outcome variables.

Results

Overall, 189 (61.6%) people owned a mobile phone which was higher in men (73.3% vs. 50%, p < 0.001), younger people (82.6% aged 30–39 years vs. 53.5% aged 60–75 years, p < 0.001). Of the total participants, 207 (67.4%) were willing to receive SMS, and 155 (50.5%) were willing to pay for receiving SMS for health information. The prevalence was significantly higher among professionals (odds ratio (OR), 95% confidence interval (CI): 4.58, 1.73–12.1) and businesspersons (OR 3.68, 95% CI 1.49–9.10) compared to farmers, respectively. The median (interquartile range [IQR]) of willingness to pay for health information SMS was 10 (28) Bangladesh Taka (BDT) (1 BDT ~ 0.013 US$), and there were no specific factors that were associated with the willingness of any higher amounts of payment. In terms of reading SMS of people who own a mobile, less than half could read SMS. The proportion of people who could read SMS was significantly higher among men, younger people, educated people, middle class or rich people, professionals or businesspersons. Of people who could read SMS, the majority read SMS occasionally.

Conclusion

A significant proportion of people are unable to read SMS. However, people are willing to receive and pay to receive SMS for health information. Education and awareness programs should be conducted among targeted groups, including people with low education and women.

Evaluating the Usability of mHealth Applications on Type 2 Diabetes Mellitus Using Various MCDM Methods

The recent developments in the IT world have brought several changes in the medical industry. This research work focuses on few mHealth applications that work on the management of type 2 diabetes mellitus (T2DM) by the patients on their own. Looking into the present doctor-to-patient ratio in our country (1:1700 as per a Times of India report in 2021), it is very essential to develop self-management mHealth applications. Thus, there is a need to ensure simple and user-friendly mHealth applications to improve customer satisfaction. The goal of this study is to assess and appraise the usability and effectiveness of existing T2DM-focused mHealth applications. TOPSIS, VIKOR, and PROMETHEE II are three multi-criteria decision-making (MCDM) approaches considered in the proposed work for the evaluation of the usability of five existing T2DM mHealth applications, which include Glucose Buddy, mySugr, Diabetes: M, Blood Glucose Tracker, and OneTouch Reveal. The methodology used in the research work is a questionnaire-based evaluation that focuses on certain attributes and sub-attributes, identified based on the features of mHealth applications. CRITIC methodology is used for obtaining the attribute weights, which give the priority of the attributes. The resulting analysis signifies our proposed research by ranking the mHealth applications based on usability and customer satisfaction.

Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review

BACKGROUND AND AIMS

Patients after transplantation need medical management for the rest of their lives, and self-management seems to lead to greater adherence to medical standards, improve early physical changes, and increase patient empowerment. The main objective of this article is to systematic review of the consideration to mobile health applications (m-Health apps) used in transplantation.

METHODS

A systematic search was conducted MEDLINE (through PubMed), Web of Science, Scopus, and Science Direct from inception to November 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this study. Comprehensive research was carried out using a combination of keywords and MeSH terms associated with m-Health, empowerment, self-management, and transplantation. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included posttransplant care and mobile phone-based applications to support self-management and self-care. Also, thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, systematic reviews, or meta-analysis were excluded.

RESULTS

We divided all the reviewed articles into four categories, self-management (medication adherence, adherence to medical regimen, and remote monitoring), evaluation, interaction, and interface; 37.5% of the studies were focused on lung transplantation. In 56.25% of the studies, medication adherence was considered because one of the main reasons for the rejection and graft loss is stated medication nonadherence. Also, 62.5% of the studies demonstrated that the use of m-health improved medication adherence and self-management in transplantation.

CONCLUSIONS

The use of m-Health apps interventions to self-management after transplantation has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. We found that m-Health solutions can help the patient in self-management in many ways after transplantation.

Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers

BACKGROUND

Understanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.

OBJECTIVES

This formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.

DESIGN

A qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.

SETTING

The study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.

PARTICIPANTS

A total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30-70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.

RESULTS

The respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient's essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient's details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2-3 times/week) preferably in the morning or evening.

CONCLUSIONS

We found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.

A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach

BACKGROUND

Antibiotic misuse is a serious public health problem worldwide. National health authorities release clinical practice guidelines (CPGs) to guide general practitioners (GPs) in their choice of antibiotics. However, despite the large-scale dissemination of CPGs, GPs continue to prescribe antibiotics that are not recommended as first-line treatments. This nonadherence to recommendations may be due to GPs misunderstanding the CPGs. A web interface displaying antibiotic prescription recommendations and their justifications could help to improve the comprehensibility and readability of CPGs, thereby increasing the adoption of recommendations regarding antibiotic treatment.

OBJECTIVE

This study aims to design and evaluate a web interface for antibiotic prescription displaying both the recommended antibiotics and their justifications in the form of antibiotic properties.

METHODS

A web interface was designed according to the same principles as e-commerce interfaces and was assessed by 117 GPs. These GPs were asked to answer 17 questions relating to the usefulness, user-friendliness, and comprehensibility and readability of the interface, and their satisfaction with it. Responses were recorded on a 4-point Likert scale (ranging from "absolutely disagree" to "absolutely agree"). At the end of the evaluation, the GPs were allowed to provide optional, additional free comments.

RESULTS

The antibiotic prescription web interface consists of three main sections: a clinical summary section, a filter section, and a recommended antibiotics section. The majority of GPs appreciated the clinical summary (90/117, 76.9%) and filter (98/117, 83.8%) sections, whereas 48.7% (57/117) of them reported difficulty reading some of the icons in the recommended antibiotics section. Overall, 82.9% (97/117) of GPs found the display of drug properties useful, and 65.8% (77/117) reported that the web interface improved their understanding of CPG recommendations.

CONCLUSIONS

The web interface displaying antibiotic recommendations and their properties can help doctors understand the rationale underlying CPG recommendations regarding antibiotic treatment, but further improvements are required before its implementation into a clinical decision support system.

Factors influencing mHealth adoption and its impact on mental well-being during COVID-19 pandemic: A SEM-ANN approach

The objectives of this study are to examine the factors affecting the intention and actual usage behavior on mHealth adoption, investigate the effect of actual usage behavior of mHealth on mental well-being of the end-users, and investigate the moderating role of self-quarantine on the intention–actual usage of mHealth under the coronavirus disease (COVID-19) pandemic situation. The required primary data were gathered from the end-users of mHealth in Bangladesh. Using the Unified Theory of Acceptance and Use of Technology (UTAUT2), this study has confirmed that performance expectancy, effort expectancy, social influence, hedonic motivation, and facilitating conditions have a positive influence on behavioral intention whereas health consciousness has an impact on both intention and actual usage behavior. mHealth usage behavior has an affirmative and meaningful effect on the mental well-being of the service users. Moreover, self-quarantine has strong influence on actual usage behavior but does not moderate the intention-behavior relationship. In addition, due to the existence of a non-linearity problem in the data set, the Artificial Neural Network (ANN) approach was engaged to sort out relatively significant predictors acquired from Structural Equation Modeling (SEM). However, this study contributes to the emergent mHealth literature by revealing how the use of the mHealth services elevates the quality of patients' mental well-being under this pandemic situation.

Consumer side economic perception of telemedicine during COVID-19 era: A survey on Bangladesh's perspective

In Bangladesh, the telemedicine industry is one of the few industries able to flourish in the contemporary era of COVID-19. But to thrive, the industry must know the viewpoints of both consumers (those who are interested in availing the services of the industry) and non-consumers to overcome deficits. This should be done to maximize profits and give optimal utility to users so that the industry can be made sustainable in the long run. The main aim of this paper is to analyze the economic perception of both the telemedicine consumers and non-consumers of Bangladesh and the actions required to be taken to optimize them. A survey was developed with 18 questions divided into several parts relating to the health identity of the respondent, the respondents' use of telemedicine, the analysis of the economic behaviors of the respondents with regards to telemedicine, and the consumer perception of the merits and demerits of telemedicine. The survey results show that about one-third has used some form of telemedicine during the COVID-19 pandemic. Among the telemedicine users, 48% used hospital-mandated telemedicine services whereas 41% used mobile telemedicine applications. The survey states that 75% were satisfied with the service they received. The average payment made by the respondent population was 532 Taka, and 62% of them thought that the amount they paid was justified. In conclusion, the results of this survey can be utilized in making economically viable telemedicine models that will give optimal utility to its consumers and help forecast the next stage of the industry for betterment in the health sector.

Towards Deriving Freight Traffic Measures from Truck Movement Data for State Road Planning: A Proposed System Framework

To make the right decisions on investments, operations, and policies in the public road sector, decision makers need knowledge about traffic measures of trucks, such as average travel time and the frequency of trips among geographical zones. Private logistics companies daily collect a large amount of freight global positioning system (GPS) and shipment data. Processing such data can provide public decision makers with detailed freight traffic measures, which are necessary for making different planning decisions. The present paper proposes a system framework to be used in the research project “A new system for sharing data between logistics companies and public infrastructure authorities: improving infrastructure while maintaining competitive advantage”. Previous studies ignored the fact that the primary step for delivering valuable and usable data processing systems is to consider the final user’s needs when developing the system framework. Unlike existing studies, this paper develops the system framework through applying a user-centred design approach combining three main steps. The first step is to identify the specific traffic measures that satisfy the public decision makers’ planning needs. The second step aims to identify the different types of freight data required as inputs to the data processing system, while the third step illustrates the procedures needed to process the shared freight data. To do so, the current work employs methods of literature review and users’ need identification in applying a user-centralized approach. In addition, we develop a systematic assessment of the coverage and sufficiency of the currently acquired data. Finally, we illustrate the detailed functionality of the data processing system and provide an application case to illustrate its procedures.

A Review on the Mobile Applications Developed for COVID-19: An Exploratory Analysis

The objective of this research is to explore the existing mobile applications developed for the COVID-19 pandemic. To obtain this research objective, firstly the related applications were selected through the systematic search technique in the popular application stores. Secondly, data related to the app objectives, functionalities provided by the app, user ratings, and user reviews were extracted. Thirdly, the extracted data were analyzed through the affinity diagram, noticing-collecting-thinking, and descriptive analysis. As outcomes, the review provides a state-of-the-art view of mobile apps developed for COVID-19 by revealing nine functionalities or features. It revealed ten factors related to information systems design characteristics that can guide future app design. The review outcome highlights the need for new development and further refinement of the existing applications considering not only the revealed objectives and their associated functionalities, but also revealed design characteristics such as reliability, performance, usefulness, supportive, security, privacy, flexibility, responsiveness, ease of use, and cultural sensitivity.

A Systematic Review of the Digital Interventions for Fighting COVID-19: The Bangladesh Perspective

The objective of this paper is to synthesize the digital interventions initiatives to fight against COVID-19 in Bangladesh and compare with other countries. In order to obtain our research objective, we conducted a systematic review of the online content. We first reviewed the digital interventions that have been used to fight against COVID-19 across the globe. We then reviewed the initiatives that have been taken place in Bangladesh. Thereafter, we present a comparative analysis between the initiatives taken in Bangladesh and the other countries. Our findings show that while Bangladesh is capable to take benefits of the digital intervention approaches, tighter cooperation between government and private organizations as well as universities would be needed to get the most benefits. Furthermore, the government needs to make sure that the privacy of its citizens are protected.