MHealth consumer apps: the case for user-centered design

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This page is a review of the Mc Curdie et al.,Fall 2012, article named: mHealth consumer applications:The case for user-centered design. mHealth applications or "apps" presents an opportunity to improve healthcare delivery and clinical outcomes.[1]

Introduction

The ability to monitor patients remotely will enable patient risk-factor management and improve treatment compliance which will facilitate early detection of medical complications and ultimately preventing unnecessary hospitalizations.[2] At a consumer health domain, this allows patients to actively engage in and self manage their condition.[3] This also allows design of timely interventions based on user behavior and produce cognitive(Interface Design for Health Care Environments: The Role of Cognitive Science),behavioral,emotional,and social health-oriented responses [3] for conditions dependent on user-behavioral change, such as those related to smoking, obesity, diabetes,and other chronic conditions.

Despite the potential benefits, pilot studies have showed mixed responses as consumers do not use apps which do not engage them. [4]

Currently, many eHealth and mHealth interventions are based on the basis of the existing health care system and these do not compare with those that involved end users in the design process.[5] The resulting systems may lack key features.[6] For this reason, there is a need for user centered design(UCD) process which plays a important role in achieving user engagement, thus increasing the chances of the effectiveness of the intervention. World Health Organization(WHO) agrees by advising that user evaluation be incorporated to ensure effective outcomes.[7] All the data from the mobile devices should be integrated with the EMR for better health care. This link has more information about this(Development of mobile platform integrated with existing electronic medical records).

Engaging users to produce effective mHealth apps

UCD involves consideration of the user at every stage of the design process. Iterative cycles of prototyping and user testing lead to improved ease of use and adoption by the end users[8]

UCD process begins at the concept generation stage. A thorough investigation of user needs is conducted to understand the intended use and goal of the mHealth application. Human factors research techniques such as ethnography, focus group discussions, and one-to-one interviews contribute to the user needs assessment. Other important factors to consider are the environment in which the application will be used, potential cognitive biases, and the groups communication style.[1]

After this initial investigation of user needs is complete, the next step is to translate these into a set of functional requirements and design guidelines. There are several ways to accomplish this. One is bottom-up thematic analysis-an iterative exploratory process of analysis of user data transcripts from interviews or focus group discussions, where text segments are coded for potential themes.[9] [10] [11] [12] This is also known as 'open coding'.[13] As the coding framework develops, transcripts are re-analyzed in view of new or emerging themes. Major themes that are relevant to the software system goals are derived. These concrete themes are then used to inform the app development through derivation of specific design principles.[1]

Initial prototypes can be simple sketches and wire frames which help to elicit feedback and lead to a deeper understanding of the intended goal of this application.[1] As the design cycle progresses, designs are evaluated and refined iteratively with users by usability testing- Think aloud or alternatively in the users' natural environment[14] by using remote data techniques such as automated usage data transfer or video. In the later design stages, users are asked to perform realistic tasks with working prototypes.[1]

Case studies of user-centered design in mHealth

A Diabetes self-management app for adolescents

One of the most prevalent chronic conditions requiring intensive self-management is type 1 diabetes involving adolescents. As smart phone technology appeals to this group, UCD can be used to develop a mHealth app to keep the young patients consistently engaged in their self-care. Mc Cardie et al. developed an app, designed for this patient group,called BANT. The early design stage of BANT involved conducting qualitatively interviews with the adolescents and their parents as well as focus group sessions with their clinical teams. One of the themes that emerged was the need for fast and discrete transactions so that adolescents can avoid social embarrassment. It would have been difficult to derive this requirement without having user involvement in the design process. Another requirement was the need for sustained user engagement with the app through rewards and incentives in the form of music and apps through iTunes store. This elicited positive health behavior in this group with minimum intervention from the care providers.[1]

A Heart Health Promotion App

Heart disease and stroke remain the leading cause of death and disability worldwide. The present online interventions are too clinically focused, and inaccessible to those who are not heart-health conscious. Thus, there is a need to empower consumers to address potential risk factors in their life style, and ultimately manage their heart health. Mc Cardie et al. developed an app named '<30 days'. The initial mobile-based prototype for this was developed and usability tested. The language used throughout the app was kept informal, brief, and accessible plus the design theme was bright and playful. The development of this mobile app was still underway(as of their article's publishment in 2012, but the early results showed that employment of UCD technologies is effective in creating an engaging and effective mHealth application.[1]

An Asthma Self-Management App

Asthma is one of the most common diseases in the world. Self-management again is a key element in maintaining asthma control for better health outcomes. Mc Cardie et al. were in the process of developing an app to suit this. They used user interviews which revealed that the fun tone used for the '<30 days'app was not well received by this group. Without user feedback, this may not have become apparent until after the app was released to the public. Prototypes of this app were being involved(as of fall 2012), and will be refined through feedback gathered during usability testing. This is key to end user adoption.[1]

Comments

Mc Cardie et al. did a study about mHealth consumer apps and the need for user interface design to accomplish that. More research has been done since and numerous technologies are coming out rapidly which all but effectively increase the mHealth domain and its utility to the consumers. I agree with Mc Cardie et al. when they said that more research needs to be done into the future. They published about three studies and indicated in depth as to what is needed in those domains and how to proceed with the usability analysis to produce user friendly mobile apps which enhance their health care and decreases the need for the involvement of the health care provider. [1]

Conclusion

User engagement can identify a number of key system requirements. The implementation of a UCD process is critical in ensuring user engagement, and consequently the app effectiveness in terms of sustained behavioral change in the users. The benefits of utilizing UCD in the domain of mHealth have been recognized. [1]

At present, medical devices, softwares, and other technologies go through a rigorous process of user needs assessment, iterative design cycles, and usability evaluations.[1] FDA mandated utilization of human factors design and evaluation practices for a wide range of medical technologies.[15] Furthermore, AHRQ [1]has recommended that usability becomes part of the certification test for EHRs. Continued research on the effectiveness of UCD in the domain of mHealth is warranted. [1]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 mHealth Consumer Apps: The Case for User-Centered Design.McCurdie, Tara; Taneva, Svetlena; Casselman, MarkView Profile; Yeung, Melanie; McDaniel, Cassie; et al. Biomedical Instrumentation & Technology, suppl. Horizons46.2 (Fall 2012): 49-56. search.proquest.com.ezproxyhost.library.tmc.edu/docview/1130656706?pq-origsite=summon
  2. Dobkin BH, Dorsch A.The Promise of mHealth:Daily Activity Monitoring and Outcome Assessments by Wearable Sensors.Neurorehab Neural Repair.2011;25(9):788-798/
  3. 3.0 3.1 Handel MJ. mHealth-Using Apps for Health and Wellness. Explore 2011; 7(4):256-261
  4. Chomutare T et al. Features of Mobile Diabetes Applications: Review of the Literature and Analysis of Current Applications Compared Against Evidence-Based Guidelines. J Med Int Res. 2011; 13(3):e65
  5. Verhoeven F et al. Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review. J Diabetes Sci Technol. 2010; 4(3):666-684
  6. Cafazzo JA et al. The User-Centered Approach in the Development of a Complex Hospital-at- Home Intervention. Studies in Health Tech and Informatics. 2009; 143:328-33
  7. WHO. mHealth: New Horizons for Health Through Mobile Technologies. Geneva, Switzerland: World Health Organization; 2011
  8. Mao J-Y, Vredenburg K, Smith PW, Carey T. The State of User-Centered Design Practice. Com ACM. 2005; 48(3):105-109
  9. Cafazzo JA et al. The User-Centered Approach in the Development of a Complex Hospital-at- Home Intervention. Studies in Health Tech and Informatics. 2009; 143:328-33
  10. Padgett D. Qualitative Methods in Social Work Research: Challenges and Rewards. Thousand Oaks, CA: Sage Publications; 1998
  11. Boyatzis R. Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks, CA: Sage Publications; 1998
  12. Braun V, Clarke V. Using Thematic Analysis in Psychology. Qualitative Res Psych. 2006; 3(2):77-101
  13. Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, CA: Sage Publications; 1990
  14. Preece J et al. Human-Computer Interaction. Reading, MA: Addison-Wesley; 1994
  15. FDA. Human Factors (Medical Devices)-Human Factors Implications of the New GMP Rule. Overall Requirements of the New Quality System Regulation. Center for Devices and Radiological Health, U.S. Food and Drug Administration. Available at: www.fda.gov/medicaldevices/ deviceregulationandguidance/humanfactors/ ucm119215.htm