- Even when mHealth apps have high usability ratings, patients still might not use them due to their own personal barriers, shows a recent study published in the Journal of Medical Internet Research. According to the researchers, this highlights a need to shape app development around patient perceptions or app efficacy and not just usability and navigability.
The researchers tested an mHealth app for postoperative care that supported recovery efforts through wellness tracking. Providers introduced 20 patients to the app at the onset of postoperative care and instructed them to use the app for 14 days following hospital discharge.
During usability assessments implemented at the start and end of the study period, patients gave the app a usability rating that scored in the top 95th percentile. Qualitative interviews also revealed that patients found the app easy to use.
However, high app usability made little difference in supporting app use. Thirty percent of patients never used the app once they got home, and ten percent used it only once. One of the zero-use patients reported limited internet connectivity, but otherwise the researchers did not collect concrete reasons for low engagement.
These results showed that with regard to the effectiveness of mHealth to improve patient care, developers need to account for more than just usability.
“Ultimately, we believe that mHealth apps should be designed with patient beliefs and attitudes in mind, and those apps should use validated content and content delivery methods that can improve patient trust, activation, and use of the intervention,” the research team explained.
For example, the research team introduced the app in a public hospital that largely serves patients with low socioeconomic status and did not limit the app to English speakers. While the app was highly usable, this patient population likely had unique characteristics that influenced their perceptions of mHealth in surgery recovery.
Very few of these patients looked toward mHealth interventions as authoritative resources to improve their care. Instead, they saw them as a “second opinion,” and in some cases as an external burden to their recovery.
“The patient’s intention to use the app is based on their attitude toward use, their perception of whether or not use is normal, and their perception of their own ability to use the app,” the research team explained. “Underlying these factors are the patient’s beliefs about using the app, beliefs about whether or not app use is normal, and their beliefs about their ability to use the app.”
These findings highlight the importance of framing apps as authoritative health tools rather than as novelty accessories.
Additionally, the researchers state that mHealth interventions need to be designed not only with patient usability in mind, but with patient preferences in mind, too. For example, several patients did not answer app prompts to photograph their wound healing progress because they did not like looking at their wounds.
The app may have been more effective if it, or the clinicians administering the app, had acknowledged patient apprehensions about wound care. The tool and clinicians could acknowledge patient concerns, letting patients know their fears are normal and equipping patients with strategies to overcome them.
Finally, the researchers suggest app developers and the clinicians who administer them remember that convenience is key. Several patients reported that they did not use the app because it was cumbersome when they were feeling ill or because it disrupted their daily lives. App developers must bear in mind patient abilities to integrate app use into their everyday lives through features such as reminders to use the app.
Clinicians can also improve app convenience once again by framing mHealth as an authoritative health tool. When patients view mHealth apps as technologies that will in fact improve their recovery, they may be more likely to adopt it into their postoperative care plans.
Ultimately, healthcare professionals must remember that while mHealth app usability is a high priority for ensuring patient engagement, there are several other important factors that will lead to use. Framing mHealth as an effective method for care improvement, as well as ensuring patients can conveniently use the tools, will help improve engagement with the tools.