Usability evaluation of mHealth apps for elderly individuals: a scoping review

Age Unplugged: A Brief Narrative Review on the Intersection of Digital Tools, Sedentary and Physical Activity Behaviors in Community-Dwelling Older Adults

This brief narrative review assesses how digital technologies-such as wearables, mobile health apps, and various digital tools such as computers, game consoles, tablets, smartphones, and extended reality systems-can influence sedentary and physical activity behaviors among community-dwelling older adults. Each section highlights the central role of these technologies in promoting active aging through increased motivation, engagement and customized experiences. It underlines the critical importance of functionality, usability and adaptability of devices and confirms the effectiveness of digital interventions in increasing physical activity and reducing sedentary behavior. The sustainable impact of these technologies needs to be further investigated, with a focus on adapting digital health strategies to the specific needs of older people. The research advocates an interdisciplinary approach and points out that such collaborations are essential for the development of accessible, effective and ethical solutions. This perspective emphasizes the potential of digital tools to improve the health and well-being of the aging population and recommends their strategic integration into health promotion and policy making.

Comparison of evaluation methods for improving the usability of a Spanish mHealth tool

OBJECTIVE

Mobile health (mHealth) technology is now widely used across health conditions and populations. The rigorous development of these tools has yielded improved health outcomes, yet the ideal approach for developing mHealth tools continues to evolve, indicating the need for rigorous usability evaluation methods. This study compares two usability evaluation methods - cognitive interviews and usability assessments employing a think-aloud approach - for adapting an evidence-based mHealth tool from English into Spanish.

METHODS

We conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City, NY, and La Romana, Dominican Republic. The Health IT Usability Evaluation Model (Health-ITUEM) was used to guide the analysis of qualitative data collected from each method.

RESULTS

Participants (N = 40) averaged 43 years old (SD = 12.26; range 20-79), identified primarily Hispanic/Latino (92.5 %), and resided in La Romana (50 %) or New York City (50 %). Both usability evaluation methods yielded similar findings, highlighting learnability and information needs as crucial components of participant feedback for the mHealth application. Cognitive interviews captured participants' perspectives on the app's interface and design. On the other hand, results from usability assessments offered insights into participants' competency while interacting with the mHealth tool.

CONCLUSION

Findings from this study highlight the contributions and limitations of including cognitive interviews and task-based usability assessments using a think-aloud approach in mHealth usability testing. Future research should employ a multi-method approach, incorporating complementary usability evaluation methods and engaging participants in multiple assessments. Using complementary usability evaluation methods may provide a more comprehensive understanding of the usability and participant experience aspects of a mHealth tool compared to using a single usability evaluation method.

Mobile health in the aging surgical patient

Mobile health includes the use of mobile devices, patient monitoring devices, and digital assistants to improve the delivery of healthcare. Aging surgical patients (ie, 65 years and older) represent a unique patient population that demands increased resources to prepare for surgery and optimize recovery. Mobile health has the potential to improve surgical patient outcomes by increasing the accessibility of personalized care and reducing costs. However, there are some challenges to consider when using mobile health in older surgical patients, such as technological literacy, visual and hearing impairment, and cognitive changes before or after anesthesia. Despite the rapid uptake of mobile health in medical specialties, its application in the surgical field is gradual. The complexity of aging surgical patients requires surgical care teams, surgical leaders, and healthcare policymakers to consider unique solutions, such as mobile health, to address this growing population's needs before and after surgery. This article will discuss the potential benefits and challenges of mobile health among aging surgical patients, as well as opportunities to support these patients and families with customizable tools to meet their preferences and needs.

Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age

BACKGROUND

Smartwatches have become readily accessible tools for detecting atrial fibrillation (AF). There remains limited data on how they affect psychosocial outcomes and engagement in older adults. We examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by age.

METHODS

We analyzed data from the Pulsewatch study, a randomized controlled trial that enrolled patients (≥ 50 years) with a history of stroke or transient ischemic attack and CHA2DS2-VASc ≥ 2. Intervention participants were equipped with a cardiac patch monitor and a smartwatch-app dyad, while control participants wore the cardiac patch monitor for up to 44 days. We evaluated health behavior parameters using standardized tools, including the Consumer Health Activation Index, the Generalized Anxiety Disorder questionnaire, the 12-Item Short Form Health Survey, and wear time of participants categorized into three age groups: Group 1 (ages 50-60), Group 2 (ages 61-69), and Group 3 (ages 70-87). We performed statistical analysis using a mixed-effects repeated measures linear regression model to examine differences amongst age groups.

RESULTS

Comparative analysis between Groups 1, 2 and 3 revealed no significant differences in anxiety, patient activation, perception of physical health and wear time. The use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1 (β = -3.29, P = 0.046).

CONCLUSION

Stroke survivors demonstrated a willingness to use smartwatches for AF monitoring. Importantly, among these study participants, the majority did not experience negative health behavior outcomes or decreased engagement as age increased.

Old age or cognitive decline? Examining the usability of a mobile health app for older Australians

There is a growing literature on the role of mobile health applications (mHealth apps) in supporting older adults and the self-management of personal health. The purpose of this pilot study is to assess the usability of a government-funded mobile health app amongst older Australians and to evaluate whether cognitive function and demographic characteristics (i.e. age, gender, education) are associated with usability. A total of 28 older adults living in a regional city in Australia took part in the study. The participants were recruited using purposive sampling. Data collection instruments consisted of validated cognitive tests, task-based usability tests, and a questionnaire. The data was analyzed using non-parametric strategies. The findings of this study demonstrated that a government-funded, mHealth app was usable by older adults. Users were able to perform basic tasks in an effective and efficient manner. The hypothesis that elderly age would be significantly associated with performance on cognitive tests, as well as usability, was not supported. Performance on some cognitive tests was significantly and positively related to usability. Education and gender were not related to usability. The results suggest that traditional stereotypes surrounding aging and cognitive decline need to be reexamined.

Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study

BACKGROUND

Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted.

OBJECTIVE

The aim of this study was to assess the usability of an app among people at risk of DM2.

METHODS

A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis.

RESULTS

In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app.

CONCLUSIONS

Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial.

Examining Outcomes and Challenges of Telepsychiatry in Australian Elderly: A Scoping Review

Methods

To find relevant articles, we searched PubMed, Scopus, and Web of Science databases. We used a data extraction form to gather information from primary studies. Two researchers followed inclusion and exclusion criteria to select studies and extract data. Disagreements were resolved through discussion with all researchers. Studies needed to be in English, about telepsychiatry for Australian seniors, and use any technology type (synchronous, asynchronous, or both). We excluded nontelepsychiatry articles, books, book chapters, conference abstracts, and editor letters.

Results

Telepsychiatry was effectively employed to manage depression, anxiety, delirium, and cognitive impairments. Among these four disorders, telepsychiatry was mostly used for depression. Videoconference and telephone were mostly used to provide telepsychiatry services. Most telepsychiatry services for Australian seniors included "patient education on disorder control and management," "creating continuous interaction between the patient and the therapist," and "remote patients' assessment." "Reductions in symptoms of disorders," "improving patients' satisfaction with telepsychiatry," and "cost-effectiveness of telepsychiatry" were the most important positive outcomes of using telepsychiatry. We also identified four challenges in using telepsychiatry for elderly individuals in Australia.

Conclusions

This study is the first scoping review in Australia and provides valuable insight into telepsychiatry for elderly individuals.

A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study

BACKGROUND

The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia.

OBJECTIVE

This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach.

METHODS

Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively.

RESULTS

A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as "good." The main usability issues concerned navigation logic and comprehensibility of app content.

CONCLUSIONS

The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study.

Interviews with HIV Experts for Development of a Mobile Health Application in HIV Care-A Qualitative Study

The Communication and Tracing App HIV (COMTRAC-HIV) project aims to develop a mobile health application for integrated care of HIV patients due to the low availability of those apps in Germany. This study addressed organizational conditions and necessary app functionalities, especially for the care of late diagnosed individuals (late presenters) and those using pre-exposure prophylaxis. We followed a human-centered design approach and interviewed HIV experts in Germany to describe the context of use of the app. The interviews were paraphrased and analyzed with a qualitative content analysis. To define the context of use, user group profiles were defined and tasks derived, which will represent the functionalities of the app. A total of eight experts were included in the study. The results show that the app should include a symptom diary for entering symptoms, side effects, and their intensity. It offers chat/video call functionality for communication with an HIV expert, appointment organization, and sharing findings. The app should also provide medication overview and reminders for medications and appointments. This qualitative study is a first step towards the development of an app for HIV individuals in Germany. Further research includes involving patients in the initial app design and test design usability.

Nursing Informatics' Contribution to One Health

OBJECTIVES

To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health.

METHODS

This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current.

RESULTS

A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health.

CONCLUSIONS

Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.

Designing Mobile Health Applications to Support Walking for Older Adults

Physical activity is extremely important at an older age and has major benefits. There is a range of applications that help maintain physical activity. However, their adoption among older adults is still limited. The purpose of the study is to explore the key aspects of the design of mobile applications that support walking for older adults. We conducted a field study with older adults, aged 69-79 years, using a technology probe (a mobile application developed as an early prototype) with the purpose of eliciting requirements for mobile health applications. We interviewed the participants during and after the study period, asking them about their motivation for walking, usage of the application, and overall preferences when using such technologies. The findings suggest that mobile applications that support walking should address a range of walking variables, support a long-term learning process, and enable the user to take control and responsibility for the walk. In addition, we provide design guidelines concerning the motivation for walking and the data visualization that would make technology adoption easier. The findings from this study can be used to inform the design of more usable products for older users.