JMIR Publications

ABSTRACT

Background:

The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable to assess the usability of mHealth apps. This English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps.

Objective:

This study aimed to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ) (interactive for patients) on the Left-handed Doctor, one of the most popular “Reaching Out To Patients” interactive mHealth apps with the chatbot function in China, to test the reliability and cross-cultural adaptability of the MAUQ.

Methods:

The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on the Good Doctor, one of the most influential “Reaching Out To Patients” mHealth apps without the chatbot function in China. After asking for the researchers’ [1] approval to use the Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. After a trial survey participated by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved C-MAUQ was finally used to evaluate the usability of the Left-handed Doctor through an online questionnaire survey answered by 322 participants on wenjuanxing, to test its internal consistency, reliability, and validity.

Results:

The improved C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ [1], including (i) redundancy, (ii) incompleteness, (iii) misuse of pats of speech, (iv) choice of inappropriate words, (v) incomprehensibility, and (vi) cultural difference-induced improper translation, were improved. As shown in the analysis of data obtained through an online survey, the improved C-MAUQ had a better internal consistency (the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861~0.938, p<.01), reliability (Cronbach α=0.988), and validity (KMO=0.973), compared with the C-MAUQ. It was effectively used to test the usability of the Left-handed Doctor, eliciting over 80% of informants’ positive attitudes towards this mHealth app.

Conclusions:

The improved C-MAUQ is highly reliable and valid on the Left-handed Doctor, suitable for testing the usability of interactive mHealth apps used by patients in China. This finding is in tune with [1], further confirming the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users’ age, gender, education, profession, and possibly previous experience with mobile (health) apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among Chinese young female college students who were more engaged in the interaction with healthcare chatbots. This age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America [10] and Malaysia [13] and identifies areas for further research on the social, cultural, and gender adaptation of health technologies.