JMIR Publications

ABSTRACT

Background:

Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to certain demographics . In particular, patients who are older or from rural communities represent a large segment of people who are currently underutilizing mHealth solutions and are considered medically underserved. Rural communities commonly have a higher rate of chronic disease and reduced access to providers; therefore, rural patients could benefit from adopting digital solutions such as mHealth apps. However, system usability continues to be a barrier to mHealth adoption among users with non-traditional digital literacy.

Objective:

This study investigated if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural cancer patients with minimal design changes and forgoing the co-design process.

Methods:

We developed the Assuage app to serve as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of four (4) mobile user interfaces (UIs) based on open-source libraries from Apple’s ResearchKit and CareKit that all had varying complexity in reporting distress symptoms with cancer patients. Cancer patients were recruited to complete the distress assessment using a randomly selected UI. Data was collected on participants’: ages, location, mobile app usage, and familiarity with mobile health apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores.

Results:

Thirty (30) current and/or post-surgery cancer patients participated in this pilot study. Most participants were over 50 (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mobile apps for health (21/30, 70%). General mobile app use was split with (14/30, 43%) not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with two of the UIs achieving an SUS score >=80, meeting the industry standard of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens.

Conclusions:

The findings from this study show that most cancer patients (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above average (68). This suggests that with minimal interface alterations, Apple’s ResearchKit and CareKit libraries can provide usable UIs for older and rural users. When resources are limited, the design stage can be simplified by omitting the codesign process, while still preserving suitable usability for users with non-traditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for both interface and electronic survey design, specifically: how to segment and navigate surveys, present important interface elements, and signal gestural interactions.