JMIR Publications

ABSTRACT

Background:

Digital healthcare applications (DiGA) have been integrated into Germany’s healthcare system since 2019, offering certified medical devices for various health conditions. This study focuses on deprexis and Selfapy, the first two permanently approved DiGA for depressive disorders in Germany, to evaluate their usability for people ≥ 60 years. The study’s significance is underscored by the underrepresentation of older people in previous DiGA studies, accompanied with an emergent risk of distribution inequalities for this vulnerable population. The prospective observational study employs the People at the Centre of Mobile Application Development (PACMAD) usability model in a mixed methods design. The study’s multi-stage data collection encompasses socio-demographic data, quantitative questionnaires about health literacy (HLS-EU-Q16), electronic health literacy (GR-eHEALS), media affinity, depressive symptoms (PHQ-9), and the perceived usability (SUS) as well as a qualitative think aloud and semi-structured interview. Participants were equally allocated to use either deprexis or Selfapy. Recruitment of 18 participants took place at three hospital departments (Psychiatry, Psychosomatics, Geriatrics) in spring 2024. Participants qualified if they were 60 years or older, diagnosed with mild or moderate depressive disorder, owned a digital device, and gave written consent to participate.

Objective:

This study’s aim is to evaluate the usability of the DiGA deprexis and Selfapy for people ≥ 60 years with mild or moderate depressive disorders.

Methods:

The prospective observational study employs the People at the Centre of Mobile Application Development (PACMAD) usability model in a mixed methods design. The study’s multi-stage data collection encompasses socio-demographic data, quantitative questionnaires about health literacy (HLS-EU-Q16), electronic health literacy (GR-eHEALS), media affinity, depressive symptoms (PHQ-9), and the perceived usability (SUS) as well as a qualitative think aloud and semi-structured interview. Participants were equally allocated to use either deprexis or Selfapy. Recruitment of 18 participants took place at three hospital departments (Psychiatry, Psychosomatics, Geriatrics) in spring 2024. Participants qualified if they were 60 years or older, diagnosed with mild or moderate depressive disorder, owned a digital device, and gave written consent to participate.

Results:

Quantitative analysis revealed age, gender, depressive severity, and health literacy parity between both groups. Selfapy users displayed marginally lower technical proficiency and also lower usability scores. Qualitative data showed among participants of the Selfapy group lower usability due to design-related errors and higher cognitive load. Despite visual, psychomotor, and cognitive challenges, participants endorsed both DiGA for older users, stressing the importance of assistance and practising the usage.

Conclusions:

Reported difficulties in usability may help to improve future DiGA development for older people, especially as the willingness to use DiGA is existent. Data highlights the need to enhance accessibility and usability of DiGA for older individuals, who face unique challenges due to age-related sensory, motor, and cognitive changes. This way, DiGA can become more accessible and beneficial, ultimately reducing healthcare disparities as well as enhancing the quality of life for this vulnerable group. There is a necessity to take into account the needs of the target groups of DiGA in the authorisation process and increase efforts to offer older adults support to bridge the digital divide. Clinical Trial: The study has been prospectively registered in the German Clinical Trials Register (DRKS00033640, registered on 18/03/2024, available from https://drks.de/search/de/trial/DRKS00033640).