JMIR Publications

ABSTRACT

Background:

Nearly 20 million new cancer cases and 9.7 million deaths occurred globally in 2022. Europe, with less than 10% of the world’s population, accounts for over 22% of new cancer cases and 20% of deaths, reflecting an aging population, prevalent lifestyle risk factors, and extensive screening programs. Approximately 40% of cancers are preventable through lifestyle interventions, underscoring the importance of effective prevention strategies. The European Code Against Cancer provides evidence-based guidelines driving health initiatives across Europe. Supported by Europe’s Beating Cancer Plan and EU4Health, the EU Mobile App for Cancer Prevention was developed to disseminate these recommendations. However, its effectiveness relies heavily on usability across populations with diverse digital and health literacy levels—a critical gap this study addresses.

Objective:

This study aimed to identify enablers, barriers, and user requirements for the EU Mobile App for Cancer Prevention (English version). It evaluated how app usability varied among individuals with different digital health literacy levels and diverse sociodemographic backgrounds. Additionally, user feedback on mock wireframes was collected to inform design enhancements for broader usability.

Methods:

A mixed-methods usability study was conducted in seven European countries involving 76 adults (aged 19–84), recruited via purposive quota sampling. Participants completed quantitative usability testing using mock wireframes to perform ten predefined tasks simulating core app functionalities (e.g., profile setup, goal tracking). Task completion times, success rates, self-reported confidence, and perceived difficulty were recorded. Digital health literacy was measured using the eHealth Literacy Scale (eHEALS). Qualitative data were gathered through focus groups guided by semi-structured interviews, and thematic content analysis was conducted. Statistical analyses included descriptive statistics and one-way ANOVA to explore group differences.

Results:

Overall, task completion rates were high (75%–98%), indicating good general usability. However, significant differences emerged based on age, educational attainment, and digital health literacy. Younger participants, individuals with higher education, and those with higher digital health literacy reported greater confidence and less difficulty performing tasks. Conversely, older adults and participants with lower digital health literacy encountered more usability challenges. Qualitative analysis identified four key themes influencing usability: accessibility (multilingual support, simple language), user-centric design (age-friendly interfaces, intuitive navigation), ethical concerns (data privacy and security), and motivational features (gamification, personalized health goals).

Conclusions:

The EU Mobile App for Cancer Prevention demonstrated overall good usability among diverse user groups. However, to optimize effectiveness, interfaces should accommodate varying digital health literacy and age-related needs. Robust data privacy measures and motivational design features are crucial for building user trust and sustained engagement. Future research will pilot the finalized app to assess real-world adoption and its impact on cancer prevention behaviors.