Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Dec 3, 2025
Open Peer Review Period: May 31, 2026 - Jul 31, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Configurational Pathways to High-Quality HIV/AIDS Mobile Applications: A Fuzzy-Set Qualitative Comparative Analysis of Researcher and Patient Perspectives
ABSTRACT
Background:
Mobile health (mHealth) applications have become important tools for HIV/AIDS management. While the Mobile App Rating Scale (MARS) and its user version (uMARS) are widely used for quality assessment, how different stakeholder groups combine quality dimensions to form overall judgments remains unclear. Discrepancies between researcher evaluations and patient perceptions may critically affect app adoption and clinical effectiveness.
Objective:
This study aimed to compare configurational pathways leading to high subjective quality ratings in HIV/AIDS apps between researchers and patients using fuzzy-set qualitative comparative analysis (fsQCA).
Methods:
Twenty-one HIV/AIDS mobile applications were evaluated by three researchers using the original MARS and two HIV-positive patients using the uMARS. Six conditions were examined: engagement, functionality, aesthetics, information quality, privacy protection, and developer type. Necessary and sufficient configurations were identified for both evaluator groups.
Results:
Distinct evaluation patterns were observed. Five sufficient configurations were identified for researchers (solution consistency=0.981, coverage=0.649); four were identified for patients (solution consistency=0.998, coverage=0.796). Researchers emphasized privacy and information quality. Patients prioritized engagement and functionality. For patient evaluations, functionality demonstrated the highest necessity consistency (0.907), meeting the necessity threshold. Case-level analysis identified exemplary applications: Wu Ai Fang Hua and Ai Yi Jian for researcher-oriented quality; Chabei for patient-centered excellence. Chabei emerged as the only cross-validated typical case across both groups.
Conclusions:
Fundamental divergence exists between researcher and patient evaluations of HIV/AIDS mHealth applications. Multiple equifinal pathways lead to high subjective quality, with no single configuration satisfying all pathways. Audience-specific strategies are indicated for developers: privacy and information quality should be prioritized for researcher endorsement, while engagement and functionality should be emphasized for patient adoption. Patient perspectives should be incorporated into mHealth development. Regulatory attention to privacy perception gaps is warranted to protect vulnerable populations.
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