Research raises questions about app usability, accessibility

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While mobile health apps have the potential to help patients better manage their chronic conditions, consumers that would benefit most—the poor and minorities—are not able to access and use the technology to realize the benefits.

That’s the finding of a new observational study published in the Journal of General Internal Medicine researching the impact of apps developed to enable adults to manage their chronic conditions.

According to David Bates, MD, chief of the Division of General Internal Medicine and Primary Care at Boston’s Brigham and Women’s Hospital and co-author of the article, the objective of the study was to investigate the usability and accessibility of mHealth apps for diabetes, depression and caregiving in low-income, racially and ethnically diverse populations.

“A lot of work, time and energy are going into app development,” says Bates. “But, most of the apps that are being developed are not necessarily targeted at those groups to meet their needs.”

Researchers observed 26 patients who used 11 of the most popular health apps (four for diabetes, four for depression, and three for caregiving) on iPad and Android tablets. As many as 60 percent of the participants were African American, 27 percent were white, 8 percent were Asian, and another 8 percent were Latino, while nearly 70 percent were deemed to have limited health literacy.

Researchers gave patients condition-specific data entry and data-retrieval tasks, such as entering blood glucose values into a diabetes app or recording medication instructions. What researchers found was that patients could complete only a small percentage of tasks without any assistance.

Among their findings:

  • Patients struggled even more with retrieving data, such as information about upcoming appointments that had been entered into caregiving apps. Participants completed only 79 out of 185 tasks (43 percent), across the 11 apps without help.
  • All the apps required significant manual data entry and progression through multiple screens and steps, making it difficult for patients and caregivers to complete basic, yet critical, tasks. In all, participants were able to complete only half of the data entry tasks—such as entering a blood glucose level—without assistance. Many were hampered by unclear explanations of what needed to be entered.
  • None of the apps had simple interfaces with large buttons and easy-to-follow instructions and navigation. In general, the apps lacked explanations of the relevance of various functions—for instance, why a diabetic patient might wish to look back at a prior meal.

“I was surprised that people could do only 43 percent of the tasks, and they struggled even with quite simple tasks like for diabetics taking their blood sugar and putting it into the app,” Bates says. “That’s about as basic a task as you can have. App developers often don’t include patients or providers when the apps are being developed. Our feeling is that it’s important to include both patients and providers.”

Bates and his co-authors recommend that app developers employ “participatory design strategies” in which they take into consideration easy-to-use features and navigation. That way, they say, developers will ensure their products are tailored to the needs of vulnerable populations that are disproportionately affected by chronic conditions such as diabetes and depression.

“We have a huge problem with the cost of care in this country. If we want to address that, we need apps and tools that will help people manage their conditions effectively,” concludes Bates. “As a provider, I want to be able to prescribe apps for my patients.”

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