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Research: Commercially Available Health Apps Not Consistently Usable, Accessible for Low-Income and Elderly Patients

August 1, 2016
by Heather Landi
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While mobile health applications have the potential to help patients manage chronic conditions, commercially available health apps are not designed with the most vulnerable patients in mind, according to a recent Commonwealth Fund-supported research study.

For the study, published in the Journal of General Internal Medicine, David Bates, M.D., chief innovation officer and senior vice president, Brigham and Women’s Hospital, as well as researchers at the Center for Vulnerable Populations at San Francisco General Hospital, University of California, sought to examine mobile health apps’ acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications.

According to the study authors, as currently designed, “health apps can present challenges to the vulnerable populations who would likely benefit the most, including the poor and patients with low levels of health literacy.”

The study authors note the potential for mobile health apps to help patients monitor things such as changes to diet, exchange and medication as it relates to managing chronic conditions, such as diabetes and depression. “These tasks that can be made easier by mobile apps that provide patients with reminders and education about caring for their conditions. Apps also can help patients and providers track health data over time, helping to reveal how changes in behavior and medication influence outcomes.”

For the study, researchers observed patients using several commercially available apps for diabetes and depression. The researchers also studied the usability of apps for elderly patients’ caregivers, who are often geographically dispersed and need to share medical information.

The researches selected 11 popular mobile health apps to manage diabetes, depression, and caregiving and observed 26 patients using them. The study participants were racially/ethnically diverse with either diabetes, depression or were caregivers. Nearly 70 percent were deemed to have limited health literacy. For the study, each participant was given condition-specific data entry and data-retrieval tasks, such as entering blood glucose values into a diabetes app or recording medication instructions.

According to the study authors, the study results indicated that 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,” the study authors wrote.

And, patients struggled 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 11 apps, without assistance, according to the study findings.

And, study authors noted that 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,” the study authors stated.

According to the study, three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management.

The study authors concluded that while patients express interest in using technologies for self-management, current tools are not consistently usable for diverse patients.

App developers need to engage a diverse set of patients in the design and testing of their products and should employ participatory design strategies in order to have an impact on chronic conditions such as diabetes and depression that disproportionately affect vulnerable populations, according to the study authors.

“In addition, the apps should be able to remind users of the rationale for each task and should integrate data from other sources, such as pharmacies, to reduce the need for manual data entry,” the study authors wrote.

The bottom line, according to the study authors, is that to reduce health disparities, app developers must ensure their products are tailored to the needs of the populations that are likely to benefit the most from their use. Moving forward, research on the impact of such apps on uptake, use, self-management behaviors, and health outcomes also is needed, the study authors stated.


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