Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences

Objective Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications (‘apps’) for consumers’ self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. Materials and Methods ‘Health app’ was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively. Results Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26–35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers’ data. Conclusions The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring.

[1]  L. Emmerton,et al.  Contribution of mobile health applications to self-management by consumers: review of published evidence. , 2016, Australian health review : a publication of the Australian Hospital Association.

[2]  P. Krebs,et al.  Health App Use Among US Mobile Phone Owners: A National Survey , 2015, JMIR mHealth and uHealth.

[3]  Francisco J. García-Peñalvo,et al.  An Empirical Assessment of a Technology Acceptance Model for Apps in Medical Education , 2015, Journal of Medical Systems.

[4]  B. Khatoon The use of a mobile app to motivate evidence-based oral hygiene behaviour , 2015, BDJ.

[5]  Rachel Kenny,et al.  Feasibility of "CopeSmart": A Telemental Health App for Adolescents , 2015, JMIR mental health.

[6]  G Dante Roulette,et al.  Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. , 2015, Gynecologic oncology.

[7]  B. Kaambwa,et al.  Development of an Online Well-Being Intervention for Young People: An Evaluation Protocol , 2015, JMIR research protocols.

[8]  D. Petitti,et al.  A Mobile Cloud-Based Parkinson’s Disease Assessment System for Home-Based Monitoring , 2015, JMIR mHealth and uHealth.

[9]  Oksana Zelenko,et al.  Mobile App Rating Scale: A New Tool for Assessing the Quality of Health Mobile Apps , 2015, JMIR mHealth and uHealth.

[10]  Wilhelm Kirch,et al.  Acceptance Factors of Mobile Apps for Diabetes by Patients Aged 50 or Older: A Qualitative Study , 2015, Medicine 2.0.

[11]  Pilot study to evaluate a tailored text message intervention for pregnant smokers (MiQuit): study protocol for a randomised controlled trial , 2015, Trials.

[12]  Hyeoun-Ae Park,et al.  Development of a Smartphone Application for Clinical-Guideline-Based Obesity Management , 2015, Healthcare informatics research.

[13]  C. Witt,et al.  Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials , 2014, Trials.

[14]  Elgar Fleisch,et al.  Efficacy of an internet and SMS-based integrated smoking cessation and alcohol intervention for smoking cessation in young people: study protocol of a two-arm cluster randomised controlled trial , 2014, BMC Public Health.

[15]  Margaret M. Quinlan,et al.  Determinants of adoption of smartphone health apps among college students. , 2014, American journal of health behavior.

[16]  Charlie Hargood,et al.  Understanding Usage of a Hybrid Website and Smartphone App for Weight Management: A Mixed-Methods Study , 2014, Journal of medical Internet research.

[17]  Yannan Jiang,et al.  Using mobile technology to support lower-salt food choices for people with cardiovascular disease: protocol for the SaltSwitch randomized controlled trial , 2014, BMC Public Health.

[18]  Tyler Sax,et al.  Just a Fad? Gamification in Health and Fitness Apps , 2014, JMIR serious games.

[19]  E. Finkelstein,et al.  The Economic Burden of Self-Reported and Undiagnosed Cardiovascular Diseases and Diabetes on Indonesian Households , 2014, PloS one.

[20]  Helen Christensen,et al.  Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial , 2013, BMC Psychiatry.

[21]  Morwenna Kirwan,et al.  Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial , 2013, Journal of medical Internet research.

[22]  J. McGill,et al.  Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants , 2013, Diabetes Care.

[23]  Giuseppe Riva,et al.  Ensuring the Best Care for Our Increasing Aging Population: Health Engagement and Positive Technology Can Help Patients Achieve a More Active Role in Future Healthcare , 2013, Cyberpsychology Behav. Soc. Netw..

[24]  Clifford C Dacso,et al.  InSpire to Promote Lung Assessment in Youth: Evolving the Self-Management Paradigms of Young People With Asthma , 2011, Medicine 2.0.

[25]  Todd W. Sands,et al.  Development and pilot testing of a mobile health solution for asthma self-management: asthma action plan smartphone application pilot study. , 2013, Canadian respiratory journal.

[26]  Ambarish Pandey,et al.  Smartphone Apps as a Source of Cancer Information: Changing Trends in Health Information-Seeking Behavior , 2012, Journal of Cancer Education.

[27]  Hyeoun-Ae Park,et al.  Development of a Health Information Technology Acceptance Model Using Consumers’ Health Behavior Intention , 2012, Journal of medical Internet research.

[28]  P. S. Gill,et al.  Distraction: an assessment of smartphone usage in health care work settings , 2012, Risk management and healthcare policy.

[29]  L. Tarassenko,et al.  Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial , 2012, BMJ : British Medical Journal.

[30]  Christopher Cunningham,et al.  Gamification by Design - Implementing Game Mechanics in Web and Mobile Apps , 2011 .

[31]  David Coyle,et al.  Design and evaluation guidelines for mental health technologies , 2010, Interact. Comput..

[32]  H. Kuo,et al.  A mobile telephone-based interactive self-care system improves asthma control , 2010, European Respiratory Journal.

[33]  Beom Suk Jin,et al.  Usability risk level evaluation for physical user interface of mobile phone , 2010, Comput. Ind..

[34]  J. Virchow,et al.  Persistence with asthma treatment is low in Germany especially for controller medication – a population based study of 483 051 patients , 2010, Allergy.

[35]  Richard J. Holden,et al.  The Technology Acceptance Model: Its past and its future in health care , 2010, J. Biomed. Informatics.

[36]  N. Thorogood,et al.  Qualitative Methods for Health Research. (2nd edition) , 2009 .

[37]  M. Thesis,et al.  ERASMUS UNIVERSITY ROTTERDAM , 2009 .

[38]  I. Ajzen,et al.  Prediction and change of health behavior: Applying the reasoned action approach. , 2007 .

[39]  C. Schmidt,et al.  [Pain acceptance - concept and validation of a German version of the chronic pain acceptance questionnaire]. , 2007, Schmerz.

[40]  D. Baker,et al.  Health literacy and the risk of hospital admission , 1998, Journal of General Internal Medicine.

[41]  L. Cahalin,et al.  A PILOT STUDY OF CHILDHOOD HEALTH BEHAVIOR AND ASTHMA USING THE HEALTH BELIEF MODEL , 2006 .

[42]  J. Fereday,et al.  Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development , 2006 .

[43]  E. Brink,et al.  Constructing grounded theory : A practical guide through qualitative analysis , 2006 .

[44]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[45]  K. Charmaz,et al.  Constructing Grounded Theory: A practical guide through qualitative analysis Kathy Charmaz Constructing Grounded Theory: A practical guide through qualitative analysis Sage 224 £19.99 0761973532 0761973532 [Formula: see text]. , 2006, Nurse researcher.

[46]  Sally Morton,et al.  Meta-Analysis: Chronic Disease Self-Management Programs for Older Adults , 2005, Annals of Internal Medicine.

[47]  P. Leavy,et al.  The Practice of Qualitative Research , 2005 .

[48]  T. Pigott,et al.  A practitioner-based asthma intervention program with African American inner-city school children. , 2005, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[49]  K. Lorig,et al.  Patient Self-Management: A Key to Effectiveness and Efficiency in Care of Chronic Disease , 2004, Public health reports.

[50]  Kuo-Wei Yeh,et al.  Effects of a Self‐Management Asthma Educational Program in Taiwan Based on PRECEDE‐PROCEED Model for Parents with Asthmatic Children , 2004, The Journal of asthma : official journal of the Association for the Care of Asthma.

[51]  Judith Green,et al.  Qualitative methods for health research , 2004 .

[52]  Ilkka Korhonen,et al.  Health monitoring in the home of the future. , 2003, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[53]  Helen Lester,et al.  Perceived stress during undergraduate medical training: a qualitative study , 2003, Medical education.

[54]  Junling Ren,et al.  Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. , 2002, American journal of public health.

[55]  B. Young Postpositivism and Educational Research , 2000 .

[56]  A. Stewart,et al.  Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. , 1999, Medical care.

[57]  D. Baker,et al.  Inadequate literacy is a barrier to asthma knowledge and self-care. , 1998, Chest.

[58]  Nina S. Parikh,et al.  Inadequate functional health literacy among patients at two public hospitals. , 1995, JAMA.

[59]  I. Ajzen,et al.  A Comparison of the Theory of Planned Behavior and the Theory of Reasoned Action , 1992 .

[60]  Fred D. Davis Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[61]  M. Becker,et al.  The Health Belief Model: A Decade Later , 1984, Health education quarterly.

[62]  I M Rosenstock,et al.  Compliance with a medical regimen for asthma: a test of the health belief model. , 1978, Public health reports.