A review of privacy and usability issues in mobile health systems: Role of external factors

The increased penetration of mobile devices has created opportunities in the health sector and led to emerging of mobile health systems. As much as the mobile health systems have registered tremendous progress, they have been faced with privacy and usability issues. Due to the sensitivity of health information, there is an ethical need to equip mobile health systems with adequate privacy measures. However, these systems should also be useable by the intended users. Even though many researchers are working on solutions, the issues still persist. External factors such as cultural differences have also contributed to the issues, yet they have been under researched. In this article, we conduct a systematic literature review of 22 articles, categorize and present privacy and usability issues and possible solutions. We then discuss the relevance and implications of external factors to the findings on privacy and usability. We end with recommendations to address these external factors.Peer Reviewe

User Preferences for Privacy Protection Methods in Mobile Health Apps: A Mixed-Methods Study

Background: Mobile health (mHealth) apps have the potential to facilitate convenient health care delivery and self-management of health. However, many users have concerns about their privacy when they use mHealth apps. Different apps provide different solutions for protecting users’ privacy. Objective: The purpose of this study was to determine user preferences among the several privacy protection methods used in current mHealth apps and the reasons behind their preferences. Methods: Five privacy protection methods currently used in mHealth apps were presented to a group of study participants who had mild or moderate depression and expressed concerns about privacy of information when they used mental health apps. After a demonstration of the methods, study participants were asked to fill out a questionnaire and indicate their perceived privacy protection level (PPPL) of each method, their preference rating for each method, and the privacy protection methods they had used in the past. A brief interview was then conducted to collect study participants’ comments on these methods and elicit the reasons for their preference ratings. Statistical analysis was performed to determine the statistical significance of differences in participants’ preference ratings and in the PPPLs obtained for the five methods. Study participants’ comments on the privacy protection methods and suggestions were noted and summarized. Results: Forty (40) study participants were selected from a large candidate pool using the IRB approved selection criteria. All study participants viewed the app demonstration and understood the five privacy protection methods properly, which was indicated by their correct sorting of the PPPL of the five methods in their answers to the questionnaire. All study participants specified their preferences with respect to these methods and provided the rationale behind their selections on the questionnaire and during the brief interview. The results indicate that the users preferred privacy protection methods with customizable modules in multi-purpose apps because of their convenience and strong privacy protection, where the customization can be done either in the app or via a Web portal. Conclusions: This study identified user preferred privacy protection methods. These identified privacy protection methods may be used in many types of apps that perform sensitive health information management to better protect users’ privacy and encourage more users to adopt these mHealth apps

User Authentication in Smartphones for Telehealth

Many functions previously conducted on desktop computers are now performed on smartphones. Smartphones provide convenience, portability, and connectivity.  When smartphones are used in the conduct of telehealth, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA) breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare. This paper presents and examines several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers. The applications of these authentication methods in telehealth are discussed. Keywords: Authentication, Biometrics, HIPAA, Mobile security, Telehealt

Application of Artificial Intelligence and Data Science in Detecting the Impact of Usability from Evaluation of Mobile Health Applications

Mobile health (mHealth) applications have demonstrated immense potential for facilitating preventative care and disease management through intuitive platforms. However, realizing transformational health objectives relies on creating accessible tools optimized for different users. This research analyses mHealth app usability data sourced from online repositories to reveal the impact of usability (ease of use) from evaluating mobile health applications. Thoroughly examining interfaces with a utilization of statistical tests of significance, platform, integra-tions, and various application features shows complex relationships between usability and users experience. This work shows that applying random forest models can accurately classify the ease-of-use of mHealth applications. This work sheds light on the connections between design choices and their effects, guiding intentional improvements to expand the reach of mHealth. It does so by providing insights into the subtle ways that people interact with mHealth applications. The methodologies and findings provide actionable insights for developers and practitioners passionate about advancing digital healthcare

Designing a Multimedia Intervention for Illiterate and Semi-Illiterate Pregnant Women in Developing Countries: A Case of Uganda

Die hohe Müttersterblichkeit in Entwicklungsländern ist zum Teil auf indirekte Faktoren wie Analphabetismus und eingeschränkten Zugang zu Gesundheitsinformationen für Mütter zurückzuführen. Während gebildete Frauen auf Gesundheitsinformationen über Online-Plattformen und mHealth-Apps zugreifen können, müssen Analphabetinnen diese in Gesundheitseinrichtungen abrufen, was aufgrund der Transportkosten oft nicht möglich ist. Mobilfunktechnologie hat in der Gesundheitsversorgung Chancen für ressourcenarme Gemeinschaften eröffnet, die sonst nicht von den digitalen Technologien profitiert hätten. Obwohl Mobilfunktechnologie in der Müttergesundheit eingesetzt wird, können die meisten Maßnahmen nicht von Analphabeten genutzt werden, verwenden Sicherheitsmodelle die nicht auf den Kontext von Entwicklungsländern zugeschnitten sind, und wurden nicht auf ihre Auswirkungen auf die Müttergesundheit hin evaluiert. In dieser Arbeit wurden zwei (Web und Mobile) Apps entwickelt, die die Übermittlung von multimedialen Nachrichten zur Müttergesundheit, Terminerinnerungen und Anrufe/Chats erleichtern. Um die Anforderungen der Nutzer zu erfassen, wurde eine Feldstudie mit halbstrukturierten Interviews und Fokusgruppendiskussionen mit schwangeren Analphabetinnen, Gesundheitsexperten und Entwicklern durchgeführt. Es folgte die Entwicklung eines Sicherheitsmodells (T2RoL) zur Sicherung der Gesundheitsinformationen in den Apps, die dann nach einem nutzerzentrierten Designansatz entwickelt wurden. Eine zweite Feldstudie in Form von halbstrukturierten Interviews und Umfragen wurde durchgeführt, um die mobile App in einer randomisierten kontrollierten Studie mit 80 schwangeren Analphabetinnen über 9 Monate zu evaluieren. Die Auswertung zeigte, dass die App akzeptiert wurde sowie einfach zu erlernen und zu benutzen war. Das Wissen über Müttergesundheit in der Interventionsgruppe verbesserte sich, was sich positiv auf gesundheitsbezogene Entscheidungen und Gesundheitsmaßnahmen auswirkte.Maternal mortality is high in developing countries partly due to indirect factors such as illiteracy and limited access to maternal health information. While literate women can access health information from online platforms, and mHealth apps, illiterate women must get it from health facilities which is often not possible due to lack of transport fees. Mobile technology has opened opportunities in maternal health care for low resource communities that would otherwise not have benefited from digital technologies. Although used in maternal health, most interventions are not usable by the illiterate, use security models that are not tailored to the developing countries’ context, and have not been evaluated to assess their impact on maternal health care. In this thesis, two (web and mobile) apps that facilitate delivery of multimedia-based maternal health messages, appointment reminders, and calls/ chats were developed. To gather user requirements, a field study in form of semi-structured interviews and focus group discussions was conducted with illiterate pregnant women, health practitioners and developers. Development of a security model (T2RoL) to secure the health information in the apps followed. The apps were then developed following a user-centered design approach. A second field study in form of semi-structured interviews and surveys was conducted to evaluate the mobile app through a randomized controlled trial with 80 illiterate pregnant women that were followed for 9 months. Overall, results show that the app was acceptable, easy to learn and use. There was improved maternal health knowledge among the intervention group which positively influenced health related decision making and health practices

Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications.

Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies

A participatory process to design an app to improve adherence to anti-osteoporotic therapies: A development and usability study

Objective: The aim of the study was to develop an app to improve patients’ adherence to therapy for osteoporosis and to test its usability. Methods: In Phase I, the app functions needed to improve medication adherence were identified through a focus group with six patients with osteoporosis and a joint interview with two bone specialists. The app prototype was then developed (Phase II) and refined after its feasibility testing (Phase III) for 13–25 days by eight patients. Finally, the app underwent usability testing (Phase IV) for 6 months by nine other patients. The mHealth App Usability Questionnaire (MAUQ) was used to collect the assessment of the app by the 17 patients. Results: The final version of the app provided information on osteoporosis, allowed patients to contact the bone specialist for an additional consultation, and generated a reminder for taking medications accompanied by feedback on adherence. The assessment of the app was positive but evaluations differed between the feasibility and usability testing, with the former displaying a significantly (p ≤.05) better assessment across all MAUQ items. Conclusions: In this study, we tested an app for improving adherence to medical therapies in patients with osteoporosis. The usability testing revealed a lower “patient-centered” performance of the app as compared to that observed during the feasibility phase. Future developments of the study include increasing the testing cohort and adding a technical support during the usability testing

Design of a tablet computer app for facilitation of a molecular blood culture test in clinical microbiology and preliminary usability evaluation

BACKGROUND: User mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS). OBJECTIVE: The objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation. METHODS: The MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations. RESULTS: Four medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS. CONCLUSIONS: The preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test

PDapp - A mobile solution for continuous follow-up of Parkinson's disease patients

A doença de Parkinson é uma doença degenerativa que afeta principalmente neurónios produtores de dopamina, numa área específica do cérebro chamada substantia nigra. Os sintomas desenvolvem-se lentamente ao longo dos anos e a doença progride de uma forma muito variável de pessoa para pessoa. Estimulação Cerebral Profunda (DBS) é uma prática comum como tratamento nas fases mais tardias da doença. O sistema iHandU é um aparelho inovador que se pode equipar para medir a rigidez do pulso durante esta cirurgia. PDapp é uma aplicação móvel que procura trazer as funcionalidades da iHandU para fora da sala de cirurgia, de forma a ajudar os pacientes com um seguimento contínuo da sua doença e a sua progressão ao longo do tempo. Tem como objetivo criar uma ligação entre os pacientes e os seus médicos, fora do ambiente hospitalar. A PDapp fornece aos seus pacientes ferramentas para gerir a sua doença com medicação, testes e a possibilidade de informar os seus médicos de acontecimentos importantes relacionados à doença. Os médicos terão acesso a um dashboard especializado onde poderão analisar as informações dos seus doentes, o seu historial e acontecimentos recentes. O sistema será composto de uma aplicação móvel, uma plataforma web para o dashboard e uma base de dados na cloud. No final, teremos um sistema capaz de integrar a aplicação móvel dos pacientes, o dashboard dos médicos e a iHandU para fazer testes. A aplicação móvel terá de ser interativa e facilmente usável por pacientes com Parkinson's. O dashboard dos médicos será focado em apresentar a informação mais essencial de uma forma direta e costumizável, para que os médicos possam tomar melhores decisões. Um sistema como a PDapp pode ter grande impacto nas vidas de pacientes com Parkinson's, ajudando a gerir a doença e a liga-los aos seus médicos nos momentos importantes.Parkinson's disease is a neurodegenerative disorder that affects dopamine-producing ("dopaminergic") neurons predominately in a specific area of the brain called substantia nigra. Symptoms develop slowly over the years, and the disease's progression is often different from person to person. Deep Brain Stimulation is a common practice in the later stages of the disease as treatment. The iHandU system is a novel, comfortable, and wireless device, designed to classify the wrist rigidity during this practice. PDapp is a mobile app solution to bring the iHandU's capabilities out of the surgery room and help patients with a continuous follow up of their disease's progression through time. It strives to connect the patients and their doctors outside of the clinical environment. It provides patients with a high-quality mobile application for managing their disease with medication and tests, as well as keep their doctors informed of important events related to the disease. On the other hand, the doctors have access to a specialised dashboard to get an overview of all their patients' history and their most recent events. The system required will be composed of a mobile application, a web platform to host the dashboard, and a cloud-based database to persist all the data necessary. By the end of this project, we should have a system capable of successfully integrating a mobile application for the patients, a dashboard for the doctor, and the iHandU for performing tests. The mobile app should be highly usable and interactive for users with Parkinson's disease, and the dashboard should be focused and clean to provide the doctors with the best overview of their patients and current situations. A system like PDapp can have a significant impact on the lives of these patients by easing their access to relevant tools and connecting them to their doctors whenever needed