Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study

BACKGROUND: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting. METHODS: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction. RESULTS: All of the participants were women, ranging from 18–64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas. CONCLUSION: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health

Technology acceptance, social marketing and the design of a mobile health app to support active aging amongst senior citizens in the Asia Pacific region

This chapter presents the findings from a usability study on health apps on older members of the population in the Asia-Pacific region. Life expectancy continues to increase around the world, and this has long-term implications for society in terms of managing the health care needs of an ageing population. Mobile health apps are increasingly seen as a mechanism to help improve the health, independence and quality of life of older individuals. However, health professionals highlight that the natural process of ageing has, in general, an adverse impact on people's physical and cognitive functions; hence, closer interactions between health care and technology researchers are necessary to ensure that health apps correctly address the needs of this target population. This study shows that several design aspects of health apps in the marketplace require modification to produce robust, reliable, meaningful and usable technologies. The research draws on the concept of usability and the technology acceptance model to explain the factors that predict the successful adoption of health apps amongst senior members of the population in Singapore and Australia