Thies Kathleen, Anderson Daren, Cramer Benjamin
Community Health Center, Inc., Weitzman Institute, Middletown, CT, United States.
Western Michigan University, Kalamazoo,, MI, United States.
JMIR Hum Factors. 2017 Oct 3;4(4):e24. doi: 10.2196/humanfactors.7709.
Thousands of mobile health (mHealth) apps have been developed to support patients' management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers' adoption of these technologies.
The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful.
We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. Interviews were not recorded.
There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to.
This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users' electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies.
为支持患者进行健康管理，已开发出数千款移动健康（mHealth）应用程序，但许多应用程序的有效性仍不明确。虽然移动健康应用程序似乎有望改善各类人群慢性病的自我管理，但未能使应用程序的系统要求与最终用户的需求、兴趣或资源相平衡，可能会削弱消费者对这些技术的采用。
本研究的最初目的是评估一款商业移动健康应用程序对联邦合格健康中心（FQHC）中患有未控制的糖尿病和/或高血压的成年患者改善临床结局的有效性。患者将临床数据输入该应用程序，该应用程序还支持患者与医疗服务提供者之间的信息传递。经过4个月的大力招募后，由于入组率低且入组患者对应用程序的使用不一致，该试验被暂停。项目目标改为了解试验失败的原因。
我们使用用户-任务-情境（eUTC）可用性框架为参与试验的患者和工作人员制定了一组访谈问题。所有访谈均通过电话进行，持续20至30分钟。访谈未进行录音。
在我们的环境中，应用程序、最终用户以及招募和治疗方法之间匹配度不佳。可用性测试可能在发布前就揭示了这一点，但当时没有进行。在常规护理期间，临床工作人员没有足够的时间让患者熟悉应用程序或检查临床数据和信息，而这些都是无补偿的活动。一些患者没有正确使用该应用程序。缺乏与电子健康记录（EHR）的集成被认为是患者和工作人员都面临的问题，他们还表示该应用程序只是又一件需要关注的事情。
这项简短的试验凸显了移动健康应用程序使用中的陷阱。有效使用移动健康工具需要应用程序、用户的电子健康（eHealth）素养、治疗方法、工作人员时间以及服务补偿之间良好匹配。最后三个是影响应用程序采用的环境背景因素，而背景是实施科学中的一个重要因素。我们建议研究人员在移动健康技术的试验和采用中考虑背景因素。
