A framework for culturally adapting mental mHealth apps

BackgroundNoncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications.ObjectiveThis research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings.MethodsA total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app.ResultsAs shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03).ConclusionsGenerally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value.

Mobile health (mHealth) apps are widely available, and some have proven safe and effective for management of specific chronic conditions. Despite a high degree of interest, the potential of these technologies has yet to be realized. Patient and clinician attitudes are key factors that influence the adoption of mHealth apps but remain poorly understood, particularly in the United States. This study aimed to identify both patient and clinician attitudes that can influence recommending and adopting mHealth apps. Using well-established technology adoption and implementation science frameworks, this study included a deductive content analysis using a rapid qualitative analytic method. Semistructured interviews were conducted with patients and clinicians to identify technical and material, social and personal, and policy and organizational factors that can influence the recommendation or adoption of mHealth apps. The interviews and data analysis were performed between September 2023 and August 2024. Participants included 20 clinicians (n=12, 60% general internists) with a mean time in practice of 17 (SD 11.6) years, and 28 patients with a mean age of 59 (SD 12.1) years. A total of 7 categories related to patients' and clinicians' attitudes toward mHealth apps emerged: (1) apps as tools to improve health by extending care, (2) the role of apps in enhancing the patient-clinician relationship, (3) the need for simplicity and efficiency in app design, (4) the influence of prior experience with mHealth apps, (5) comfort with technology, (6) recommendations from trusted sources, and (7) education and hands-on experience. Although similar factors were considered by patients and clinicians, their views about older adults' interest and ability to use mHealth apps differed. Understanding patient and clinician views about mHealth apps provides critical insights for developing approaches to facilitate their use. These findings suggest patients and clinicians share similar views about the benefits of mHealth apps. Nonetheless, clinicians' perceptions about older patients' interest and ability to use mHealth apps may negatively impact recommendation of mHealth apps and subsequent adoption by older adults.

BackgroundKnowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited.ObjectiveWe aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500).MethodsAdolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample’s representativeness. The sociodemographic factors were the adolescents’ age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children’s online health information–seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate).ResultsMore than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information–seeking behaviors and adolescents’ mHealth app use.ConclusionsThese findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents’ mHealth app use. We initially showed parents as significant role models for their children’s adoption of, and engagement with, mHealth apps when they actively mediate their online health information–seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents’ mHealth app use longitudinally.

Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps. This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included "endometriosis," "adenomyosis," and "pelvic pain." mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ≥3.5 were classified as "good" according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care. In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (≥3.5) in the domains of usability (16/19, 84.2%), visual design (14/19, 73.7%), user engagement (11/19, 57.9%), and content (15/19, 78.9%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6%), therapeutic alliance (9/19, 47.4%), and general subjective evaluation (6/19, 31.6%). Although time and geographical location can influence the search results, we identified 6 "good-quality" endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user's endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps. PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj.

Objectives: Mobile Health (mHealth) apps have emerged as transformative tools with the potential to revolutionize health-care delivery, particularly in resource-constrained settings like Bangladesh. This cross-sectional study aimed to explore the trends of use of mHealth apps among Bangladeshi physicians and assess their attitudes toward integrating these apps into the health-care system. Material and Methods: Data were collected from 120 physicians using structured questionnaires, addressing awareness, usage patterns, barriers, and future considerations related to mHealth apps. Descriptive statistical analyses were conducted to identify factors influencing mHealth app adoption and attitudes among Bangladeshi physicians. Results: The results indicated a relatively high level of engagement with mHealth apps among Bangladeshi physicians, with 63.3% reporting personal usage for health monitoring. However, variability in recommendation practices and integration into clinical workflows highlighted challenges in adoption. Barriers to adoption included lack of awareness, security concerns, and technological barriers. Despite these challenges, a significant proportion of physicians expressed willingness to consider adopting mHealth apps in the future. Conclusion: The findings of this study underscore the need for targeted interventions to address barriers to mHealth app adoption and promote their effective integration into Bangladesh’s health-care system. Recommendations include targeted educational initiatives, addressing infrastructure barriers, and fostering collaboration among stakeholders. By leveraging mHealth technology, Bangladesh can advance toward a more accessible, efficient, and patient-centered health-care delivery model.

Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one's body during adolescence is scarce. mHealth apps might shape adolescents' body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8% girls; mean age 13.43, SD 1.69 years). The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later (β=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls' physical self-worth in the 12th month (β=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents' body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents' body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents' body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls.

Background: Chronic conditions negatively impact health and well-being; however, lifestyle risk reduction can slow their progression. Monitoring behaviours, tracking health statistics and receiving health education via mobile Health (mHealth) apps can empower patients with chronic conditions to adopt and maintain healthy lifestyles. Given nurses’ roles in managing chronic conditions, they are ideally positioned to integrate mHealth apps into patient care. However, there is currently a gap in our understanding of nurses’ experiences using this technology in their practice. Aim: This paper explores nurses’ experiences using mHealth apps to support patients with, or at risk of, chronic conditions. Design: This qualitative descriptive study was undertaken within a concurrent mixed methods project. Method: Data were collected through semi-structured video interviews with 13 nurses. Interviews were analysed using reflexive thematic analysis. The COREQ checklist was used to guide reporting. Results: Three themes were identified regarding nurses’ experiences of using mHealth apps. The first theme focused on perceptions of mHealth app personal use. In the second theme of perceived benefits of mHealth app use in practice, the two subthemes were: a) health tracking and health literacy, and b) mHealth apps are the future. The final theme, perceived confidence in mHealth app recommendation, also included two subthemes, namely: a) perceived role in app recommendation and b) nurses’ education needs. Conclusion: Exploring nurses’ experience with mHealth apps is crucial for improving the uptake of this technology in usual care. Nurses recognise the potential of mHealth apps to increase health literacy and patient independence, but often lack confidence in using them in practice. Therefore, it is essential to prepare nurses to integrate mHealth apps into their routine practice. This can be achieved by developing a clear framework for mHealth app appraisal and providing the necessary education and training to utilise this framework effectively.

Mobile health (mHealth) apps are becoming a promising tool to motivate sustainable lifestyle and behavior changes, including modifications to diet and exercise. However, most current mHealth apps do not have meaningful, and sustained user acceptance, particularly, among adolescents. They perceive mHealth apps designed for adults to be tedious and visually unexciting, which discourage adolescent usage. Researchers and adolescent mHealth app developers would benefit from a foundational understanding of which functions and features adolescents feel would most motivate app use. Capturing caregivers' and health care providers' inputs are also important as both groups play an integral role in adolescent health care decision-making. The purpose of the study is to explore and analyze mHealth app features identified by adolescents, caregivers, and health care providers that have the potential to inspire continued use, thereby resulting in sustained health behavior changes in adolescents. We used inductive thematic analysis of qualitative data obtained from semi-structured focus groups conducted via Zoom©. Important features of mHealth apps that encourage adoption and continued use were explored with 25 participants, including adolescents, their caregivers, and health care providers. Common features facilitating continual usage of mHealth apps that were identified as significant by participating adolescents, their caregivers and health care providers were: look and feel of the app, customization, educational information/recommendations, and integration with electronic health record. Features such as gamification and social interaction that are usually lacking in current adolescent mHealth apps were well recognized as meaningful for motivational purposes. The findings suggest that adolescents and caregivers identify an app as valuable when it is user-friendly and intuitive and appreciate features that are motivating and can engage users in positive behaviors. Health care providers prefer mHealth apps that are user-friendly and can be effectively integrated into the cycle of care, thereby enabling delivery of efficient and value-based health care. Thus, mHealth app designs that are informed by health care providers' clinical experience and needs, in combination with app features that are desired and supported by both adolescents and their caregivers, have the potential to motivate widespread adoption and long-term use, which could result in improved health behaviors and outcomes among adolescents.

BACKGROUND There is data paucity regarding users’ awareness of privacy concerns and the resulting impact on the acceptance of mobile health (mHealth) apps, especially in the Saudi context. Such information is pertinent in addressing users’ needs in the Kingdom of Saudi Arabia (KSA). OBJECTIVE This article presents a study protocol for a mixed method study to assess the perspectives of patients and stakeholders regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA and the factors affecting the adoption of mHealth apps. METHODS A mixed method study design will be used. In the quantitative phase, patients and end users of mHealth apps will be randomly recruited from various provinces in Saudi Arabia with a high population of mHealth users. The research instrument will be developed based on the emerging themes and findings from the interview conducted among stakeholders, app developers, health care professionals, and users of mHealth apps (n=25). The survey will focus on (1) how to improve patients’ awareness of data security, privacy, and confidentiality; (2) feedback on the current mHealth apps in terms of data security, privacy, and confidentiality; and (3) the features that might improve data security, privacy, and confidentiality of mHealth apps. Meanwhile, specific sections of the questionnaire will focus on patients’ awareness, privacy concerns, confidentiality concerns, security concerns, perceived usefulness, perceived ease of use, and behavioral intention. Qualitative data will be analyzed thematically using NVivo version 12. Descriptive statistics, regression analysis, and structural equation modeling will be performed using SPSS and partial least squares structural equation modeling. RESULTS The ethical approval for this research has been obtained from the Biomedical and Scientific Research Ethics Committee, University of Warwick, and the Medical Research and Ethics Committee Ministry of Health in the KSA. The qualitative phase is ongoing and 15 participants have been interviewed. The interviews for the remaining 10 participants will be completed by November 25, 2023. Preliminary thematic analysis is still ongoing. Meanwhile, the quantitative phase will commence by December 10, 2023, with 150 participants providing signed and informed consent to participate in the study. CONCLUSIONS The mixed methods study will elucidate the antecedents of patients’ awareness and concerns regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA. Furthermore, pertinent findings on the perspectives of stakeholders and health care professionals toward the aforementioned issues will be gleaned. The results will assist policy makers in developing strategies to improve Saudi users’/patients’ adoption of mHealth apps and addressing the concerns raised to benefit significantly from these advanced health care modalities. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/54933

BackgroundGum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting.ObjectiveThe aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app.MethodsThe first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires.ResultsThere was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=−2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04).ConclusionsPotential mHealth users will be willing to pay for app use depending on their perception of the app’s ability to help them personally, provided they define themselves as currently unhealthy.

Since app stores launched in 2008, the number of direct-to-consumer mobile health (mHealth) apps has grown to hundreds of thousands. mHealth apps are often unregulated by international regulatory agencies and rarely evaluated for effectiveness, quality, data security, and safety. Evaluation frameworks and scales exist, but the onus of evaluating mHealth apps remains on end users. This best practice review aims to facilitate clinical implementation of mHealth by providing healthcare professionals with practical guidance for evaluating mHealth apps. We searched online for evaluation frameworks, scales, and searchable databases that met inclusion criteria: accessible online, preferably peer reviewed, available in English, and focused on mHealth. Three frameworks, two scales, and two searchable databases met the criteria and are reviewed. Frameworks, scales, and searchable databases generally assess app accessibility/usability, subject/content quality, and effectiveness. However, data privacy/security and engagement are rarely measured, and clinical effectiveness is often of limited focus. Considerations for mHealth implementation with marginalized and international groups are also discussed. We propose evidence-based guidelines and information to evaluate and integrate mHealth apps into healthcare settings and patient treatment plans. To our knowledge, these are the first guidelines proposed specific to integrating mHealth apps into clinical practice. The guidance for making quality recommendations to patients is of high utility to providers and healthcare organizations wishing to support treatment plans and behavior change through technological adjuncts. Future research should focus on the use of evaluation frameworks and scales to improve mHealth implementation and health outcomes.

BackgroundThere is data paucity regarding users’ awareness of privacy concerns and the resulting impact on the acceptance of mobile health (mHealth) apps, especially in the Saudi context. Such information is pertinent in addressing users’ needs in the Kingdom of Saudi Arabia (KSA).ObjectiveThis article presents a study protocol for a mixed method study to assess the perspectives of patients and stakeholders regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA and the factors affecting the adoption of mHealth apps.MethodsA mixed method study design will be used. In the quantitative phase, patients and end users of mHealth apps will be randomly recruited from various provinces in Saudi Arabia with a high population of mHealth users. The research instrument will be developed based on the emerging themes and findings from the interview conducted among stakeholders, app developers, health care professionals, and users of mHealth apps (n=25). The survey will focus on (1) how to improve patients’ awareness of data security, privacy, and confidentiality; (2) feedback on the current mHealth apps in terms of data security, privacy, and confidentiality; and (3) the features that might improve data security, privacy, and confidentiality of mHealth apps. Meanwhile, specific sections of the questionnaire will focus on patients’ awareness, privacy concerns, confidentiality concerns, security concerns, perceived usefulness, perceived ease of use, and behavioral intention. Qualitative data will be analyzed thematically using NVivo version 12. Descriptive statistics, regression analysis, and structural equation modeling will be performed using SPSS and partial least squares structural equation modeling.ResultsThe ethical approval for this research has been obtained from the Biomedical and Scientific Research Ethics Committee, University of Warwick, and the Medical Research and Ethics Committee Ministry of Health in the KSA. The qualitative phase is ongoing and 15 participants have been interviewed. The interviews for the remaining 10 participants will be completed by November 25, 2023. Preliminary thematic analysis is still ongoing. Meanwhile, the quantitative phase will commence by December 10, 2023, with 150 participants providing signed and informed consent to participate in the study.ConclusionsThe mixed methods study will elucidate the antecedents of patients’ awareness and concerns regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA. Furthermore, pertinent findings on the perspectives of stakeholders and health care professionals toward the aforementioned issues will be gleaned. The results will assist policy makers in developing strategies to improve Saudi users’/patients’ adoption of mHealth apps and addressing the concerns raised to benefit significantly from these advanced health care modalities.International Registered Report Identifier (IRRID)DERR1-10.2196/54933

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.

BackgroundHospital-based violence intervention programs have shown promise in mitigating the effects of violence, but their impact is limited by time constraints and inefficient practices faced by the violence prevention professionals (VPPs) who function as case managers. Mobile health (mHealth) apps offer the potential to enhance communication and service delivery between VPPs and clients, but few have been specifically designed for vulnerable populations.ObjectiveThis study aims to design an mHealth app to improve communication and access to resources between survivors of violence and their VPPs using human-centered design (HCD) and iterative prototyping methods.MethodsHCD methodology was used, including rounds of Participatory Design, Low-fidelity Prototype Testing, and High-fidelity Prototype Testing. The Participatory Design phase included in-depth interviews and co-design, followed by inductive qualitative analysis to inform the mHealth app’s initial low-fidelity design. The Low-fidelity Prototype Testing phase included in-depth interviews with probing questions about the low-fidelity design, followed by inductive qualitative analysis to inform the mHealth app’s initial high-fidelity design. The High-fidelity Prototype Testing phase used the Rapid Iterative Testing and Evaluation (RITE) method and inductive qualitative analysis to rapidly collect and integrate VPP feedback into the mHealth app’s final design approved for implementation.ResultsNine VPPs participated in 3 rounds of testing and feedback. Participatory Design identified four key themes: (1) trust, (2) personal connection, (3) tailored resource curation, and (4) management of administrative burdens. Low-fidelity Prototype Testing identified three additional key themes: (5) intuitive and comprehensive design, (6) dynamic journey and sense of progress, and (7) standardization of verbiage and design choices. High-fidelity Prototype Testing through RITE identified 181 actionable issues, with 133 addressed, achieving a 73% impact ratio (used to measure the effectiveness of usability improvements). High-fidelity Prototype Testing identified 9 key themes, reaffirming 5 themes from prior testing sessions (themes 2, 3, 5, 6, and 7) and uncovering four novel themes: (8) control over boundaries, (9) celebration of client successes, (10) client empowerment, and (11) warm handoff. The final mHealth app version adapted from 3 low-fidelity digital representations (wireframes) to 25 high-fidelity wireframes of a mHealth app to support case management.ConclusionsThe combination of HCD and RITE methodologies resulted in an mHealth app tailored to the needs of VPPs working with survivors of violence. This approach may be transferable to the development of other mHealth apps for specialized populations, although further research with larger samples would be needed to establish generalizability.

Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For userexperience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showedthatrehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4%; postpandemic: 146/178, 82.0%; P=.006) steadily increased after the outbreak. mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion.