Technology Acceptance of two mobile health apps during an observational technology evaluation study: Qualitative results of a mixed-methods study (Preprint)

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Abstract
BACKGROUND Mobile health apps are useful tools for research and disease management. However, implementation of mHealth apps is lacking in many areas. While mHealth apps offer various advantages to researchers and patients, their effectiveness depends on its actual use by the intended population. Barriers to the adoption of mHealth apps often stem from human factors such as usability or technology acceptance. OBJECTIVE This study explores user perceptions of two mHealth apps in the setting of an observational technology evaluation study with the goal to investigate technology acceptance as a barrier to the implementation of mHealth apps in research. METHODS Patients with chronic diseases as well as healthy participants used a symptom and activity e-diary (SAD) and a Cognitive Test App (CTA) over the course of four weeks within the IDEA-FAST Feasibility study. Thereafter, 61 qualitative interviews were conducted, recorded and transcribed. A qualitative content analysis using the Unified Theory of Acceptance and Use of Technology (UTAUT) was performed. RESULTS As the apps did not directly impact the participants’ health, motivation and adherence to schedule were issues with actual use. Some users perceived the SAD as a burden, while others enjoyed tracking their symptoms. The three tests of the CTA differed in popularity. While one test was described as repetitive, another was perceived as too hard and frustrated users. An important aspect of motivation for participants was feedback on their data and performance. While using the apps was quick, the fixed periods of use were more problematic, as they could lead to conflicts with a user’s daily life. Participants preferred using their own phone. The support provided by written instructions and the study team was sufficient for most participants. Participants stressed the importance of good relations with the study team. CONCLUSIONS In choosing suitable applications, one size will certainly not fit all. For medical research, pre-testing of all materials with the potential users is of utmost importance. When an app seemingly does not provide direct impact on the users’ health, other factors can motivate usage, e.g. feedback, gamification, adjustable functions, applicability on all smartphone operating systems and good relations to the study team.

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