A recent article in the Journal of mHealth and uHealth caught my attention: Association Between the Characteristics of mHealth Apps and User Input During Development and Testing: Secondary Analysis (Frey et. all, 2023).

Of course I’m interested in what users think of mHealth apps and what that means for the app’s success.

My guess was it should be obvious that when user input is prioritized, they are more engaged because the content is easy to relate to.

For the most part, that guess was confirmed. But I wanted to call out a couple specific results that as a content designer, I’m particularly interested.

A brief overview of the study

The researchers had 3 goals:

• understand how user input during development and testing phases were different between countries, conditions, and app risks;
• find out if more user input was related to higher app ratings or downloads;
• and, if more user input meant greater compliance with best practices in clinical assurance, data privacy, risk management, and user experience.

This study was done in the UK and included 1595 apps. The dataset had been previously collected by the Organisation for the Review of Care and Health Apps (ORCHA). Each app was evaluated using 300 objective questions. These questions came from standards, guidelines, and regulatory requirements from several widely recognized national and international regulatory organizations.

There were some limitations that bothered me while I read the study. I felt certain definitions and criteria significantly influenced the results of the study.

But it’s a secondary analysis of a recycled dataset. You work with what you have.

Although it didn’t set me completely at ease, the researchers did address their limitations and speculated what kind of data they’d need and how it would’ve helped.

Results

I won’t dig deep into all the results.

Suffice it to say that, on the whole, the study determined that overall, yes, user involvement are associated with mHealth apps that are clinically sound, regulation compliant, and are tools people want to use and have a good experience using.

A few specific results relevant to my work in content design were:

Apps that involved user input were more likely to explain how user data collected was used.

Users want to know how their data is being used. They want reassurance that their personal health information is safe.

As a content designer, I need to be aware of this and advocate for the user by pressing for answers on questions they care about, like “Is this information necessary for us to collect? Why?” and “How will the company having this information benefit the user?”

Apps that involved user input were more likely to clearly state who the app is and is not for.

I once read a review written by an 11 year old for a menstrual cycle and fertility tracking app. She had made an account with a false birth date to track her cycle markers and symptoms. She wrote that she didn’t feel some topics in the app were appropriate for someone her age. The company responded, saying she was in violation of their terms of service which stated the app is meant for people age 13+, and she needed to close her account. From her review it was clear that she understood her birth date wasn’t in the target range, and that was the reason for the false date.

I wonder what, if any, message the user received about this policy during onboarding. At the very least, including a reason at that touchpoint for why the restriction existed could have convinced her that this wasn’t the app for her.

It also brings to mind digital health services that are only available with partnered health insurance plans. How do you tell people who have a different plan that they’re not eligible to use the app?

It’s a challenging to balance objectivity and empathy matters in conveying messages like these, especially when there’s a character limit. But it’s important nevertheless. The benefit to prospective users includes saving on invested time, relevance, and legal liability.

Apps that involved user input were more likely to allow for notification management.

This isn’t strictly related to UX copy. But it is related to content design and information architecture.

A company may be tempted to maintain control of notifications. This allows for notifications to frequently remind users to engage with an app. Users might not appreciate constant notifications. They want control. And they should be in control. User freedom is a fundamental usability heuristic.

App designers can respect this important user issue by surfacing this app utility. It doesn’t have to be top-level, but it should be logically and intuitive located within the app.

Working with them could improve the relationship between the user and the product.

Apps that involved user input were more likely to explain clinical or technical terms.

While I do believe in breaking down complex concepts to plain language, I have three thoughts to add.

First, it’s important to consider who the target audience is. Who are they (demographically)? What do they know about this topic? What are the words they use when talking about this topic?

That’s is the first step to initially gauge the language to use within a product.

Second, users language might change over time. In the menstrual cycle and fertility tracking app mentioned earlier, there is a unique language culture among users. There are a lot of acronyms. Frequent users who have gained the knowledge easily navigate the in-app discussions forums. New users are constantly seeking clarification.

Just because long-time users have an evolved terminology, doesn’t mean the app should. Designers should aim keep barriers low for new users. Relying on basic language means experienced users can still understand it, and yet it’s not exclusive.

Third, there are several online tools for measuring readability. Many are free and low-effort. Designers should use them.

Or hire a UX Writer.

Other insights

There were a few more ideas mentioned in the article that I found thought-provoking.

Here are a couple:

To ensure that new health technologies help improve rather than exacerbate such inequalities, it is critical to actively involve disadvantaged individuals to understand their needs and the barriers they may face to accessing health innovations.

“Digital determinants of health” is the phrase used to describe the direct and indirect ways that health technology influences equity in health and well-being. It is becoming a hot discussion and growing public health concern.

We shouldn’t stop at getting input from users representative of disadvantaged groups. We need to make sure they have access to these tools we’re using their input to develop. Otherwise, what’s the point?

…countries with higher, compared with lower, digital maturity in health care may offer better access to funding or know-how to support user involvement activities or may allow developers to invest more resources into those activities…

Per this study, the largest number of health apps were developed in the US and UK. The most The UK was in the top 5 countries for including user input during development. The US was not in the 5 top for including user input during development or testing.

While I suspect limitations of the study may play a role in understanding this data, I do think it makes an interesting insight: a country’s overall financial investment in digital health is not the same as it’s digital health infrastructure maturity. I may be mistaken, but from my pulse on the healthtech sector, it seems the UK’s health organizations and compliance entities have are developing a strong coordinated effort in regulating and funding digital health tools.

And yet, investment in understanding user’s experiences and perspectives is a sort of investment in the success of a product which means a positive financial impact on the companies that own them.

Final thoughts

I felt the limitations of the study’s dataset made me suspect of the results overall. Nevertheless, the article was thought-provoking. The researchers used their findings not as an end-all for this area of research, but as a means to highlight the need for further studies on user-involvement in the development of mHealth and the potential that this involvement could unlock.

References

Frey, A., Baines, R., Hunt, S., Kent, R., Andrews, T., & Leigh, S. (2023). Association between the characteristics of MHealth apps and user input during development and testing: Secondary analysis of app assessment data. Jmir Mhealth and Uhealth, 11, e46937. https://doi.org/10.2196/46937

American Medical Association & American Medical Association. (2022, August 15). Patients want privacy, accountability for how their health data is used. American Medical Association. https://www.ama-assn.org/delivering-care/patient-support-advocacy/patients-want-privacy-accountability-how-their-health-data

User Control and Freedom (Usability Heuristic #3). (n.d.). Nielsen Norman Group. https://www.nngroup.com/articles/user-control-and-freedom/

Governing Health Futures 2030 Commission (2021). Policy brief: The digital determinants of health. Geneva. https://governinghealthfutures2030.org/pdf/policy-briefs/DigitalDeterminants.pdf

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Interested in partnering? Let’s talk to see how I can help you create a comfortable digital health experience. Drop me a note at evy.haan@gmail.com.

Photo by Etienne Girardet on Unsplash.