Mobile Applications for Advance Care Planning: A Comprehensive Review of Features, Quality, Content, and Readability

McDarby, Meghan; Llaneza, Danielle; George, Login S.; Kozlov, Elissa

doi:10.1177/1049909120959057

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…The app Accordons-nous obtained high scores on readability (overall score of 87.4 on the Scolarius test, corresponding to elementary school level). This is one of the best scores compared with other similar apps internationally [ 21 ]. However, the language difficulty varies across different pages of the app.…”

Section: Discussionmentioning

confidence: 99%

“…Mobile apps for ACP are available in some countries. Their potential is recognized; however, existing products have limited features and operate mostly in English only [ 21 , 22 ]. We did not find comparable tools available in French.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, they are poor in terms of design quality, layout, and functionality. Only one app (in English) was assessed as “fairly easy to read” [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study

Schöpfer¹,

Ehrler²,

Berger³

et al. 2022

JMIR Hum Factors

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Background Advance care planning, including advance directives, is an important tool that allows patients to express their preferences for care if they are no longer able to express themselves. We developed Accordons-nous, a smartphone app that informs patients about advance care planning and advance directives, facilitates communication on these sensitive topics, and helps patients express their values and preferences for care. Objective The first objective of this study is to conduct a usability test of this app. The second objective is to collect users’ critical opinions on the usability and relevance of the tool. Methods We conducted a usability test by means of a think-aloud method, asking 10 representative patients to complete 7 browsing tasks. We double coded the filmed sessions to obtain descriptive data on task completion (with or without help), time spent, number of clicks, and the types of problems encountered. We assessed the severity of the problems encountered and identified the modifications needed to address these problems. We evaluated the readability of the app using Scolarius, a French equivalent of the Flesch Reading Ease test. By means of a posttest questionnaire, we asked participants to assess the app’s usability (System Usability Scale), relevance (Mobile App Rating Scale, section F), and whether they would recommend the app to the target groups: patients, health professionals, and patients’ caring relatives. Results Participants completed the 7 think-aloud tasks in 80% (56/70) of the cases without any help from the experimenter, in 16% (11/70) of the cases with some help, and failed in 4% (3/70) of the cases. The analysis of failures and difficulties encountered revealed a series of major usability problems that could be addressed with minor modifications to the app. Accordons-nous obtained high scores on readability (overall score of 87.4 on Scolarius test, corresponding to elementary school level), usability (85.3/100 on System Usability Scale test), relevance (4.3/5 on the Mobile App Rating Scale, section F), and overall subjective endorsement on 3 I would recommend questions (4.7/5). Conclusions This usability test helped us make the final changes to our app before its official launch.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study

Schöpfer¹,

Ehrler²,

Berger³

et al. 2022

JMIR Hum Factors

View full text Add to dashboard Cite

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“…[5][6][7] For example, while there has been an exponential increase in the number of eHealth tools, the quality found in usability testing has not increased at an equivalent rate. [14][15][16] Furthermore, in a recent review of the feasibility of 11 web-based ACP eHealth tools, the authors concluded that there was insufficient evidence to recommend use by individuals with limited health or computer literacy due to poor design quality. 16 In contrast, by adhering to these eHealth lessons, PREPARE has been shown to be efficacious and feasible among diverse English and Spanish-speaking older adults.…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly important for those experiencing systemic patterns of disadvantage, such as non-English speaking older adults and those with limited health and computer literacy. 3,12,13 Although some feasibility reviews have been conducted of web-based and mobile applications, [14][15][16][17] and online resources are available, [18][19][20] practical guidance for the development of eHealth tools for diverse older adults does not yet exist in the geriatrics literature. Therefore, the goal of this article is to provide guidance for the development and refinement of eHealth tools for diverse, older populations and provide pragmatic examples from an evidenced-based eHealth tool called PREPARE for Your Care (www.…”

Section: Introductionmentioning

confidence: 99%

Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program

Scheerens

Gilissen

Volow

et al. 2021

J American Geriatrics Society

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Background/Objectives Electronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models. Design Guidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced‐based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations. Results Guidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co‐create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized. Conclusion eHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the “lessons learned” may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.

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Are Mobile Applications in Laryngology Designed for All Patients?

et al. 2022

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Objectives Mobile applications (apps) are multiplying in laryngology, with little standardization of content, functionality, or accessibility. The purpose of this study is to evaluate the quality, functionality, health literacy, readability, accessibility, and inclusivity of laryngology mobile applications. Methods Of the 3230 apps identified from the Apple and Google Play stores, 28 patient‐facing apps met inclusion criteria. Apps were evaluated using validated scales assessing quality and functionality: the Mobile App Rating Scale (MARS) and the Institute for Healthcare Informatics App Functionality Scale. The Clear Communication Index (CDC) Institute of Medicine Strategies for Creating Health Literate Mobile Applications, and Patient Education Materials Assessment Tool (PEMAT) were used to evaluate apps health literacy level. Readability was assessed using established readability formulas. Apps were evaluated for language, accessibility features, and representation of a diverse population. Results Twenty‐six apps (92%) had adequate quality (MARS score > 3). The mean PEMAT score was 89% for actionability and 86% for understandability. On average, apps utilized 25/33 health literate strategies. Twenty‐two apps (79%) did not pass the CDC index threshold of 90% for health literacy. Twenty‐four app descriptions (86%) were above an 8th grade reading level. Only 4 apps (14%) showed diverse representation, 3 (11%) had non‐English language functions, and 2 (7%) offered subtitles. Inter‐rater reliability for MARS was adequate (CA‐ICC = 0.715). Conclusion While most apps scored well in quality and functionality, many laryngology apps did not meet standards for health literacy. Most apps were written at a reading level above the national average, lacked accessibility features, and did not represent diverse populations. Laryngoscope, 133:1540–1549, 2023

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Mobile Applications for Advance Care Planning: A Comprehensive Review of Features, Quality, Content, and Readability

Cited by 11 publications

References 27 publications

A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study

A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study

Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program

Are Mobile Applications in Laryngology Designed for All Patients?

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