Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking (Preprint)

Abstract

BACKGROUND Early identification of quality-of-life losses and side effects is a key challenge in breast cancer therapy. Digital tools can implement regular screening for side effects as well as patient education for improved self-management. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in three breast cancer centers. The app simultaneously serves as a therapy companion, as a tool for documenting of quality of life, and patient-reported side effects. The need for the usage of digital tools to improve patient care such as tumor therapy, therapy adherence, and patient satisfaction is continually on the rise. However, the evidence on the effect of such long-term usage of mobile health (mHealth) apps in aftercare for breast cancer patients has been limited. Therefore, evaluating the usability and understanding the user experience of such mHealth apps is an important research question. OBJECTIVE A usability study was conducted to find out how patients rate their engagement with the app, the user experience, and the benefits of using the app. METHODS A mixed-methods approach was chosen, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App usability questionnaire, MAUQ) and semi-structured interviews. Interviews were transcribed verbatim and analyzed according to thematic analysis. The analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was carried out for the quantitative data. RESULTS The MAUQ results indicated good overall usability for two different points of time. The analysis of the eye-tracking recordings and the interviews showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and the usefulness of the app as a therapy companion were rated positively by the participants. However, requests for additional app features as well as suggestions for improving the content and usability of the app were also identified. Relevant themes included the optimization of the appointment feature, updating the app's content regularly, and the self-administration of content. A key point is that the app currently informs the patient mainly in a passive way. CONCLUSIONS The results of this usability study demonstrate good usability of the Enable App as well as the potential for further development. We could conclude from patients’ feedback and requests that the app needs to be further developed to allow for active input of patient information and thus encourage continued use of the app throughout therapy. Our findings will also help other researchers in tailoring their mHealth apps towards the actual needs of patients in breast cancer therapy.