title: Supporting cancer patients in illness management: usability evaluation of a mobile app.
abstract: BACKGROUND
  Mobile phones and tablets currently represent a significant presence in people's everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care.
  
  
  OBJECTIVE
  Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets.
  
  
  METHODS
  The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants' feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management.
  
  
  RESULTS
  The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients' requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process.
  
  
  CONCLUSIONS
  Understanding and addressing users' requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues.
authors.affiliation: Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway. Jelena.Mirkovic@rr-research.no.
authors.forename: Jelena
authors.identifier: http://orcid.org/0000-0001-6828-1230
authors.initials: J
authors.lastname: Mirkovic
authors.forename: David R
authors.identifier: http://orcid.org/0000-0001-9968-9968
authors.initials: DR
authors.lastname: Kaufman
authors.forename: Cornelia M
authors.identifier: http://orcid.org/0000-0001-6521-4884
authors.initials: CM
authors.lastname: Ruland
keywords: cell phone; mobile applications; patients; self-care; smartphone; symptom assessment; user-computer interface