title: Usability of Commercially Available Mobile Applications for Diverse Patients.
abstract: Mobile applications or 'apps' intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications.
  
  
  
  The objective of this study was to investigate the usability of existing mobile health applications ("apps") for diabetes, depression, and caregiving, in order to facilitate development and tailoring of patient-facing apps for diverse populations.
  
  
  
  Usability testing, a mixed-methods approach that includes interviewing and direct observation of participant technology use, was conducted with participants (n = 9 caregivers; n = 10 patients with depression; and n = 10 patients with diabetes) on a total of 11 of the most popular health apps (four diabetes apps, four depression apps, and three caregiver apps) on both iPad and Android tablets.
  
  
  
  The participants were diverse: 15 (58 %) African Americans, seven (27 %) Whites, two (8 %) Asians, two (8 %) Latinos with either diabetes, depression, or who were caregivers.
  
  
  
  Participants were given condition-specific tasks, such as entering a blood glucose value into a diabetes app. Participant interviews were video recorded and were coded using standard methods to evaluate attempts and completions of tasks. We performed inductive coding of participant comments to identify emergent themes.
  
  
  
  Participants completed 79 of 185 (43 %) tasks across 11 apps without assistance. Three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management.
  
  
  
  App developers should employ participatory design strategies in order to have an impact on chronic conditions such as diabetes and depression that disproportionately affect vulnerable populations. While patients express interest in using technologies for self-management, current tools are not consistently usable for diverse patients.
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, CA, USA. Urmimala.Sarkar@ucsf.edu.|DGIM at SFGH, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94143, USA. Urmimala.Sarkar@ucsf.edu.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, CA, USA.|DGIM at SFGH, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94143, USA.
authors.forename: Gato I
authors.initials: GI
authors.lastname: Gourley
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, CA, USA.|DGIM at SFGH, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94143, USA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, CA, USA.|DGIM at SFGH, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94143, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Tieu
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, CA, USA.|DGIM at SFGH, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94143, USA.
authors.forename: Cassidy
authors.initials: C
authors.lastname: Clarity
authors.affiliation: Information Systems, Partners HealthCare System, Wellesley, MA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Newmark
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Karandeep
authors.initials: K
authors.lastname: Singh
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D040421:Cell Phone / Q000706:statistics & numerical data; D003863:Depression / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data; D017216:Telemedicine / Q000706:statistics & numerical data*; D014584:User-Computer Interface; D035862:Vulnerable Populations / Q000208:ethnology / Q000523:psychology*
keywords: chronic diseases; computers; handheld; informatics; patient engagement