title: Usability of a Novel Mobile Health iPad App by Vulnerable Populations.
abstract: BACKGROUND
  Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs.
  
  
  OBJECTIVE
  The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid.
  
  
  METHODS
  We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability.
  
  
  RESULTS
  Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance.
  
  
  CONCLUSIONS
  Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities.
authors.affiliation: Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States.
authors.forename: David P
authors.identifier: http://orcid.org/0000-0001-7879-4427
authors.initials: DP
authors.lastname: Miller
authors.affiliation: Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston-Salem, NC, United States.
authors.forename: Kathryn E
authors.identifier: http://orcid.org/0000-0001-9006-4064
authors.initials: KE
authors.lastname: Weaver
authors.affiliation: Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, United States.
authors.forename: L Doug
authors.identifier: http://orcid.org/0000-0002-5706-4377
authors.initials: LD
authors.lastname: Case
authors.affiliation: Wake Forest Health Sciences, Enterprise Information Management, Winston-Salem, NC, United States.
authors.forename: Donald
authors.identifier: http://orcid.org/0000-0003-1899-5731
authors.initials: D
authors.lastname: Babcock
authors.affiliation: Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston-Salem, NC, United States.
authors.forename: Donna
authors.identifier: http://orcid.org/0000-0001-6737-9818
authors.initials: D
authors.lastname: Lawler
authors.affiliation: Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States.
authors.forename: Nancy
authors.identifier: http://orcid.org/0000-0002-8498-0792
authors.initials: N
authors.lastname: Denizard-Thompson
authors.affiliation: University of Texas Dell Medical School, Department of Internal Medicine, Austin, TX, United States.
authors.forename: Michael P
authors.identifier: http://orcid.org/0000-0002-6657-7342
authors.initials: MP
authors.lastname: Pignone
authors.affiliation: Wake Forest School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC, United States.
authors.forename: John G
authors.identifier: http://orcid.org/0000-0002-7949-7050
authors.initials: JG
authors.lastname: Spangler
keywords: decision support techniques; health literacy; primary care; technology assessment; vulnerable populations