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      A user-centred design framework for mHealth

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          Abstract

          Background

          Mobile health (mHealth) has the potential to improve access to healthcare, especially in developing countries. The proliferation of mHealth has not been accompanied by a corresponding growth in design guidelines for mHealth applications. This paper proposes a framework for mHealth application design that combines the Information Systems Research (ISR) framework and design thinking. We demonstrate a use case for the proposed framework in the form of an app to read the result of the tuberculin skin test (TST), which is used to screen for latent tuberculosis infection. The framework was used in the re-design of the TST reading app but could also be used in earlier stages of mHealth app design.

          Methods

          The ISR framework and design thinking were merged based on how the modes of design thinking integrate with the cycles of the ISR framework. Using the combined framework, we re-designed an mHealth app for TST reading, intended to be used primarily in a developing context by healthcare workers. Using the proposed framework, the app was iterated upon and developed with the aid of personas, observations, prototyping and questionnaires.

          Result

          The combined framework was applied through engagement with end-users, namely ten healthcare workers and ten graduate students. Through review of the literature and iterations of the app prototype, we identified various usability requirements and limitations. These included challenges related to image capture and a misunderstanding of instructions. These insights influenced the development and improvement of the app.

          Conclusion

          The combined framework allowed for engagement with end-users and for low-cost, rapid development of the app while addressing contextual challenges and needs. The integration of design thinking modes with the ISR cycles was effective in achieving the objectives of each approach. The combined framework acknowledges the importance of engaging users when implementing mHealth technologies, especially in developing and under-resourced contexts. Findings from this study support the use of this framework as a guide in the design of user-centred mHealth interventions.

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          Most cited references57

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          Design Science in Information Systems Research

          March, Park, Ram (2004)
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            The Coding Manual for Qualitative Researchers

            Johnny Saldaña’s unique and invaluable manual demystifies the qualitative coding process with a comprehensive assessment of different coding types, examples and exercises. The ideal reference for students, teachers, and practitioners of qualitative inquiry, it is essential reading across the social sciences and neatly guides you through the multiple approaches available for coding qualitative data.</p> <p>Its wide array of strategies, from the more straightforward to the more complex, is skillfully explained and carefully exemplified providing a complete toolkit of codes and skills that can be applied to any research project. For each code Saldaña provides information about the method′s origin, gives a detailed description of the method, demonstrates its practical applications, and sets out a clearly illustrated example with analytic follow-up. <br> <br> Now with a companion website, the book is supported by: </p> <ul> <li>SAGE journal articles showing coding being applied to real research </li> <li>Sample transcripts highlighting coding techniques </li> <li>Links to CAQDAS sites to introduce relevant software </li> <li>Practical student exercises Links to video and digital content </li> </ul> <p>This international bestseller is an extremely usable, robust manual and is a must-have resource for qualitative researchers at all levels.<br> <br> Click here for a listing of Johnny Saldaña′s upcoming workshops.</p>
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              Mapping mHealth Research: A Decade of Evolution

              Background For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 August 2020
                2020
                : 15
                : 8
                : e0237910
                Affiliations
                [1 ] Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
                [2 ] Division of Epidemiology and Biostatistics, School of Public Health and CIDRI-AFRICA, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
                [3 ] Institute for Global Health, University College London, London, United Kingdom
                Columbia University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-7564-954X
                http://orcid.org/0000-0003-2146-5600
                http://orcid.org/0000-0003-1210-2832
                http://orcid.org/0000-0003-2024-4179
                Article
                PONE-D-20-01209
                10.1371/journal.pone.0237910
                7444488
                32813711
                42b9ce78-2fa7-4b07-a9b5-ea600b338f4a
                © 2020 Farao et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 January 2020
                : 5 August 2020
                Page count
                Figures: 6, Tables: 7, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001321, National Research Foundation;
                Award ID: 98788
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: U54EB027049
                Award Recipient :
                The research has been supported by the South African Research Chairs Initiative of the Department of Science and Technology and the National Research Foundation of South Africa (Grant No. 98788), and the Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, which is funded by National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health (Award No. U54EB027049). The content is solely the responsibility of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                All relevant data are within the manuscript. The summarized and synthesized data included in the paper constitute the minimal data set required to replicate the study's findings.

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