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      An mHealth App for Users with Dexterity Impairments: Accessibility Study

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          Abstract

          Background

          A mobile health (mHealth) system called iMHere (interactive mobile health and rehabilitation) was developed to support individuals with chronic conditions and disability in their self-management regimens. The initial design of iMHere, however, lacked sufficient accessibility for users with a myriad of dexterity impairments. The accessibility of self-management apps is essential in ensuring usability.

          Objective

          This study aims to increase the usability of the iMHere system for users with dexterity impairments by increasing the app’s accessibility.

          Methods

          We targeted the accessibility redesign by focusing on the physical presentation and the navigability of the iMHere apps. Six participants presenting with dexterity impairments were included in the usability study of the original and redesigned apps.

          Results

          We observed a lower number of touches needed to complete tasks ( P=.09) and time to complete individual tasks ( P=.06) with the redesigned app than with the original app; a significantly lower time for users to complete all tasks ( P=.006); and a significantly lower error rate ( P=.01) with the redesigned app than with the original app. In fact, no errors occurred with use of the redesigned app. Participant-reported overall average usability of the redesigned app ( P=.007) and usability of individual modules ( P<.001) were significantly higher than that of the original app due mostly to better ease of use and learnability, interface quality, and reliability.

          Conclusions

          Improved usability was achieved using a redesigned app. This study offers insight into the importance of personalization in enhancing the accessibility and also identifies strategies for improving usability in app development.

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          Most cited references34

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          Self-management education: History, definition, outcomes, and mechanisms

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            The Purdue Pegboard Test: normative data for people aged 60 and over.

            Manual dexterity is frequently evaluated in rehabilitation services to estimate hand function. Several tests have been developed for this purpose, including the Purdue Pegboard, which measures fine manual dexterity. The goals of the study were to verify the test-retest reliability with subjects aged 60 and over without upper limb impairment, and to develop normative data based on a random sample of healthy older community-living individuals. The results show that the test-retest reliability is good (intra-class correlation coefficients from 0.66 to 0.90, depending on the subtest). Norms are presented to help clinicians involved in rehabilitation services to better differentiate real dexterity deficits from those that may be attributed to normal ageing.
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              Management of chronic disease by patients.

              Chronic conditions dominate health care in most parts of the world, including the United States. Management of a disease by the patient is central to control of its effects. A wide range of influences in the person's social and physical environments enhance or impede management efforts. Interventions to improve management by patients can produce positive outcomes including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use. Successful programs have been theory based. Self-regulation is a promising framework for the development of interventions. Nonetheless, serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of the factors beyond patient behavior that enable or deter effective management, limitations of study designs in much work to date, reliance on short-term rather than long-term assessments, and failure to evaluate the independent contribution of various program components.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                January 2019
                08 January 2019
                : 7
                : 1
                : e202
                Affiliations
                [1 ] Health & Rehab Informatics Department of Health Information Management University of Pittsburgh Pittsburgh, PA United States
                [2 ] Department of Physical Medicine and Rehabilitation University of Pittsburgh Pittsburgh, PA United States
                Author notes
                Corresponding Author: Bambang Parmanto parmanto@ 123456pitt.edu
                Author information
                http://orcid.org/0000-0002-3045-9918
                http://orcid.org/0000-0002-4907-8402
                http://orcid.org/0000-0003-0738-0192
                Article
                v7i1e202
                10.2196/mhealth.9931
                6329431
                30622096
                73e8bb8b-d2a4-44f9-be48-1cdbfc28e84e
                ©Daihua Yu, Bambang Parmanto, Brad Dicianno. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 08.01.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 29 January 2018
                : 18 February 2018
                : 21 June 2018
                : 27 August 2018
                Categories
                Original Paper
                Original Paper

                accessibility,dexterity impairments,disability,mhealth,self-management,smartphone apps,spina bifida,spinal cord injury,wellness,mobile phone

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