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      A Mobile App for Assisting Users to Make Informed Selections in Security Settings for Protecting Personal Health Data: Development and Feasibility Study

      research-article
      , DSc, PhD 1 , , , PhD 1 , , MSc 1 , , MSc 1
      (Reviewer), (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      data security, mobile app, education, feasibility studies

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          Abstract

          Background

          On many websites and mobile apps for personal health data collection and management, there are security features and privacy policies available for users. Users sometimes are given an opportunity to make selections in a security setting page; however, it is challenging to make informed selections in these settings for users who do not have much education in information security as they may not precisely know the meaning of certain terms mentioned in the privacy policy or understand the consequences of their selections in the security and privacy settings.

          Objective

          The aim of this study was to demonstrate several commonly used security features such as encryption, user authentication, and access control in a mobile app and to determine whether this brief security education is effective in encouraging users to choose stronger security measures to protect their personal health data.

          Methods

          A mobile app named SecSim (Security Simulator) was created to demonstrate the consequences of choosing different options in security settings. A group of study participants was recruited to conduct the study. These participants were asked to make selections in the security settings before and after they viewed the consequences of security features. At the end of the study, a brief interview was conducted to determine the reason for their selections in the security settings. Their selections before and after the security education were compared in order to determine the effectiveness of the security education. The usability of the app was also evaluated.

          Results

          In total, 66 participants finished the study and provided their answers in the app and during a brief interview. The comparison between the pre- and postsecurity education selection in security settings indicated that 21% (14/66) to 32% (21/66) participants chose a stronger security measure in text encryption, access control, and image encryption; 0% (0/66) to 2% (1/66) participants chose a weaker measure in these 3 security features; and the remainder kept their original selections. Several demographic characteristics such as marital status, years of experience using mobile devices, income, employment, and health status showed an impact on the setting changes. The usability of the app was good.

          Conclusions

          The study results indicate that a significant percentage of users (21%-32%) need guidance to make informed selection in security settings. If websites and mobile apps can provide embedded security education for users to understand the consequences of their security feature selection and the meaning of commonly used security features, it may help users to make the best choices in terms of security settings. Our mobile app, SecSim, offers a unique approach for mobile app users to understand commonly used security features. This app may be incorporated into other apps or be used before users make selections in their security settings.

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          Most cited references18

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          Privacy and human behavior in the age of information.

          This Review summarizes and draws connections between diverse streams of empirical research on privacy behavior. We use three themes to connect insights from social and behavioral sciences: people's uncertainty about the consequences of privacy-related behaviors and their own preferences over those consequences; the context-dependence of people's concern, or lack thereof, about privacy; and the degree to which privacy concerns are malleable—manipulable by commercial and governmental interests. Organizing our discussion by these themes, we offer observations concerning the role of public policy in the protection of privacy in the information age.
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            A qualitative study of user perceptions of mobile health apps

            Background Mobile apps for health exist in large numbers today, but oftentimes, consumers do not continue to use them after a brief period of initial usage, are averse toward using them at all, or are unaware that such apps even exist. The purpose of our study was to examine and qualitatively determine the design and content elements of health apps that facilitate or impede usage from the users’ perceptive. Methods In 2014, six focus groups and five individual interviews were conducted in the Midwest region of the U.S. with a mixture of 44 smartphone owners of various social economic status. The participants were asked about their general and health specific mobile app usage. They were then shown specific features of exemplar health apps and prompted to discuss their perceptions. The focus groups and interviews were audio recorded, transcribed verbatim, and coded using the software NVivo. Results Inductive thematic analysis was adopted to analyze the data and nine themes were identified: 1) barriers to adoption of health apps, 2) barriers to continued use of health apps, 3) motivators, 4) information and personalized guidance, 5) tracking for awareness and progress, 6) credibility, 7) goal setting, 8) reminders, and 9) sharing personal information. The themes were mapped to theories for interpretation of the results. Conclusions This qualitative research with a diverse pool of participants extended previous research on challenges and opportunities of health apps. The findings provide researchers, app designers, and health care providers insights on how to develop and evaluate health apps from the users’ perspective. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3808-0) contains supplementary material, which is available to authorized users.
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              Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.

              This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed. These apps have the potential to provide low-cost, around-the-clock access to high-quality, evidence-based health information to end users on a global scale. However, they have not yet lived up to their potential due to multiple barriers, including lack of regulatory oversight, limited evidence-based literature, and concerns of privacy and security. The future directions may consist of improving data integration into the health care system, an interoperable app platform allowing access to electronic health record data, cloud-based personal health record across health care networks, and increasing app prescription by health care providers. For consumer mobile health apps to fully contribute value to health care delivery and chronic disease management, all stakeholders within the ecosystem must collaborate to overcome the significant barriers.
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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
                December 2018
                11 December 2018
                : 6
                : 12
                : e11210
                Affiliations
                [1 ] Department of Health Information Management University of Pittsburgh Pittsburgh, PA United States
                Author notes
                Corresponding Author: Leming Zhou lmzhou@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-4398-0267
                http://orcid.org/0000-0002-4907-8402
                http://orcid.org/0000-0003-1661-1079
                http://orcid.org/0000-0002-1608-7214
                Article
                v6i12e11210
                10.2196/11210
                6305877
                30538088
                d721e975-33c1-4cf9-90cc-7e96cd63b451
                ©Leming Zhou, Bambang Parmanto, Zakiy Alfikri, Jie Bao. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 11.12.2018.

                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
                : 1 June 2018
                : 19 July 2018
                : 12 September 2018
                : 23 September 2018
                Categories
                Original Paper
                Original Paper

                data security,mobile app,education,feasibility studies
                data security, mobile app, education, feasibility studies

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