This article presents a comprehensive and multistage approach to the development of the user experience (UX) for an mHealth application targeting older adult patients with chronic diseases, specifically chronic heart failure and chronic obstructive pulmonary disease. The study adopts a mixed methods approach, incorporating both quantitative and qualitative components. The underlying hypothesis posits that baseline medicine adherence knowledge (measured by the MARS questionnaire), beliefs about medicines (measured by the BMQ questionnaire), and level of user experience (measured by the SUS and UEQ questionnaires) act as predictors of adherence change after a period of usage of the mHealth application. However, contrary to our expectations, the results did not demonstrate the anticipated relationship between the variables examined. Nevertheless, the qualitative component of the research revealed that patients, in general, expressed satisfaction with the application. It is important to note that the pilot testing phase revealed a notable prevalence of technical issues, which may have influenced participants' perception of the overall UX. These findings contribute to the understanding of UX development in the context of mHealth applications for older adults with chronic diseases and emphasise the importance of addressing technical challenges to enhance user satisfaction and engagement.

Center for Digital Health Palacký University Olomouc 77900 Olomouc Czech Republic

Czech National eHealth Center University Hospital Olomouc Zdravotníků 248 7 77900 Olomouc Czech Republic

Department of Psychology Faculty of Arts Palacký University Olomouc Křížkovského 10 77900 Olomouc Czech Republic

Medicines Optimisation Innovation Centre Pine House Antrim Area Hospital Site Bush Road Antrim BT41 2RL UK

See more in PubMed

Chew S., Lai P.S.M., Ng C.J. Usability and Utility of a Mobile App to Improve Medication Adherence among Ambulatory Care Patients in Malaysia: Qualitative Study. JMU. 2020;8:e15146. doi: 10.2196/15146. PubMed DOI PMC

Patel T., Ivo J., Faisal S., McDougall A., Carducci J., Pritchard S., Chang F. A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers. J. Med. Internet Res. 2020;22:e18073. doi: 10.2196/18073. PubMed DOI PMC

Shamsujjoha M., Grundy J., Li L., Khalajzadeh H., Lu Q. Human-Centric Issues in eHealth App Development and Usage: A Preliminary Assessment; Proceedings of the IEEE International Conference on Software Analysis, Evolution and Reengineering (SANER); Honolulu, HI, USA. 9–12 March 2021; pp. 506–510. DOI

McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., et al. ESC Scientific Document Group. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368. PubMed DOI

Ramani G.V., Uber P.A., Mehra M.R. Chronic Heart Failure: Contemporary Diagnosis and Management. Mayo Clin. Proc. 2010;85:180–195. doi: 10.4065/mcp.2009.0494. PubMed DOI PMC

Beggs S.A.S., McDonagh T.A., Gardner R.S. Chronic heart failure: Epidemiology, investigation, and management. Medicine. 2022;50:479–486. doi: 10.1016/j.mpmed.2022.05.002. DOI

Špinar J., Špinarová L., Vítovec J. Patofyziologie, příčiny a epidemiologie chronického srdečního selhání. Vnitřní Lékařství. 2018;64:834–838. doi: 10.36290/vnl.2018.114. PubMed DOI

Burdese E., Testa M., Raucci P., Ferreri C., Giovannini G., Lombardo E., Avogadri E., Feola M. The usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients. Diseases. 2018;6:10. doi: 10.3390/diseases6010010. PubMed DOI PMC

Jessup M., Brozena S. Heart failure. N. Engl. J. Med. 2003;348:2007–2018. doi: 10.1056/NEJMra021498. PubMed DOI

Ding H., Jayasena R., Chen S.H., Maiorana A., Dowling A., Layland J., Good N., Karunanithi M., Edwards I. The Effects of Telemonitoring on Patient Compliance With Self-management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial. J. Med. Internet Res. 2020;22:e17559. doi: 10.2196/17559. PubMed DOI PMC

Andrès E., Talha S., Zulfiqar A.A., Hajjam M., Ervé S., Hajjam J., Gény B., Hajjam El Hassani A. Current Research and New Perspectives of Telemedicine in Chronic Heart Failure: Narrative Review and Points of Interest for the Clinician. J. Clin. Med. 2018;7:544. doi: 10.3390/jcm7120544. PubMed DOI PMC

Liu S., Li J., Wan D., Li R., Qu Z., Hu Y., Liu J. Effectiveness of eHealth Self-management Interventions in Patients With Heart Failure: Systematic Review and Meta-analysis. J. Med. Internet Res. 2022;24:e38697. doi: 10.2196/38697. PubMed DOI PMC

Xu L., Li F., Zhou C., Li J., Hong C., Tong Q. The effect of mobile applications for improving adherence in cardiac rehabilitation: A systematic review and meta-analysis. BMC Cardiovasc. Disord. 2019;19:166. doi: 10.1186/s12872-019-1149-5. PubMed DOI PMC

Karagiannis D., Mitsis K., Nikita K.S. Development of a Low-Power IoMT Portable Pillbox for Medication Adherence Improvement and Remote Treatment Adjustment. Sensors. 2022;22:5818. doi: 10.3390/s22155818. PubMed DOI PMC

Payne A., Surikova J., Liu S., Ross H., Mechetiuc T., Nolan R. Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure. JMIR Hum. Factors. 2015;2:e7. doi: 10.2196/humanfactors.4125. PubMed DOI PMC

Auton A., Zaman S., Padayachee Y., Samways J., Quaife N., Sweeney M., Tenorio I., Linton N., Cole G., Peters N., et al. Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives. JMIR Nurs. 2023;6:e44630. doi: 10.2196/44630. PubMed DOI PMC

Vuorinen A., Leppänen J., Kaijanranta H., Kulju M., Heliö T., van Gils M., Lähteenmäki J. Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial. J. Med. Internet Res. 2014;16:e282. doi: 10.2196/jmir.3651. PubMed DOI PMC

Pauwels R.A., Buist S., Calverley P.M.A., Jenkins C.R., Hurd S.S. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 2001;163:1256–1276. doi: 10.1164/ajrccm.163.5.2101039. PubMed DOI

Časný Záchyt Chronické Obstrukční Plicní Nemoci v Rizikové Populace. [(accessed on 15 July 2023)]. Available online: https://nsc.uzis.cz/zdraveplice/index.php?pg=chopn.

Poberezhets V., Kasteleyn M.J. Telemedicine and home monitoring for COPD—A narrative review of recent literature. Curr. Opin. Pulm. Med. 2023;29:259–269. doi: 10.1097/MCP.0000000000000969. PubMed DOI

Farias R., Sedeno M., Beaucage D., Drouin I., Ouellet I., Joubert A., Abimaroun R., Patel M., Rjeili M.A., Bourbeau J. Innovating the treatment of COPD exacerbations: A phone interactive telesystem to increase COPD Action Plan adherence. BMJ Open Respir. Res. 2019;6:e000379. doi: 10.1136/bmjresp-2018-000379. PubMed DOI PMC

Leonard R., Forte M., Mehta D., Mujahid H., Stansbury R. The impact of a telemedicine intervention on home non-invasive ventilation in a rural population with advanced COPD. Clin. Respir. J. 2020;15:728–734. doi: 10.1111/crj.13354. PubMed DOI

Alghamdi S.M., Janaudis-Ferreira T., Alhasani R., Ahmed S. Acceptance, adherence and dropout rates of individuals with COPD approached in telehealth interventions: A protocol for systematic review and meta-analysis. BMJ Open. 2019;9:e026794. doi: 10.1136/bmjopen-2018-026794. PubMed DOI PMC

Korkmaz Yaylagul N., Kirisik H., Bernardo J., Dantas C., van Staalduinen W., Illario M., De Luca V., Apóstolo J., Silva R. Trends in Telecare Use among Community-Dwelling Older Adults: A Scoping Review. Int. J. Environ. Res. Public Health. 2022;19:16672. doi: 10.3390/ijerph192416672. PubMed DOI PMC

Lilholt P.H., Heiden S., Hejlesen O.K. User Satisfaction and Experience with a Telehealth System for the Danish TeleCare North Trial: A Think-Aloud Study. In: Lovis C., Séroussi B., Hasman A., Pape-Haugaard L., Saka O., Andersen S.K., editors. Studies in Health Technology and Informatics No. 205. IOS Press; Amsterdam, The Netherlands: 2014. pp. 900–904. PubMed DOI

Brunton L., Bower P., Sanders C. The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis. PLoS ONE. 2015;10:e0139561. doi: 10.1371/journal.pone.0139561. PubMed DOI PMC

Jiang Y., Sun P., Chen Z., Guo J., Wang S., Liu F., Li J. Patients’ and healthcare providers’perceptions and experiences of telehealth use and online health information use in chronic disease management for older patients with chronic obstructive pulmonary disease: A qualitative study. BMC Geriatr. 2022;22:9. doi: 10.1186/s12877-021-02702-z. PubMed DOI PMC

Dias A., Pereira C., Monteiro M.J., Santos C. Patients’ beliefs about medicines and adherence to medication in ischemic heart disease. Atención Primaria. 2014;46:101–106. doi: 10.1016/S0212-6567(14)70074-5. PubMed DOI PMC

Gagnon M.D., Waltermaurer E., Martin A., Friedenson C., Gayle E., Hauser D.L. Patient Beliefs Have a Greater Impact than Barriers on Medication Adherence in a Community Health Center. J. Am. Board Fam. Med. 2017;30:331–336. doi: 10.3122/jabfm.2017.03.160129. PubMed DOI

Matoulková P., Pavlatová J., Selke Krulichová I. Postoje a adherence diabetiků 2. typu k farmakologické léčbě—Pilotní projekt. [(accessed on 23 October 2023)];Klin. Farmakol. 2012 26:113–116. Available online: https://www.klinickafarmakologie.cz/artkey/far-201203-0002_Postoje_a_adherence_diabetiku_2_typu_k_farmakologicke_lecbe-pilotni_projekt.php.

Roy N.T., Sajith M., Bansode M.P. Assessment of Factors Associated with Low Adherence to Pharmacotherapy in Elderly Patients. J. Young Pharm. 2017;9:272–276. doi: 10.5530/jyp.2017.9.53. DOI

Hamine S., Gerth-Guyette E., Faulx D., Green B.B., Ginsburg A.S. Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review. J. Med. Internet Res. 2015;17:e52. doi: 10.2196/jmir.3951. PubMed DOI PMC

Horne R., Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J. Psychosom. Res. 1999;47:555–567. doi: 10.1016/s0022-3999(99)00057-4. PubMed DOI

Horne R., Weinman J., Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol. Health. 1999;14:1–24. doi: 10.1080/08870449908407311. DOI

Matoulková P., Krulichová I.S., Macek K., Vlček J., Baštecká D., Prixová M., Horne R. Chronically Ill Czech Patient’s Beliefs About Medicines: The Psychometric Properties and Factor Structure of the BMQ-CZ. Ther. Innov. Regul. Sci. 2013;47:341–348. doi: 10.1177/2168479013481968. PubMed DOI

Thorneloe R.J., Griffiths C.E., Ashcroft D.M., Cordingley L. The challenges of assessing patients’ medication beliefs: A qualitative study. BMC Health Serv. Res. 2017;17:119. doi: 10.1186/s12913-017-2020-y. PubMed DOI PMC

Chan A.H.Y., Horne R., Hankins M., Chisari C. The Medication Adherence Report Scale: A measurement tool for eliciting patients’ reports of nonadherence. Br. J. Clin. Pharmacol. 2020;86:1281–1288. doi: 10.1111/bcp.14193. PubMed DOI PMC

Ládová K., Matoulková P., Zadák Z., Macek K., Vyroubal P., Vlček J., Morisky D.E. Self-reported and objective adherence. J. Eval. Clin. Pract. 2014;20:671–677. doi: 10.1111/jep.12201. PubMed DOI

Schrepp M., Hinderks A., Thomaschewski J. Applying the User Experience Questionnaire (UEQ) in Different Evaluation Scenarios. In: Marcus A., editor. Lecture Notes in Computer Science. Springer; Cham, Switzerland: 2014. p. 8517. DOI

Brooke J. SUS: A ‘Quick and Dirty’ Usability Scale. In: Jordan P.W., Thomas B., McClelland I.L., Weerdmeester B., editors. Usability Evaluation in Industry. CRC Press; Boca Raton, FL, USA: 1996. DOI

Lewis J.R. The System Usability Scale: Past, Present, and Future. Int. J. Hum. Comput. Interact. 2018;34:577–590. doi: 10.1080/10447318.2018.1455307. DOI

User Experience Questionnaire Handbook. [(accessed on 27 March 2024)]. Available online: https://www.researchgate.net/publication/281973617_User_Experience_Questionnaire_Handbook?channel=doi&linkId=56004c7008aeafc8ac8c64bb&showFulltext=true.

Schankin A., Budde M., Riedel T., Beigl M. Psychometric Properties of the User Experience Questionnaire (UEQ). In: Barbossa S., Lampe C., Appert C., Shamma D.A., Drucker S., Williamson J., Yatani K., editors. Proceedings of the 2022 CHI Conference on Human Factors in Computing Systems (CHI ‘22); New Orleans, LA, USA. 20 April–5 May 2022; New York, NY, USA: Association for Computing Machinery; 2022. pp. 1–11. DOI

Software Ergonomics for Multimedia User Interfaces. ISO; Geneva, Switzerland: 2002. 44.

Ergonomic Requirements for Office Work with Visual Display Terminals (VDTs) ISO; Geneva, Switzerland: 1996.

Braun V., Clarke V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006;3:77–101. doi: 10.1191/1478088706qp063oa. DOI

Rand C.S., Sevick M.A. Ethics in Adherence Promotion and Monitoring. Control. Clin. Trials. 2000;21:241–247. doi: 10.1016/S0197-2456(00)00085-4. PubMed DOI

Klugman C.M., Dunn L.B., Schwartz J., Cohen I.G. The Ethics of Smart Pills and Self-Acting Devices: Autonomy, Truth-Telling, and Trust at the Dawn of Digital Medicine. Am. J. Bioeth. 2018;18:38–47. doi: 10.1080/15265161.2018.1498933. PubMed DOI

Chan A.H.Y., Stewart A.W., Harrison J., Black P.N., Mitchell E.A., Foster J.M. Electronic adherence monitoring device performance and patient acceptability: A randomized control trial. Expert Rev. Med. Devices. 2017;14:401–411. doi: 10.1080/17434440.2017.1322505. PubMed DOI

Fox J., Weisberg S. Car: Companion to Applied Regression. SAGE; Newcastle upon Tyne, UK: 2020. [(accessed on 1 April 2021)]. [R package] Available online: https://cran.r-project.org/package=car.

Kerby D.S. The Simple Difference Formula: An Approach to Teaching Nonparametric Correlation. Compr. Psychol. 2014;3:11-IT. doi: 10.2466/11.IT.3.1. DOI

R Core Team R: A Language and Environment for Statistical Computing. 2021. [(accessed on 1 April 2021)]. (Version 4.0) [Computer Software] Available online: https://cran.r-project.org.

The Jamovi Project: Jamovi. 2021. [(accessed on 1 April 2021)]. (Version 2.2) [Computer Software] Available online: https://www.jamovi.org.