Key success factors for e-health apps

Improving chronic disease self-management with new technologies: lessons from IROHLA

Through IROHLA we identified and assessed e-health and m-health interventions to develop a set of key success factors for such interventions.

Not an easy task – Why?

E-health and m-health application development is evolving rapidly and a dynamic sector. Many enthusiastic developers are dedicating time and effort to building new and exciting applications to improve health and well-being among older adults. However, there is a lack of rigorous scientific evaluation criteria. This problem is often identified in scientific reviews of e-health and m-health applications. In the evaluation process we developed a number of criteria.

Questionnaires for the evaluation of E-health applications

E-health applications are of increasing importance in modern healthcare but research on the use of e-health applications among older adults with low health literacy is scarce. In the IROHLA project, two questionnaires were developed that could be used in this field of study. The E-health Needs Assessment Questionnaire (ENAQ) is useful to map the general needs of older adults with low health literacy regarding e-health. The Evaluative Questionnaire for E-health Tools (EQET) can be used to assess the suitability of e-health applications for older adults with low health literacy.

Success factors of e-health and m-health applications for older adults

  1. Understand your target group
    a. They are more concerned about privacy than younger people
    b. They are more suspicious about the reliability of information. Clearly link the contents of applications to sound scientific evidence.    Link content to medical and clinical guidelines and present them to users.
    c. They are very cost-conscious with regard to apps. High costs may represent an important barrier.
  2. Older people have lower levels of computer literacy and declining cognitive and physical flexibility.
    a. They need more time to learn to use the apps.
    b. They prefer simple and straightforward apps focusing on core issues; they do not like complex apps.

    Maintenance of health behaviours by e-health interventions: a challenge!

    Older adult: ….The liveonline course has exceeded all my expectations. I reached my goals to eat on a more regular basis and become more physically active. I’m glad that I stayed to the end in this course.

    Maintenance of health behaviours is a crucial factor for effective e-health interventions. The liveonline course was positively evaluated and supported older people in health behaviour change. However, a lot of participants did not finish this course. Results of IROHLA indicate that training of new technology, involvement of the closest social network and a personalized approach can influence the use of technology and maintenance of health behaviours.

  3. Understand the specific needs of older adults; you can learn from the communication and marketing sectors. And practice Person centered communication

Development of apps – success factors

  1. It is valuable to involve the target group during the development of the e-health tool.
    a. Involving older adults with low health literacy directly leads to better awareness of the specific barriers this group faces in using e-health tools.
    b. Co-creation of apps with older people provides insight into their perceptions and abilities.
  2. Tailor content and present information pertinent to the needs and particularities of senior citizens.
    a. Use marketing strategies that private companies use for attracting senior citizens to their products. For example private companies advise that senior citizens should be “targeted in the right way” as they are “wiser, more rational and less influenced by fashion and trends”.
    b. Attracting the population over 50 years old requires not only adapting messages but having a long-term strategy; “a global vision is needed” as is training staff, and using proper communication. (Find website here and here)
  3. Content should be presented:
    a. High contrast – white/cream lettering on a dark/black background is easiest to read.
    b. Use plain and clear fonts.
    c. Use large print type, at least 14-18, or preferably larger.
    d. Dark blues and greens for headings when colour is required.
    e. Use bold type.
    f. Avoid italicisation or writing whole phrases or sentences in capital letters.
    g. Space lines of text by at least 1.5 rather than single spacing.
    h. Use short sentences that are easy to comprehend.
    i. Break text down into clear sections based on topic.
    j. Use headings for main sections.
    k. Use diagrams and pictures when appropriate.

More information can be found here and here.

When developing apps, think of:
• Accessibility (such as ease of navigation),
• Acceptability (such as personalised interactive features),
• Sustainability (willingness to continue use).