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Abstract

mHealth
Applications are the center of attention with changing lifestyles and increase
user’s motivation. Users became more self-educated about nutrition, fitness and
general wellbeing. The available technology facilitates achieving this goal
either through mobile apps or smart watches and activity trackers that can
capture the most personal activities like heart rate, heart rate data can be
captured all the time during working hours, while exercising either running,
swimming or at the gym, even while sleeping.

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mHealth
applications are facing some challenges, some of these challenges are relate to
continuity, security and privacy and data quality which leads users to stop
using the mHealth application and abandon the application. 

1. Introduction

The
adoption rate of Smartphones and mobile apps overpass the adoption rate of
personal computer. That’s due to its portability, enriched connectivity,
efficiency, feasibility and the amount of miniature sensors attached to them.

Smartphones
have evolved from the essential usage like making and receiving calls and
messages, smartphones have become a portal camera, video recorder, sound
recorder, organizer, and lately they become bank cards through Near Field
Communication (NFC).

These
little portal devices have more connectivity sensors than modern laptops, like
GPS, Bluetooth, LTE, 4G and Wi-Fi; even your smartphone can react as a hotspot
and provide internet connectivity your laptop or other devices.

People
found to use mobile applications more than traditional websites or web
applications, and that led also the wide use and involvement of mobile
applications.

These days’
smartphones have embedded miniature sensors, sensors that can be found in
traditional Healthcare clinics and Hospitals to capturing the most personal
activities, such as heart rate, step counters, walking distance or sleep
disturbance.

2. Smartphone
Evolvements

The
smartphone has rapidly gotten evolved and developed; they have gone from old
style phones that have a tiny screen with buttons and a chunky sized, to a
touch screen technology and the nearly edge to edge display size.

Now
smartphones are rich in features and capabilities, thanks to the tiny sensors
that are embedded in the phones.

Connectivity sensors: like Wi-Fi, GPS, 3G, 4G, LTE and
NFC

Camera sensors: sensors that can capture high quality images,
image stabilizers, front and back images, even some phones have dual camera now
for taking best images

Security sensors: finger print sensors, face and eye detections

Activity and Health Sensors: Barometer, Geometer, Heart Rate,
Accelerometer

Other sensors: Proximity sensor, light sensor, Gyroscope

These
sensors are useless if they are not backed up by mobile applications. Mobile
applications interact with these sensors and feedback to the user the data or
information they captured.  

Then came
the era of Smart-Watches and Activity trackers wearable that extended the possibilities
of activity tracking in areas where mobile applications cannot be used to reached,
like activities happens while user is exercising in the Gym or outdoor, during
swimming time, or even sleeping. Here the smart watch or the activity tracker
comes in handy to continue monitoring activities and report back to the mHealth
application as connectivity is enabled.

3. mHealth
Applications

The
Guardian has stated that Mobile Applications have become more popular than web
applications. And estimated that individuals spend an average of 3 hours per
day on mobile applications (Arthur,
2014).

A study has
been made using Self Determination Theory (SDT) to test the efficacy of
motivational aid used in various mobile applications. This theory has been
conducted on the two most mobile apps (i.e. electronic periodic promts) used
features, First Automated daily reminders, and Second Promoting an oft-repeated
canard as fact (i.e. “It takes 21 days to form a habit”). The result of this
theory will help towards understanding the mechanisms underlying motivational
apps (Austin and Kwapisz, 2016).

Mobile Apps
have the potential for helping people increase their physical activity,
nutrition awareness, scheduled alerts and notifications, such as reminders to
drink water, break and move.

There are
currently over 100,000 mHealth apps in major mobile apps store like Apple App
Store and Google Play Store (Xu, and Liu, 2015).

These apps
have helped people to self-monitor and educate themselves towards nutrition,
fitness, weight management that had a great effect in reducing obesity, quit
smoking, lose weight and get fit among young people.

 

Fitness and general wellbeing applications:

Samsung
have provided a good example mHealth application called Health Application,
this application comes pre-installed in most of Samsung’s latest smartphones.
This application can automatically detects movement activities and record them,
so for example it detects when you start to walk for more than two minutes and
record how many steps you achieved, the distance and map location. This is the
least feature of the application, it can capture more activities like measures
your heart rate, set goals, and social activities. This app can also be
operated through the smart watch or the activity tracker for maximum activity
tracking and capturing. Other companies like Google have developed a similar
app called Google Fit, and Apple the Health App.

 

 

 

Weight Management Apps:

Unhealthy
dietary habits can cause weight gain and thus to obesity and other dieses that
can affect the heart, the bones. And can cause other mental dieses that can
lead to depression. Many of these dieses can be avoided by dietary
self-monitoring mobile application.

Studies
have revealed that individuals who have used mHealth applications for dietary
self-monitoring had a significantly higher adherence and completion rates
compared to a paper diary. As it has been suggested that younger generations,
prefer to use mobile applications for dietary and weight loss interventions
compared to other web-based tools (Sarcona,
Kovacs, Wright, and Williams, 2017).

Sarcona’s
and his team have declared that participants in their studies have revealed
that they felt much healthier, motivated and improved self-monitoring while
using the mHealth application.

And that’s
true as mobile technology and applications are a leading innovation in
communication and cutting edge technologies. Smartphones are in user’s pockets
and are used most of the time. Weight loss is the key in prevention of chronic
disease and therefore mHealth application can help achieving the goal of
disease prevention.

 

Diabetes Apps:

Diabetes
Mellitus (DM) is a chronic disease. A study was conducted to evaluate the
efficacy of mHealth application through a systematic review and Meta data
analysis to facilitate treatment for this disease. The result on 1263
participants stated using the mHealth application can significantly improve
control of glycated hemoglobin (HbA1c), and this can be done using the
perception of self-care contribution and health education to patients. Also,
the studies have indicated that patients become more self-confident to deal
with their diabetes (Bonoto et al., 2017).

 

4. Challenges
that are facing mHealth Apps

Although
mHealth apps are growing as people are towards healthy lifestyles and started
to look after their nutrition, diets, fitness activities and working in a
healthy environment. mHealth app development is facing some crucial
challenging’s, that leads people to stop using the apps after a brief period of
time and abandon the application.

These
challenges can be categories into these areas:

§  Application Design: There is a lack of standardized design process. A study conducted by Svensson, Magnusson and Larsson to
experience using a mobile phone dietary assessment application over 198
participants, they have found that participants are having technical
difficulties if they are not familiar with the application platform usage, e.g.
if they were iPhone users they would have used the application more easily.
Other difficulties were reported the design of the application, unnecessary
functions and unclear reminders to record (Svensson,
Magnusson, and Larsson, 2016).

 

§  Medication Management for older adults:

There are a number of mHealth applications available to help users, remember
and educate about their medication therapy. Studies have revealed that patients
with chronic diseases stop taking a medication as prescribed within the first year
and for other psychiatric diseases by 3 to 6 month.

There is a potential need and use for people aged 50 and above. Elderly
people have claimed that mHealth applications are frustrating, overwhelming and
challenging to use, as the design is somehow complicated for them to use (Grindrod, Li and Gates, 2014).

 

§  Continuity:
Mobile applications got abandoned and people stop using them, which can be
summarized in the following points.

1.     
Some people are not aware of the health application

2.     
Lack of application literacy

3.     
Lack of motivation and discipline

 

§  Quality Concerns:

1.     
Sometimes there is a lack of engagement of qualified professionals while
developing the application.

2.     
There is an absence of feedback of evidence indicating the clinical
effectiveness of the application after publishing.

3.     
Lack of peer review after application publishing.

 

§  Security and Privacy: Although most of the mHealth applications are free to download and use,
what happens to the data and information being collected and captured while
using the application? Where are they stored and how are they used? How the
application generates revenue and who funds the application development?

Perhaps these data are used towards targeted marketing, or data are
passed into other third parties for other purposes than the main purpose of the
application.

 

5. Some
suggested solutions

Design Challenges:

Mobile
application developers should have some Human Computer Interaction (HCI)
background or studies to enable them to design a more user friendly
applications. Some organizations started to apply User-Centered-Design courses
such as the course organized by IDEO.org and +Acumen (NovoEd , 2018), to enable developers to capture
not just functional requirements, but also to capture behavior requirements.
This course passes through several iterations and phases, such as investigation
phase, ideation phase, prototyping phase and finally the implementation phase.
One of the positive impacts that can be extracted from this course is that
developers or designers are in direct communication with the end user to
capture detailed usage of the system or what expected to be developed. This
process facilitates the development and testing process, and ensures that developers
deliver the expected solution from the end-user perspective.

As stated
and suggested by Hevner applying the Information Systems Research (ISR)
framework, which consist of three cycles (Hevner,
2007).

1.      Relevance Cycle: In this cycle user
environment to be identified and requirements are generated.

2.      Rigor Cycle: In this cycle a
theories and artifacts are evaluated.

3.      Design Cycle: In this cycle
artifacts were produced and tested.

 

Centralized Database Repository:

Looking at
the two major mobile application stores (Apple App Store and Google Play
Store), users have to download the application on their own devices, test them
to see if they meet their requirements, or read through each application
previous users shared feedback, experience and the given rating for the
application. This is a very time consuming process and not efficient.

There is no
centralized database mHealth repository, to systematically evaluate the apps
regarding their effectiveness and health outcome prices and user reviews. As a
concept Xu and his team were able to develop a database repository to list and
display health related applications. As a result Xu was able to provide
detailed information for more than 60,000 health related applications from
Apple App Store and Google Play Store (Xu, and Liu, 2015). So the concept of a centralized database
repository is feasible and tested for its effectiveness.

 

Gamification to increase user motivation:

Gamification
is another source of motivation that increases users’ engagement towards health
related apps, especially physical activities or food intake (Helf, and Hlavacs,
2016).

Applying
graphics, animation, challenges in term of game levels, is a more engaging
digital solution than normal texts, reports and statistics. Gamification method
works absolutely perfect for kids and children’s education and as well as in
adults.

A good
example would be Pokémon Go mobile
game, which enabled users to keep moving and discovering landmarks. This game
almost achieved 10,000,000 downloads from Google Play Store (Android Users) and
similar figures for iOS (Apple Users).

Another
good example is Zombies Run with
more than 800, 000 users, the goal is to improve the user’s level of PA.
Another good example is the Skip a Beat
Game, which uses the heart rate sensor as a game controller to create awareness
of user’s heart rate levels and enable users to control their heart rate. And
finally another game called mySugr which
is a diabetes management application and social engagements (Helf, and Hlavacs,
2016).

 

Conclusions

Health, fitness and wellbeing are areas that interests
individuals and organisations. mHealth mobile applications represents an
essential platform to facilitate the way of achieving this goal. mHealth
applications have indicated significant improvements in helping individuals
being more fit and healthy, and participated in several medical areas like
diabetes, weight management and quit smoking.

Smart watches and activity trackers expanded activity
tracking to cover maximum capturing of personal activities in areas of absence
of the smartphone, like swimming or sleeping.

mHealth applications are facing some challenges that can be
compromised into four areas, design, continuity, security and data quality.

As mHealth applications indicated future potential
evolvement and usage in Health, Fitness, Nutrition and general wellbeing, these
areas should be addressed and these challenges should be considers.

Some of the suggested solutions are a User
Centred Design approach to resolve Application Design usability issues. A
centralised database repository to enable users evaluate the mHealth
applications before downloading them and individually test them. Gamification
might be another tool to be used to increase user’s motivation and engagement.

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