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JMIR Mhealth Uhealth. 2017 Apr 11;5(4):e43. doi: 10.2196/mhealth.7268.

Usability of a Novel Mobile Health iPad App by Vulnerable Populations.

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Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC, United States.
Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston-Salem, NC, United States.
Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, United States.
Wake Forest Health Sciences, Enterprise Information Management, Winston-Salem, NC, United States.
University of Texas Dell Medical School, Department of Internal Medicine, Austin, TX, United States.
Wake Forest School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC, United States.



Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs.


The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid.


We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability.


Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance.


Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities.


decision support techniques; health literacy; primary care; technology assessment; vulnerable populations

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