User-Centered Mobile Applications for Stroke Survivors (MAPPS): A Mixed-Methods Study of Patient Preferences

Srinath Ramaswamy; Nadege Gilles; Angelika C Gruessner; Dee Burton; Marilyn A Fraser; Sarah Weingast; Saroj Kunnakkat; Aimee Afable; David Kaufman; Jonathan Singer; Clotilde Balucani; Steven R Levine

doi:10.1016/j.apmr.2023.05.009

User-Centered Mobile Applications for Stroke Survivors (MAPPS): A Mixed-Methods Study of Patient Preferences

Arch Phys Med Rehabil. 2023 Oct;104(10):1573-1579. doi: 10.1016/j.apmr.2023.05.009. Epub 2023 Jun 8.

Authors

Affiliations

¹ Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY. Electronic address: 89bharath@gmail.com.
² Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY.
³ Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY.
⁴ Arthur Ashe Institute for Urban Health, Brooklyn, NY.
⁵ Department of Medicine, Weill Cornell Medicine, New York, NY.
⁶ Department of Neurology, Case Western Reserve University, Cleveland, OH.
⁷ Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY.
⁸ Department of Medical Informatics, SUNY Downstate Health Sciences University, Brooklyn, NY.
⁹ Department of Psychological Sciences, Texas Tech University, Lubbock, TX.
¹⁰ Department of Neurology, NYU Langone Medical Center, New York, NY.

PMID: 37295706
DOI: 10.1016/j.apmr.2023.05.009

Abstract

Objective: Investigate stroke survivors' (SS) preferences for a hypothetical mHealth app for post-stroke care and to study the influence of demographic variables on these preferences.

Design: Mixed-methods, sequential, observational study.

Setting: Focus groups (phase 1) were conducted to identify SS perceptions and knowledge of mHealth applications (apps). Using grounded theory approach, recurring themes were identified. A multiple-choice questionnaire of 5 desired app features was generated using these themes and mailed to SS (national survey, phase 2). SS' demographics and perceived usefulness (yes/no) for each feature were recorded. In-person usability testing (phase 3) was conducted to identify areas of improvement in user interfaces of existing apps. Summative telephone interviews (phase 4) were conducted for final impressions supplementary to national survey.

Participants: SS aged >18 years recruited from study hospital, national stroke association database, stroke support and advocacy groups. Non-English speakers and those unable to communicate were excluded.

Interventions: None.

Main outcome measures: (1) Percentage of SS (phase 2) identifying proposed app features to be useful. (2) Influence of age, sex, race, education, and time since stroke on perceived usefulness.

Results: Ninety-six SS participated in focus groups. High cost, complexity, and lack of technical support were identified as barriers to adoption of mHealth apps. In the national survey (n=1194), ability to track fitness and diet (84%) and communication (70%) were the most and least useful features, respectively. Perceived usefulness was higher among younger SS (P<.001 to .006) and SS of color (African American and Hispanic) (ORs 1.73-4.41). Simple design and accommodation for neurologic deficits were main recommendations from usability testing.

Conclusions: SS are willing to adopt mHealth apps that are free of cost and provide technical support. Apps for SS should perform multiple tasks and be of simple design. Greater interest for the app's features among SS of color may provide opportunities to address health inequities.

Keywords: Mobile health; Post-stroke care; Rehabilitation; Smartphones; Stroke prevention; Telehealth.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Focus Groups
Humans
Mobile Applications*
Patient Preference
Surveys and Questionnaires
Survivors