CoChat
Sign Up
Cited by 17Mobile Health and mHealth ApplicationsUsability and User Interface DesignDigital Mental Health Interventions

Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking

Open access
Anders, Carolin, Moorthy, Preetha, Svensson, Laura, Müller, Julia, Heinze, Oliver, Knaup, Petra, Wallwiener, Markus, Deutsch, Thomas M +2 more·2024·JMIR Human Factors
DOI 10.2196/50926PMC PMC10951836

Published version of a preprint

Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app’s content regularly, and self-administration. In contrast to the app’s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients’ feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2196/50926

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • An iterative development process of a cancer prevention web application by Carrera et al [45] and the prevention-focused web application described by Anders et al [32] incorporated repeated cycles of feedback that shaped tutorials and interactive features.

    “Similarly, an iterative development process of a cancer prevention web application by Carrera et al [45] and the prevention-focused web application described by Anders et al [32] incorporated repeated cycles of feedback that shaped tutorials and interactive features, supporting its potential to enhance risk understanding and healthy behavior.”

    From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [32]

    The Introduction (Background; page unavailable) describes Enable as a smartphone app for therapy support for patients with breast cancer, not a cancer-prevention web application. The Discussion (Conclusions; page unavailable) says patient feedback will inform further development, but does not describe repeated feedback cycles shaping tutorials or interactive features, or a potential to improve cancer-risk understanding. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • The iterative development of the prevention web applications supports their potential to enhance risk understanding and healthy behavior.

    “Similarly, an iterative development process of a cancer prevention web application by Carrera et al [45] and the prevention-focused web application described by Anders et al [32] incorporated repeated cycles of feedback that shaped tutorials and interactive features, supporting its potential to enhance risk understanding and healthy behavior.”

    From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [32]

    The Introduction (Objectives; page unavailable) discusses iterations of app testing, and the Discussion (Conclusions; page unavailable) says patient feedback will inform further development. But the Introduction (Background; page unavailable) identifies Enable as a smartphone app supporting breast cancer therapy, not a cancer-prevention web application. The cited passages do not support claims that feedback shaped tutorials or that the app could improve risk understanding and healthy behavior. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 37

  1. [2]Tighe M Molassiotis A Morris J Richardson J Coping, meaning and symptom experience: a narrative approach to the overwhelming impacts of breast cancer in the first year following diagnosis Eur J Oncol Nurs 2011 07 15 3 226 32 10.1016/j.ejon.2011.03.004 10.1016/j.ejon.2011.03.004 21511530 S1462-3889(11)00051-2 21511530 · DOI
  2. [3]ElKefi S Asan O How technology impacts communication between cancer patients and their health care providers: a systematic literature review Int J Med Inform 2021 05 149 104430 10.1016/j.ijmedinf.2021.104430 33684711 S1386-5056(21)00056-3 33684711 PMC8131252 · DOI
  3. [4]Kashgary A Alsolaimani R Mosli M Faraj S The role of mobile devices in doctor-patient communication: a systematic review and meta-analysis J Telemed Telecare 2017 09 23 8 693 700 10.1177/1357633X16661604 27632990 1357633X16661604 27632990 · DOI
  4. [7]Chen L Bartel C Cai X Cheng Y Perer A McClaine S Kairis E Durica K Huang W Low CA Patient and provider perspectives on symptom monitoring during outpatient chemotherapy: interview study JMIR Form Res 2023 04 17 7 e46001 10.2196/46001 37067857 v7i1e46001 37067857 PMC10131985 · DOI
  5. [10]Zapata BC Fernández-Alemán JL Idri A Toval A Empirical studies on usability of mHealth apps: a systematic literature review J Med Syst 2015 02 39 2 1 10.1007/s10916-014-0182-2 25600193 25600193 · DOI · Paper page
  6. [11]Or C Tao D Usability study of a computer-based self-management system for older adults with chronic diseases JMIR Res Protoc 2012 11 08 1 2 e13 10.2196/resprot.2184 23612015 v1i2e13 23612015 PMC3626148 · DOI
  7. [12]Nielsen J What is usability? User Experience Re-Mastered: Your Guide to Getting the Right Design 2010 Cambridge, MA Morgan Kaufmann 3 22
  8. [14]Law EL Abrahão S Interplay between user experience (UX) evaluation and system development Int J Hum Comput Stud 2014 06 72 6 523 5 10.1016/j.ijhcs.2014.03.003 · DOI
  9. [16]Cai T Huang Y Zhang Y Lu Z Huang Q Yuan C Mobile health applications for the care of patients with breast cancer: a scoping review Int J Nurs Sci 2021 08 25 8 4 470 6 10.1016/j.ijnss.2021.07.003 34631997 S2352-0132(21)00080-6 34631997 PMC8488816 · DOI · Paper page
  10. [17]Sadegh SS Khakshour Saadat P Sepehri MM Assadi V A framework for m-health service development and success evaluation Int J Med Inform 2018 04 112 123 30 10.1016/j.ijmedinf.2018.01.003 29500009 S1386-5056(18)30003-0 29500009 · DOI
  11. [19]Doyle L Brady AM Byrne G An overview of mixed methods research – revisited J Res Nurs 2016 21 8 623 35 10.1177/1744987116674257 · DOI
  12. [21]Lim JY Kim Y Yeo SM Chae BJ Yu J Hwang JH Feasibility and usability of a personalized mHealth app for self-management in the first year following breast cancer surgery Health Informatics J 2023 29 1 14604582231156476 10.1177/14604582231156476 36772832 36772832 · DOI
  13. [22]Stubbins R He T Yu X Puppala M Ezeana CF Chen S Valdivia Y Alvarado M Ensor J Rodriguez A Niravath P Chang J Wong ST Patel T A behavior-modification, clinical-grade mobile application to improve breast cancer survivors' accountability and health outcomes JCO Clin Cancer Inform 2018 12 2 1 11 10.1200/CCI.18.00054 30652617 PMC10445791 30652617 · DOI
  14. [23]Cooke L Is eye tracking the next step in usability testing? Proceedings of the 2006 IEEE International Professional Communication Conference 2006 2006 IEEE October 23-25, 2006 Saragota Springs, NY 10.1109/IPCC.2006.320355 · DOI
  15. [24]Jacob RJ Karn KS Commentary on section 4 - eye tracking in human-computer interaction and usability research: ready to deliver the promises The Mind's Eye: Cognitive and Applied Aspects of Eye Movement Research 2003 Amsterdam, The Netherlands Elsevier Science 573 605
  16. [26]Moorthy P Weinert L Harms BC Anders C Siegel F German version of the mHealth app usability questionnaire in a cohort of patients with cancer: translation and validation study JMIR Hum Factors 2023 11 01 10 e51090 10.2196/51090 37910144 v10i1e51090 37910144 PMC10652191 · DOI
  17. [27]Tong A Sainsbury P Craig J Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups Int J Qual Health Care 2007 12 19 6 349 57 10.1093/intqhc/mzm042 17872937 mzm042 17872937 · DOI · Paper page
  18. [28]Harris PA Taylor R Thielke R Payne J Gonzalez N Conde JG Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support J Biomed Inform 2009 04 42 2 377 81 10.1016/j.jbi.2008.08.010 18929686 S1532-0464(08)00122-6 18929686 PMC2700030 · DOI · Paper page
  19. [30]Bansback N Li LC Lynd L Bryan S Development and preliminary user testing of the DCIDA (dynamic computer interactive decision application) for 'nudging' patients towards high quality decisions BMC Med Inform Decis Mak 2014 08 01 14 62 10.1186/1472-6947-14-62 25084808 1472-6947-14-62 25084808 PMC4130126 · DOI
  20. [31]Erol Barkana D Açık A Duru DG Duru AD Improvement of design of a surgical interface using an eye tracking device Theor Biol Med Model 2014 05 07 11 Suppl 1 Suppl 1 S4 10.1186/1742-4682-11-S1-S4 25080176 1742-4682-11-S1-S4 25080176 PMC4108870 · DOI
  21. [32]Rashid S Soo ST Sivaji A Naeni HS Bahri S Preliminary usability testing with eye tracking and FCAT analysis on occupational safety and health websites Procedia Soc Behav Sci 2013 11 06 97 737 44 10.1016/j.sbspro.2013.10.295 · DOI
  22. [33]Eghdam A Forsman J Falkenhav M Lind M Koch S Combining usability testing with eye-tracking technology: evaluation of a visualization support for antibiotic use in intensive care Stud Health Technol Inform 2011 169 945 9 21893885 21893885
  23. [34]Forsman J Anani N Eghdam A Falkenhav M Koch S Integrated information visualization to support decision making for use of antibiotics in intensive care: design and usability evaluation Inform Health Soc Care 2013 12 38 4 330 53 10.3109/17538157.2013.812649 23957739 23957739 · DOI
  24. [35]Russell DM Chi EH Olson J Kellogg W Looking back: retrospective study methods for HCI Ways of Knowing in HCI 2014 New York, NY Springer
  25. [36]Ansaar MZ Hussain J Bang J Lee S Shin KY Woo KY The mHealth applications usability evaluation review Proceedings of the 2020 International Conference on Information Networking (ICOIN) 2020 ICOIN January 7-10, 2020 Barcelona, Spain 10.1109/icoin48656.2020.9016509 · DOI
  26. [37]Kjeldskov J Skov MB Stage J A longitudinal study of usability in health care: does time heal? Int J Med Inform 2010 06 79 6 e135 43 10.1016/j.ijmedinf.2008.07.008 18757234 S1386-5056(08)00123-8 18757234 · DOI
  27. [39]Sonderegger A Zbinden G Uebelbacher A Sauer J The influence of product aesthetics and usability over the course of time: a longitudinal field experiment Ergonomics 2012 04 16 55 7 713 30 10.1080/00140139.2012.672658 22506866 22506866 · DOI
  28. [40]Nápoles AM Santoyo-Olsson J Chacón L Stewart AL Dixit N Ortiz C Feasibility of a mobile phone app and telephone coaching survivorship care planning program among Spanish-speaking breast cancer survivors JMIR Cancer 2019 07 09 5 2 e13543 10.2196/13543 31290395 v5i2e13543 31290395 PMC6647762 · DOI
  29. [41]Petrocchi S Filipponi C Montagna G Bonollo M Pagani O Meani F A breast cancer smartphone app to navigate the breast cancer journey: mixed methods study JMIR Form Res 2021 05 10 5 5 e28668 10.2196/28668 33970120 v5i5e28668 33970120 PMC8145088 · DOI
  30. [42]Wildenbos GA Jaspers MW Schijven MP Dusseljee-Peute LW Mobile health for older adult patients: using an aging barriers framework to classify usability problems Int J Med Inform 2019 04 124 68 77 10.1016/j.ijmedinf.2019.01.006 30784429 S1386-5056(18)30500-8 30784429 · DOI · Paper page
  31. [43]Morey SA Barg-Walkow LH Rogers WA Managing heart failure on the go: usability issues with mHealth apps for older adults Proc Hum Factors Ergon Soc Annu Meet 2017 09 28 61 1 1 5 10.1177/1541931213601496 · DOI
  32. [45]Jessen S Mirkovic J Halvorsen Brendmo E Solberg Nes L Evaluating a strengths-based mHealth tool (MyStrengths): explorative feasibility trial JMIR Form Res 2021 11 17 5 11 e30572 10.2196/30572 34787580 v5i11e30572 34787580 PMC8663534 · DOI
  33. [46]Graham TA Ali S Avdagovska M Ballermann M Effects of a web-based patient portal on patient satisfaction and missed appointment rates: survey study J Med Internet Res 2020 05 19 22 5 e17955 10.2196/17955 32427109 v22i5e17955 32427109 PMC7267992 · DOI
  34. [47]Avdagovska M Ballermann M Olson K Graham T Menon D Stafinski T Patient portal implementation and uptake: qualitative comparative case study J Med Internet Res 2020 07 27 22 7 e18973 10.2196/18973 32716308 v22i7e18973 32716308 PMC7427986 · DOI
  35. [48]Müller J Weinert L Svensson L Rivinius R Kreusser MM Heinze O Mobile access to medical records in heart transplantation aftercare: mixed-methods study assessing usability, feasibility and effects of a mobile application Life (Basel) 2022 08 08 12 8 1204 10.3390/life12081204 36013383 life12081204 36013383 PMC9410472 · DOI
  36. [49]Niazkhani Z Toni E Cheshmekaboodi M Georgiou A Pirnejad H Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review BMC Med Inform Decis Mak 2020 07 08 20 1 153 10.1186/s12911-020-01159-1 32641128 10.1186/s12911-020-01159-1 32641128 PMC7341472 · DOI
  37. [50]Sollie M Hansen M Thomsen JB Health technology readiness amongst patients with suspected breast cancer using the READHY-tool - a cross-sectional study J Med Syst 2023 11 16 47 1 118 10.1007/s10916-023-02016-0 37971517 10.1007/s10916-023-02016-0 37971517 PMC10654165 · DOI

Cited by

Sorted by citations

Authors
Anders, C., Moorthy, P., Svensson, L., Müller, J., Heinze, O., Knaup, P., Wallwiener, M., Deutsch, T. M., Le, T.-V., & Weinert, L.
Affiliations
  • University Hospital Heidelberg (DE)
  • Heidelberg University (DE)
Corresponding author
Anders, Carolin
ORCID
Venue
JMIR Human Factors
Publisher
JMIR Publications Inc.
Published
2024-03-05
Volume
11
Pages
e50926
ISSN
2292-9495 (ISSN-L)
DOI
10.2196/50926
PMC
PMC10951836
OpenAlex
W4389856564
Cited by
17
References
10
Citations by year
2026: 5 · 2025: 8 · 2024: 4
FWCI
5.98
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Human Factors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
breast cancer, mobile health apps, usability, user experience, eye tracking, follow-up care, quality of life, patient-reported adverse events, app engagement, user feedback, neoadjuvant therapy, adjuvant therapy, palliative care, mobile application design, self-administration, appointment reminders
MeSH terms
Eye-Tracking Technology, Breast Neoplasms, Female, Humans, Outpatients, Prospective Studies, Quality of Life, Mobile Applications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review