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Cited by 8Mobile Health and mHealth ApplicationsUsability and User Interface DesignTechnology Use by Older Adults

Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple’s ResearchKit and CareKit: Usability Study

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Donawa, Alyssa, Powell, Christian, Wang, Rong, Chih, Ming-Yuan, Patel, Reema, Zinner, Ralph, Aronoff-Spencer, Eliah, Baker, Corey E·2024·JMIR Formative Research
DOI 10.2196/57801PMC PMC11467601

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Abstract

Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple’s ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mHealth apps (21/30, 70%). General mobile app use was split, with 43% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ≥80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple’s ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions.

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  • Donawa et al [47] co-designed a mobile tool for distress management in rural communities, positioning navigation as an integrated support system that addressed emotional, informational, and logistical barriers simultaneously.

    “Similarly, Donawa et al [47] co-designed a mobile tool for distress management in rural communities, positioning navigation as an integrated support system that addressed emotional, informational, and logistical barriers simultaneously.”

    From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [47]

    The Introduction (This Study; no page supplied) explicitly says the interfaces were designed without co-design, contrary to the claim. The paper describes a mobile distress-assessment tool for rural patients with cancer, but its navigation concerns moving through the survey, not an integrated system addressing emotional, informational, and logistical barriers (Results, Usability Issues; no page supplied). (LLM, conf=0.88)

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Authors
Donawa, A., Powell, C., Wang, R., Chih, M.-Y., Patel, R., Zinner, R., Aronoff-Spencer, E., & Baker, C. E.
Affiliations
  • University of Southern California (US)
  • University of Kentucky (US)
  • Vanderbilt University (US)
  • University of California San Diego (US)
Corresponding author
Donawa, Alyssa
ORCID
Venue
JMIR Formative Research
Publisher
JMIR Publications Inc.
Published
2024-09-26
Volume
8
Pages
e57801
ISSN
2561-326X (ISSN-L)
DOI
10.2196/57801
PMC
PMC11467601
OpenAlex
W4400621139
Cited by
8
References
99
Citations by year
2026: 4 · 2025: 4
FWCI
4.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Formative Research (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 › Demography › Technology Use by Older Adults
Keywords
mobile health, cancer patients, rural patients, ResearchKit, usability, distress assessment, older adults, digital literacy, open-source library, System Usability Scale, mHealth adoption, health equity, cancer survivorship, mobile application design, rural health disparities, cancer-related anxiety
MeSH terms
Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasms, Pilot Projects, Surveys and Questionnaires, Rural Population, User-Computer Interface, Telemedicine, Mobile Applications

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