<p><b><u>Introduction</u></b>: Mobile health applications (mHealth apps) have the potential to assist patients in adhering to their physician’s advice in chronic disease management through the use of persuasive nudge. However, systematically developing the persuasive features of a mHealth app for the major user demographic of older adults is challenging. The current usability engineering framework could ensure the user-friendliness of the app but not the persuasiveness. It is necessary to extend the current framework with appropriate measures to better understand the effectiveness of persuasive design elements in an iterative design process.</p><p> </p><p><b><u>Methods:</u></b> A pilot design project was run, a persuasive mHealth app for dietary management was developed using the user-centered design approach (persona, use scenario, task analysis, and cognitive walkthrough), the pilot testing result showed high potential of technology acceptance of older adults. To further evaluate persuasiveness, a food choice experimental protocol and human decision performance metrics based on Signal Detection Theory (SDT) were proposed. A mixed-methods, full factorial user testing study was conducted with twenty older adults aged over 60 and twenty students age 18-35. Critical persuasive User Interface (UI) design variables included decision paradigm (digital nudge), nutrition information format (information nudge), and the system default pre-selection (default nudge). The proposed SDT metrics to evaluate persuasiveness were then compared with confusion matrix metrics which are frequently used to validate system decision-making performance. The relationship between the human performance, subjective workload, and perceived usability of the proposed mHealth app was also investigated.</p><p> </p><p><b><u>Results:</u></b> The ‘Two Alternative Forced Choice’ layout significantly increased the d-prime and accuracy (persuasiveness), the system default pre-selection decreased persuasiveness. The interpretative FSA Nutri-scores label reduced time of response and workload, and increased perceived ease of use, perceived ease of learning, and satisfaction. Among older adults, results differed by age, computer proficiency, and health literacy.</p><p><b><u> </u></b></p><b><u>Conclusion:</u></b> The findings of this study imply the proposed framework is a valid persuasive design research approach. And digital nudge is an effective persuasive design for mHealth app, while default nudge may give rise to negative effects. A generalized human-centered digital nudge design framework along with ageing-centered guidelines were suggested for the similar research and design projects for persuasive technology performed in the future.

Many Syrian refugees residing in Germany have been exposed to traumatizing events, while treatment options are scarce. Therefore, the self-help app “Sanadak” was developed to target post-traumatic stress in Syrian refugees. We aimed to inspect the recruitment and baseline characteristics of the participants in the trial, which is conducted to evaluate the app. Analyses were based on the recruitment sample (n = 170) and the trial sample (n = 133). Data were collected during structured face-to-face interviews in the Arabic language. Targeted outcomes included post-traumatic stress (primary; Post-traumatic Diagnostic Scale for DSM-5/PDS-5) and depressive symptoms, anxiety, resilience, among others (secondary). Recruited individuals were M = 32.8 (SD = 11.2, range = 18–65) years old; 38.8% were women. The average PDS-5 score was 23.6 (SD = 13.2) regarding trauma exposure, which was most frequently related to experiencing military- or combat-related events (32.9%). Moreover, 46.5% had major depression and 51.8% showed low resilience. Anxiety was present in 40.6% of the trial participants. Psychological distress was high in Syrian refugees residing in Germany, enrolled in a trial targeting post-traumatic stress. This underlines the need for intervention. Our results provide important figures on the mental health of a not well-studied population group in Germany.

Contexte: Malgré l’avancement des recherches sur les applications de santé mobile servant à la télésurveillance, on n’en sait très peu sur l’expérience des patients qui en utilisent. Objectifs: La présente recherche vise à évaluer l’expérience des patients des effets positifs de la télésurveillance sur la prise en charge de l’insuffisance cardiaque à domicile, des difficultés éprouvées et des facteurs favorisant ou limitant l’utilisation de l’application mobile TakeCareMC. Méthodologie: Des entrevues semi-dirigées ont été menées auprès de 12 patients suivis dans la clinique d’insuffisance cardiaque d’un centre hospitalo-universitaire et ayant utilisé l’application de surveillance à domicile pour téléphone intelligent pendant au moins trois mois d’une intervention pilote. L’application mobile demande au patient de prendre quotidiennement ses signes vitaux et de répondre à des questions sur les symptômes. Un infirmier clinicien s’occupe de surveiller les données à distance (5 jours sur 7) et de joindre le patient par téléphone en cas d’alerte. Le plan de traitement est ensuite modifié si nécessaire, soumis de nouveau au comité de surveillance et envoyé au clinicien. Les entrevues ont été enregistrées, transcrites et analysées de manière manuelle. Résultats: Tous les participants ont convenu des avantages et de la facilité d’emploi de l’application. Les avantages étaient notamment le fait que l’application favorisait la surveillance de la maladie, autant par les cliniciens que par les participants eux-mêmes, et les effets positifs perçus sur leur état de santé, l’amélioration d’un lien avec le personnel clinique et d’un accès aux soins. Les patients ont insisté sur la nécessité de personnaliser la rétroaction et les fonctions de communication interactive de l’application. L’adoption d’une telle nouvelle technologie par les patients aînés pourrait être influencée par le soutien social (des professionnels cliniques), technique et financier. Conclusion: L’application TakeCareMC a été bien reçue par les patients atteints d’insuffisance cardiaque. L’expérience et la participation des patients sont cruciales dans la mise à jour de l’application. / Background: Despite the advancement in the development of mobile health applications, little is known about the patients’ experience of using these applications for telemonitoring at home. Objective: This research aims to assess the experience of patients with heart failure on the impact, difficulties and facilitating or limiting factors of use of the TakeCareMC mobile application in the telemonitoring at home. Methods: Semi-structured interviews were conducted with 12 patients who are followed by a heart failure clinic of a university hospital center, and who used a smartphone application at home after 3 months of pilot intervention. The mobile app asks patients to measure physiological signs daily and answer daily symptoms questions. A clinical nurse took care of remote monitoring (5 days a week) and contacted the patient by telephone when there was an alert. The treatment plan was then adjusted, resubmitted to the monitoring committee and sent to the clinician. Interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: All participants expressed benefits and ease of use of the TakeCareMC application. Benefits included the fact that the app facilitated disease monitoring, both by clinicians and participants themselves, and the perceived positive effects on their health status, improved connection with staff clinic and access to care. Patients emphasized the need for personalization of feedback information and interactive communication app functions. The adoption of such a new technology with elderly patients could be influenced by social (from clinical professionals), technical and financial support. Conclusions: TakeCareMC was well accepted by heart failure patients. The experience and participation of patients are strongly recommended in the design and updating of applications.