User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study

Abstract

Background: Smartphone apps are a growing field supporting the prevention of chronic diseases. The user experience (UX) is an important predictor of app use and should be considered in mobile health research. Long-term skin protection behavior is important for those with work-related skin diseases. However, altering health behavior is complex and requires a high level of self-management. We developed a maintenance program consisting of the Mein Hautschutz im Alltag (MiA; "My skin protection in everyday life") app combined with an individual face-to-face goal-setting interview to support patients in the implementation of skin protection behavior after inpatient rehabilitation.

Objective: The objectives of this paper are to (1) describe the intervention in a standardized manner; (2) evaluate the UX, subjective quality, and perceived impact of the MiA app; and (3) evaluate the adherence to the MiA app.

Methods: We followed a user-centered and multistage iterative process in 2 steps that combined qualitative and quantitative data. The maintenance program was tested over 12 weeks after discharge from rehabilitation. The UX, subjective quality, and perceived impact were evaluated formatively based on the user version of the Mobile Application Rating Scale after 12 weeks (T2). Adherence was measured using the frequency of interactions with the app.

Results: In total, 42 patients took part (with a dropout rate of n=18, 43% at T2). The average age was 49.5 (SD 13.1) years, and 57% (24/42) were male. We found high ratings for the UX, with an average score of 80.18 (SD 8.94) out of a theoretical maximum of 100, but there were a few exceptions in the usability and interaction with the app. The app was most frequently rated with 4 out of 5 stars (15/24, 65%), which indicates a high subjective quality. Furthermore, the app seemed to influence important determinants to implement skin protection behavior. Adherence to skin protection tracking was higher over the study period than adherence to skin documentation and goal assessment. The number of adherent participants to skin protection tracking was higher in the skin care and skin cleansing categories (28/42, 67% each) compared to the skin protection category (13/42, 31%) on day 1 and decreased until day 84 in all dimensions (12/42, 29% each for skin care and skin cleansing; 9/42, 21% for skin protection).

Conclusions: The results in terms of adherence met the expectations and were consistent with those of other studies evaluating the use of apps for chronic diseases. Interaction with the app could be increased using artificial intelligence to determine eczema severity via photos. It should be investigated which subgroups have difficulties with usability to individualize the support to a greater degree during onboarding. There is a need for further research regarding the effectiveness of the MiA app on skin protection behavior, quality of life, and eczema severity.

Keywords: Template for Intervention Description and Replication; app; artificial intelligence; behavior change; behavior change techniques; complex intervention; mHealth; mobile health; occupational dermatology; skin diseases; smartphone; user experience.

Figure 1

Theoretical model to explain the influence of user experience (UX) and its 5 dimensions—content, usability, aesthetic, trust, and feelings and emotions—on the intention and recommendation to use the app (proximal) results, as well as the revisiting the app and long-term use of the app (distal) results as the basis for this study.

Figure 2

(A) Overview of the menu; (B) overview of the My Skin Protection Behavior component with the option to enter the frequencies of skin cleansing (green line) and applications of skin care cream (red line) and skin protection cream (blue line); (C) overview of the My Skin Documentation component, which allows for taking pictures of the front and back side of the right and left hand that can be enlarged and to which personal notes can be added; (D) overview of the My Skin Protection Goals component with the overview of the goal achievement; (E) To Listen component and 4 podcast episodes; (F) overview of the Skin Protection 101 component with different questions and an example unfolded answer; (G) overview of the My Accountabilities component with different questions and an exemplary unfolded answer; and (H) presentation of the research questionnaire with the 6 categories, whereby categories 1 to 3 (sociodemographic data, skin protection behavior, and questions about the organization) can be completed immediately and categories 4 to 6 (skin protection behavior, app evaluation, and impact of the app) are activated after 12 weeks of use.

Figure 3

Study process of multistage iterative testing of the app-based maintenance program for patients with work-related skin diseases consisting of (1) iterative development and testing and (2) 12-week testing and piloting. MiA: Mein Hautschutz im Alltag (My skin protection in everyday life); TIP: tertiary individual prevention; UX: user experience.

Figure 4

Flowchart of the study population in step 2, including assessment for eligibility, participation, and follow-up at T1 and T2. MiA: Mein Hautschutz im Alltag (My skin protection in everyday life); TIP: tertiary individual prevention.

Figure 5

Results for the 5 user experience (UX) dimensions—content, usability, aesthetic, trust, and feelings and emotions—from the participants at T2 (n=24). The ratings range from 1 to 5. A rating of 1 means a low rating, and a rating of 5 is a high rating.

Figure 6

Results on the perceived impact of the Mein Hautschutz im Alltag (My skin protection in everyday life) app regarding skin protection behavior by the participants at T2 (n=24).

Figure 7

(A) Adherence to tracking of skin cleansing on the app function My Skin Protection Behavior, (B) adherence to tracking of skin protection on the app function My Skin Protection Behavior, and (C) adherence to tracking of skin care on the app function My Skin Protection Behavior by all participants during the 12-week pilot-testing (n=42).

Figure 8

(A) Adherence to the achievement of skin protection goals on the app function My Skin Protection Goals and (B) adherence to skin documentation on the app function My Skin Documentation by all participants during the 12-week pilot-testing (n=42).