Facilitators, barriers, and recommendations for mobile health applications among Chinese older populations: a scoping review

Abstract

Background: Mobile health (mHealth) applications have become indispensable in people's daily lives and are now incorporated into a multitude of healthcare services. However, due to inappropriate designs and ineffective promotional strategies, the rates of uptake and continued use of mHealth applications in older adults are usually low. Given that recent evidence has reported distinct mHealth adoption patterns between Chinese and non-Chinese populations, the aim of this scoping review was to map relevant evidence on the end-user perceptions and age-appropriate recommendations for interface design, persuasive features, and promotional strategies among Chinese older adults.

Methods: All primary studies conducted in Chinese older people aged 60 + years, including quantitative, qualitative, and mixed methods research, examining end-user perceptions (e.g., motivators, barriers, and design) of mHealth applications were considered eligible for inclusion. Four electronic databases (PubMed, CINAHL, PsycINFO, and Medline) were searched from their inceptions through 31 May 2024. A narrative approach was adopted for data analyses relevant to the study aim.

Results: A total of 23 studies (n = 8,203) were included. End-user perceptions (facilitators and barriers) of older people were narratively synthesized according to the socio-ecological model (individual/product, interpersonal, community, and societal). In Chinese deaf and hard-of-hearing older adults, the lack of proficiency in mastering operations of smartphone, Internet, and mHealth applications greatly jeopardized their communication with family or friends, accessibility to online medical consultations, and access to public places amidst COVID-19 pandemic. Recommended interface designs were categorized into various aspects of functional impairments (vision, manual dexterity, and cognition) of elderly users. Seven promotional strategies were also highlighted, whereas more than half of the studies recommended education measures (e.g., personalized family/peer- or health professional-led training program) and technical support (e.g., face-to-face instructions, detailed manual instructions, and timely consultation services). Other recommendations included increased publicity, co-creation, and supportive government policies.

Conclusion: This review synthesizes the existing relevant evidence and hence provides age-friendly recommendations for interface designs, persuasive features, and promotional strategies in Chinese older populations. Overall, this study empirically offers actionable guidelines for mHealth developers to meet the multifaceted needs of older people.

Keywords: Behavioral intention; Ehealth; Enablers; Health informatics; Mobile apps; Mobile healthcare; Obstacles; Smartphones; Tablets; mHealth apps.

Fig. 1

Study selection flow

Fig. 2

Recommended interface designs