# A Systematic Review of Usefulness Design Goals of Occupational Mobile Health Apps for Healthcare Workers

Nurha Yingta, José Abdelnour Nocera, Obed Brew, Ikram Ur Rehman

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Nurha Yingta, José Abdelnour Nocera, Obed Brew, Ikram Ur Rehman. A Systematic Review of Usefulness Design Goals of Occupational Mobile Health Apps for Healthcare Workers. 18th IFIP Conference on Human-Computer Interaction (INTERACT), Aug 2021, Bari, Italy. pp.359-363, 10.1007/978-3-030-85607-6_37. hal-04291229

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# A Systematic Review of Usefulness Design Goals of Occupational Mobile Health Apps for Healthcare Workers.

Nurha Yingta¹, Jose Abdelnour-Nocera¹,², Obed Brew¹ and Ikram Ur Rehman¹

¹ University of West London, St Marry, Ealing UK
21363511@student.uwl.ac.uk, {abdejos, brewobe, rehmikr} @uwl.ac.uk

² ITI/Larsys, Funchal, Portugal

**Abstract.** To improve healthcare professionals´ health and wellbeing at work, many available effective treatments including meditation, and workplace intervention, have been developed. However, the utilisation of these interventions is still limited. Currently, various mobile health applications (mHealth Apps) exist to help a wide range of users with different occupational health issues, such as stress, anxiety, and burnout. Despite their advantages, post-download uptake of mHealth apps by end-users remains low. Some of the reasons for this are poor usability, irrelevant or missing user-desired features, and poor user experience. This review paper explores the usefulness of mHealth Apps for the early detection of occupational-related ill-health among healthcare workers. Science Direct, ACM Digital Library, IEEE Xplore, and SAGE Journal were searched comprehensively to identify relevant research articles. A total of 9546 reviewed papers were primarily identified through the systematic search on the databases. 2546 articles were removed from them, by duplication check on a RefWorks software. Titles and abstract screening of the remaining 126 led to 50 relevant articles being selected for full text screening. Of these 76 were excluded based on exclusion criteria. Finally, 19 articles were selected for a final inclusion to identify the relevant usefulness design goals, including usability, utility and user experience, deemed as critical for apps´ adoption and use. These goals include provide contextually relevant information, which is easy to understand for usability; support self-help guidance and in-depth knowledge for occupational health and wellbeing for utility: reinforced trust and perceived security in m-Health apps for user experience.

**Keywords:** Occupational Health, Usability, Utility, User Experience, Healthcare Workers

## 1 Occupational Mobile Health and Usefulness

Occupational-related ill-health (ORIH) is a major health concern for successful economic growth. In UK, the rate of ORIH is 4.8 thousand per 100,000 workers [1], and it is commonly associated with any physical and mental health conditions that result from organisational factors as well as an imbalance of demands, skills and social support at work [2]. Current data suggests most ORIH in UK are mental health related (51% of 1.6 million cases), followed by musculoskeletal (30%) – other types of illness make up 19% [3].

Workers in the medical sector are at increased risk of occupational-related ill-health due to the extraordinary stressors in this environment [4]. Stressors related to the healthcare profession include long work hours, dealing with pain, loss and emotional
suffering, disease outbreak, and providing support to families [5, 6]. These stressors
can trigger physical and mental health issues, such as stress, burnout and anxiety.

Despite the advantages of mHealth apps, it remains a huge challenge to find effective ones supporting the prevention and management of occupational ill-health as not much has been done to identify and assess the factors impacting the usefulness and adoption in the contexts of usability, utility and user experience terms. Therefore, the review focuses on the usefulness design goals of mobile mHealth apps to support occupational ill-health in HCWs.

Most of the research on usefulness and mHealth has been focused on perceived use-
fulness and based on acceptance models such as the Technology Acceptance Model
(TAM) and e-Commerce Acceptance Model (EAM) [7, 8]. Several authors in previous
studies have addressed the terms “usefulness” in different ways. For example, Nielsen
[9] defines a useful interactive system as compounded with the attribution of usability
and utility. In addition to usability and utility, usefulness is influenced by the emotional
feelings with a system, including enjoyment to provide a richer experience of continued
use [10, 11]. Overall, the literature on usefulness reflects that this is a complex construct
defined by usability, utility and user experience (UX) factors contingent on users’ con-
texts and sociocultural backgrounds. Having a consideration of HCW’s real-world ex-
periences is vital to designing integrated and useful mHealth solutions [12].

## 2 Review Methodology and Findings

Four resources including ACM digital Library, IEEE Xplore, SAGE journal, and Sci-
ence Direct were searched in December 2020, and repeated in February 2021, to iden-
tify relevant studies. The search terms relating to occupational “mHealth apps”, “well-
being health apps”, “usefulness”, “usability”, “utility”, “user experience”, and
“healthcare workers” in different Boolean operator (“AND” and “OR”) were used to
identify relevant literature. Screening for inclusion was then carried out to extract rele-
vant studies identifying the key design goals that enhance the adoption and continued
use of such mHealth apps. A PRISMA Flowchart was created to identify the following
points; (1) studies that use occupational health apps or wellbeing health apps; (2 stud-
ies that relevant to usability, utility and user experience; (3) studies that were conducted
with healthcare workers or workers. We excluded studies that reported on health apps
used only by patient (s), abstract, posters, and studies with no full text available.

A total of 9546 reviewed papers were primarily identified through the systematic
search on the databases. 2546 articles were removed from them, by duplication check
on a RefWorks software. Titles and abstract screening of the remaining 126 led to 50
relevant articles being selected for full text screening. Of these 76 were excluded based
on exclusion criteria. Finally, 19 articles were selected for a final inclusion to identify
the relevant usefulness of mHealth apps. We cannot list all reviewed papers here due
to space limitations of the poster paper, but we have provided at least the most important
reference for each goal in table 1.
<table><caption>**Table 1.** Identified usefulness design goals of occupational m-Health apps proven to be relevant or often lacking.</caption><thead><tr><td>Concept</td><td>Goals (position statement)</td><td>Goal Definition</td><td>Reference</td></tr></thead><tbody><tr><td rowspan="2">Usability Goals</td><td>Provide contextually relevant information, which is easy to understand</td><td>Healthcare workers have mentioned apps should reflect their own work domain context and roles</td><td>[13]</td></tr><tr><td>Match user expectations about the type of app: prevention or management</td><td>Help the user access the information they need whether the app helps them prevent or manage work-related ill-health.</td><td>[14]</td></tr><tr><td rowspan="2">Utility Goals</td><td>Support self-help guidance and in-depth knowledge for occupational health and well-being</td><td>The reviewed literature reveals this is a feature that is lacking or not sufficiently developed</td><td>[15]</td></tr><tr><td>Promote social connectedness</td><td>The app should include some communication and information sharing features such as a group collaboration among app users and with clinicians.</td><td>[16]</td></tr><tr><td rowspan="2">User Experience Goals</td><td>Reinforced trust and perceived security in m-Health apps</td><td>It is necessary for users to feel confident that the system will behave as intended. This has resulted in increased collaboration with the system securely and willingly.</td><td>[17]</td></tr><tr><td>Manage the performance expectancy of m-Health apps</td><td>The app design should be consistent with its intended goal, e.g. if it is presented as a prevention app then its features should be consistent with this aim.</td><td>[18]</td></tr></tbody></table>

## 3 Discussion and Conclusions

The findings presented here provide an enhanced understanding of usefulness design goals that should be considered in designing an mHealth app to support healthcare workers health and wellbeing in healthcare work setting. The identified design goals highlight not only the key dimensions of usefulness, but also the key insights needed to
inform design to improve adoption and continued use of such occupational mHealth apps. For instance, in relation to usability and user experience goals, given the fast-paced nature of healthcare work, workers' everyday usage and associated experiences should be considered in the design of such health apps. This is in line with previous study by [20], which suggests that understanding ordinary users' experience, cognitive challenges and demands from the workplace context will ensure the design of relevant and useful mHealth solution. Moreover, in relation to utility goals, mHealth apps will have the potential to provide healthcare workers with a better health and wellbeing if the crucial features are effectively incorporated in such apps. This suggests that having a consideration of user desired features could lead to the increased adoption and continued use of the system [21].

The review presented in this paper provides insightful knowledge for the design of occupational mHealth apps to enhance the usefulness of such health apps. Due to the nature of healthcare professionals work contexts and environments, future occupational mHealth apps should be designed differently following domain-relevant and distinct design goals such as those identified in this review. The proposed goals address these aspects and are contributions to the literature on mHealth by advancing knowledge on the user-centred design of this genre of apps, focusing on healthcare workers [16, 22].

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