Abstract B81: Can “mHealth” improve risk assessment? A usability study of older, low-income women answering the Athena Breast Health Questionnaire app.
Authors: Thorsen Cristina M. , Kaplan Celia P. , Brasic Natasha , Esserman Laura J. , Luce Judith A. , Howe Rebecca , Veer Laura J. van 't , Bravo Carolina , Wheelock Alyse , Ozanne Elissa M. ,   Athena Breast Health Network Investigators
Published: August 2014

Abstract
Introduction: Mobile health (mHealth) tools may offer an opportunity for breast cancer screening and prevention especially among minority populations who are known to access the internet at higher rates with mobile devices. However, the use of mHealth applications (apps) has not been well studied in older, low-income, minority populations. This study sought to determine the usability of an mHealth Breast Health Risk Assessment Questionnaire app for older, low-income women.
Methods: We performed fifteen semi-structured interviews of women with diverse backgrounds who used the Athena Breast Health Questionnaire iPad app, which was available in Spanish and English. The app was developed by the Athena Breast Health Network, a breast cancer screening collaboration of the five University of California medical centers. Women were recruited during their screening mammography visit at the San Francisco General Hospital Avon Mammography Center.
Results: Fifteen women were interviewed; five Hispanic, five non-Hispanic white, three African American and two Filipina women. Four women were Spanish speaking only. The median age of women was 61 (range, 45-79). The women's level of education ranged from third grade to graduate school. Fourteen women owned a mobile phone, three owned a smart phone, and three had previously used an iPad. The average time to complete the questionnaire for all women was 16.4 minutes (range, 6.6-35 minutes). The subgroup of Spanish speaking women took longer, averaging 24.5 minutes. The majority of women needed initial instruction regarding scrolling and free text entry.
All fifteen women interviewed thought the Athena Breast Health Questionnaire app was easy or very easy to use. Eleven women preferred answering the iPad questionnaire compared to the pen-and-paper form previously completed for their mammogram. Two women preferred pen-and-paper, both Spanish speaking; and two women had no preference, including one who started using a mobile phone within the past month and another woman who did not own one. Three of the four women who did not prefer the app had lower than a tenth grade education. All four that did not prefer the app were concerned that a clinic would not be able to offer the initial instruction needed or to provide assistance for questions though they thought the app was easy to use.
Conclusion: Older, low-income, minority women easily used a mHealth app to answer a breast health risk assessment questionnaire. Particular formats of questions, such as the use of scrolling, were initially difficult but participants easily overcame such difficulties and learned the skills of using a touchscreen. Spanish speaking women had a lower preference for the app, but this finding may be confounded with education level. Further evaluation of the validity of women's responses using the app in a clinical setting is needed.
Citation Format: Cristina M. Thorsen, Celia P. Kaplan, Natasha Brasic, Laura J. Esserman, Judith A. Luce, Rebecca Howe, Laura J. van 't Veer, Carolina Bravo, Alyse Wheelock, Elissa M. Ozanne, . Athena Breast Health Network Investigators. Can “mHealth” improve risk assessment? A usability study of older, low-income women answering the Athena Breast Health Questionnaire app. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B81.