Shao Yi He, Wei Sen Zhang, Chao Qiang Jiang, Ya Li Jin, Tai Hing Lam, Kar Keung Cheng, Lin Xu
Association of adverse childhood experiences with anemia in older Chinese: Guangzhou Biobank Cohort Study
Scientific reports
health care systems rapidly deploying digital tools disease management however studies evaluated usability vulnerable populations understand barriers app usage among vulnerable populations employed usercentered design ucd methods development new text messaging app study aimed describe variations patients engagement app design process focusing limited health literacy lhl limited english proficiency lep limited digital literacy ldl conducted 20 indepth semistructured interviews primary care patients public health care system used openended discussions card sorting tasks seek input mobile phones text messaging used open coding categorize patterns mobile phone usage evaluate engagement card sorting process examined qualitative differences engagement examining extensiveness participant feedback existing novel text messaging content calculated proportion patients providing extensive feedback existing novel content overall health literacy english proficiency digital literacy average age 20 participants 59 sd 8 years 13 65 female 18 90 nonwhite 16 80 lhl 13 65 lep depression 14 70 diabetes participants smartphones 1820 90 regularly used text messaging 1520 75 14 70 reported difficulty texting inability type physical disability low literacy identified 10 participants specifically ldl 7 participants lep 10 lhl half participants required modification card sorting activity owing understanding able read cards allotted time proportion participants gave extensive feedback existing content lower participants limited versus adequate english proficiency 413 30 vs 57 71 limited versus adequate health literacy 716 44 vs 34 75 limited versus adequate digital literacy 410 40 vs 610 60 none differences statistically significant examining proportion patients gave extensive feedback novel messaging content lhl less engaged adequate health literacy 816 50 vs 44 100 statistical differences subgroup despite widespread mobile phone use digital literacy barriers common among vulnerable populations engagement card sorting activity varied among participants appeared lower among lhl lep ldl researchers employing traditional ucd methods routinely measure communication domains among enduser samples future work needed replicate findings larger samples augmentation card sorting direct observation audiovisual cues may productive eliciting feedback communication barriers