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Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care—one of the most effective ways to prevent illness—can be improved through mobile health apps.
This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive.
In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app’s usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting.
An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the “interface and satisfaction,” “ease of use,” and “usefulness” components.
MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries—often lacking other tools—can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government.
In 2019 and 2020, COVID-19 attracted international attention as a serious threat to public health [
Higher-income and further-developed countries such as Japan, the United States, and South Korea indeed started using digital technology to fight COVID-19, including such methods as contact tracing, the internet of things, big-data analytics, and artificial intelligence [
Nonetheless, most people in lower-income and underdeveloped countries lack access to complex digital technology, as these countries’ levels of information and communications technology infrastructure are much lower than those of more developed countries [
For the above reasons, learning self-care is important [
COVID-19–related smartphone apps offer useful capabilities and functionalities, such as tracking, follow-up, and prevention [
While a basic mobile app can be built solely by a person or persons with sufficient development skills, such an app is unlikely to become a useful, popular app; it has been built using only the knowledge and skills of the developer or developers, without input or feedback from specialized experts. Knowing this, we decided to design our app with deeper knowledge in the areas of mobile app design, development, and COVID-19 health information. This involved conducting a study in which we would ask various experts—health practitioners and mobile technology professionals—for their help; in this way, the resulting app would be designed using much deeper and broader knowledge than a single author or team could provide.
We also decided to use the ADDIE (analysis, design, development, implementation, and evaluation) education model, which is used to build educational systems. While the app we wanted to create was not an educational system per se, it did aim to teach, and we wanted it to teach effectively. We observed a strong correlation between our concept of a mobile app and educational systems created using the ADDIE model. Why did we decide to use this model to create a mobile app? We believed that an app that was designed using an educational model had a greater chance to teach its users effectively than an app designed without an educational methodology.
Therefore, in this study, we aimed to design, develop, and implement a standalone mobile app for training self-care skills based on the ADDIE educational model in order to improve self-care and prevent COVID-19, particularly in underdeveloped countries. We evaluated various facets of the app, all directly or indirectly related to its main goal: to help its users enhance their self-care skills in the context of COVID-19.
The present methodological study used the ADDIE educational design model to develop an educational mobile app for self-care with the purpose of supporting self-prevention of COVID-19 [
Educational app development (analysis, design, development, implementation, and evaluation) model phases.
During the analysis phase, we sought to determine the appropriate practical contents of the mobile app and categorize them. For this purpose, from October 1 to 15, 2020, we interviewed 3 infectious disease experts and 2 nursing specialists. Because of COVID-19 conditions, the interviews were remote and used the Zoom meeting software. We used qualitative methods to analyze and categorize the resulting content requirements for a self-care mobile app [
In the design phase, we focused on optimizing the user experience of the designed mobile app and its feature list; we did so through online workshops with a group of experts in the fields of health information technology, medical informatics, user experience design, and Android mobile app development. The experts were enrolled via requests on social networks (eg, Instagram, Facebook, and LinkedIn) sent from October 20 to 28, 2020; we tried to enroll as many experts as possible.
According to the literature, we required between 14 and 28 experts [
We asked 5 experts in the field of user experience design and development of mobile health (mHealth) apps for assistance. They ranked the prototype using Jacob Nielsen’s 10 general principles of severity for evaluating interactive design, which use a 5-point scale [
The results of the analysis and design phases provided the knowledge to be used in the development phase, in which we developed a database using My Structured Query Language (MySQL) and a mobile app, which we called “MyShield,” using Android Studio. The development phase took place from November 1 to 8, 2020.
During this stage, we recruited ordinary people (ie, nonexperts) for our study through purposive sampling. Interested candidates contacted us through online registration after seeing the recruitment posts on social networks (including Instagram, Facebook, and LinkedIn). Twenty-seven participants registered; this was within the intended range of 25 to 30 subjects, as used in other, similar studies [
We used an online workshop to introduce the research team and project aims. During the workshop, we explained the ADDIE design process to the participants and their involvement. As a pretest, conducted before using the app, the participants were required to complete a self-care inventory (SCI) questionnaire. This questionnaire includes 30 items and 6 dimensions [
Once the participants completed the questionnaires, they started using the MyShield app, from November 10 to December 25, 2020 (45 days). During these 45 days, we asked the participants to use the app every day for as long as they wanted, but for at least 20 minutes per day; the time of day did not matter. The app contains an initial guide (presented as a showcase); we also created a WhatsApp group where the participants could ask us any questions related to the study and the app. The initial guide feature displayed the guidelines on how to work with the app after the user’s first encounter with it. The app also contained an “About Us” section, where users could find information about the research, the app design team, and how to contact the team. The app allowed users to update to a newer version in the case of any resolved technical issues.
After the implementation phase ended on December 26, 2020, we used the standard standalone MAUQ (Mobile Health App Usability Questionnaire) to evaluate the usability of the app. This questionnaire has 3 factors: ease of use (5 items), interface and satisfaction (7 items), and usefulness (6 items). It is based on a 7-item Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree) [
The participants in the pretest and posttest surveys provided informed consent. Tarbiat Modares University Ethics Committee (IR. MODARES. REC.1399.142) approved the entire study protocol.
In the analysis phase, meetings with the experts helped us find the optimal content of the MyShield app, including the main menu. The participants agreed that MyShield should cover the following 5 topics: self-motivation, daily life management, personal hygiene, healthy eating, and exercise.
We determined that self-motivation content should teach the users how to think positively, motivate themselves, and utilize their intrinsic motivations. In matters related to daily life management, the app should include strategies on how to manage stress, fear, and anger. Education is also essential in other areas, such as managing life during personal quarantine and social activities. The personal hygiene aspect should deal with education related to masking and observing social distancing, washing hands, and use of disinfectants. Healthy eating education should include information on useful supplements, beverages, fatty foods, proteins, dairy products, nutrition programs, and controlling or avoiding smoking. Exercise education should cover such topics as exercising at home, conditions for exercising outdoors, professional exercise, the intensity of exercise, and exercise in self-quarantine.
Online workshops conducted with the 14 experts were utilized to determine the practical features; moreover, the user experience decided during the design phase helped us to determine the practical design of MyShield, as follows. The app starts with an initial opening screen. Next, the registration page appears. Here, the user must provide a few pieces of personal information (email, user name, and password). An introduction slide appears on the initial launch of the app. Three slides appear to be ideal for introducing the app. We found that in order to familiarize the user with the app, the showcase should appear after the introduction slide. After this, the user sees the main menu. It has two action bars: one, at the top of the page, displays the search feature of the entire app; while the other, at the bottom of the page, contains buttons, messages, help, settings, and profiles. On the left-hand side, there is a hamburger button (3 horizontal lines) which, when tapped, leads to the app’s settings. The settings include fonts, title searches, option selection and clearing, find, last read, light or dark theme, notification, changing passwords, and an “About Us” option. The content had a share button, which should be checked as marked. In addition, the users had an option of liking or disliking the content.
During the heuristic evaluation of the app’s prototype, these features each earned 0 to 2 points, meaning that the prototype received a rejection or an acceptable score.
In the development phase, functional requirements, user interface screens, and software database designs were created. The interface design was a process that involved installing specialized software on smartphones and connecting them to the internet, so that users could register their accounts in the app. Thus, the users were registered on the server and their registration IDs were stored on the app server. MySQL was used to design and develop the database, and Android Studio was used to develop the app. Eventually, after thorough consultation with infectious disease specialists and experienced nurses, a beta version of MyShield was developed and released (
User experience flow of the MyShield mobile app.
MyShield’s prototype scoring according to a heuristic evaluation based on Jacob Nielsen’s 10 general principles.
Heuristic principle | ΣAa | ΣBb | Expert identification number | ||||
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|
|
1 | 2 | 3 | 4 | 5 |
Visibility of system status | 4 | 3 | 0 | 1 | 2 | 1 | 0 |
Match between system and the real world | 2 | 2 | 0 | 0 | 0 | 0 | 2 |
User control and freedom | 4 | 3 | 1 | 1 | 0 | 2 | 0 |
Consistency and standards | 2 | 1 | 0 | 1 | 0 | 0 | 1 |
Error prevention | 6 | 3 | 2 | 2 | 1 | 1 | 0 |
Recognition rather than recall | 3 | 1 | 0 | 0 | 1 | 1 | 1 |
Flexibility and efficiency of use | 9 | 3 | 2 | 2 | 2 | 2 | 1 |
Aesthetic and minimalist design | 6 | 3 | 1 | 0 | 1 | 2 | 2 |
Error identification, diagnosis, and recovery | 3 | 1 | 0 | 1 | 0 | 1 | 1 |
Help and documentation | 6 | 3 | 2 | 2 | 1 | 1 | 0 |
Total | 45 | 23 | 8 | 10 | 8 | 11 | 8 |
aΣA: total number of points.
bΣB: number of points after removing duplicates.
Examples of pages from the MyShield self-care mobile app.
The participants completed the MAUQ questionnaire designed for standalone mHealth apps. Overall, all items received a score of 3.5 or higher (
Demographic characteristics of the participants (N=27).
Characteristics, n (%) | Values | ||
|
|||
|
18-28 | 7 (26) | |
|
29-38 | 12 (44) | |
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39-50 | 8 (30) | |
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|||
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Male | 12 (44) | |
|
Female | 15 (56) | |
|
|||
|
High school diploma | 3 (11) | |
|
Some college credits, no degree | 5 (19) | |
|
Bachelor’s degree | 10 (37) | |
|
Master’s degree | 5 (19) | |
|
Professional degree | 3 (11) | |
|
Doctoral degree | 1 (4) | |
|
|||
|
1-2 | 5 (19) | |
|
3-5 | 10 (37) | |
|
5 or more | 12 (44) |
The mean and SD of the results obtained from the MyShield usability app according to the Mobile Health App Usability Questionnaire. These statements can receive responses ranging from 1 (strongly disagree) to 7 (strongly agree).
Items, mean (SD) score | Values | ||
|
|||
|
1. The app was easy to use. | 6.54 (0.499) | |
|
2. It was easy for me to learn to use the app. | 6.33 (0.471) | |
|
3. The interface of the app allowed me to use all the functions (such as entering information, responding to reminders, viewing information) offered by the app. | 6.29 (0.568) | |
|
4. The navigation was consistent when moving between screens. | 6.15 (0.422) | |
|
5. Whenever I made a mistake using the app, I could recover easily and quickly. | 6.00 (0.756) | |
|
|||
|
1. I like the interface of the app. | 6.95 (0.213) | |
|
2. The information in the app was well organized, so I could easily find the information I needed. | 6.93 (0.258) | |
|
3. The app adequately acknowledged and provided information to let me know the progress of my action. | 6.89 (0.348) | |
|
4. Overall, I am satisfied with this app. | 6.83 (0.373) | |
|
5. The amount of time involved in using this app has been fitting for me. | 6.69 (0.462) | |
|
6. I would use this app again. | 6.49 (0.523) | |
|
7. I feel comfortable using this app in social settings. | 6.18 (0.383) | |
|
|||
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1. The app improved my access to health care services. | 6.51 (0.5) | |
|
2. The app would be useful for my health and well-being. | 6.44 (0.585) | |
|
3. The app helped me manage my health effectively. | 6.20 (0.72) | |
|
4. I could use the app even when the internet connection was poor or not available. | 5.88 (0.391) | |
|
5. This app has all the functions and capabilities I expected it to have. | 5.75 (0.652) | |
|
6. This mHealth app provided an acceptable way to receive health care services, such as accessing educational materials, tracking my own activities, and performing self-assessment. | 5.63 (0.483) |
In the pretest, the participants completed an SCI questionnaire before using the app: 2 respondents scored below 50, 8 scored 50 to 90, 14 scored 91 to 119, and 3 scored above 120 (
After the users used MyShield, we examined their average scores (0-5) for the self-care dimensions in the pretest and posttest to determine which dimensions had improved and which had decreased. The mean mental well-being score increased from 2.95 in the pretest to 3.88 in the posttest. For the physical health dimension, the mean score increased from 3.21 to 4.17. The increases for the other dimensions were visibly smaller (
Pre- and posttest participants’ self-care assessment. The left panel shows posttest results against pretest results. Points above the gray line show an improvement in the posttest. The right panel (a modification of the modified Tukey mean-difference plot, presented by Kozak and Wnuk [
Comparison of mean scores for the self-care dimensions of the MyShield app. The graph is ordered by the dimensions’ improvement among the users.
This study aimed to develop a self-care app in order to help users improve their skills to prevent COVID-19 infection. To this end, we have developed, with the help of various field experts, a mobile app called MyShield; it is designed to work mainly in underdeveloped countries, as people in such countries are often left alone to struggle with their fear of COVID-19.
We designed MyShield using the ADDIE educational model. This is a novel, interdisciplinary approach to app design. MyShield is a mobile app that, in addition to being a potential public health resource, is also an educational entity built to teach people self-care skills and health knowledge that is effective well beyond the use of the app. MyShield utilizes the ADDIE educational model to enable users to teach themselves these self-care skills, making the app a channel of knowledge the user can learn from. A possible effect that the app attempts to achieve is an increased chance for users to protect themselves from COVID-19. While MyShield is just a tool to initiate this learning, it is the source of the positive effects we have just discussed. We hope this plan will come to fruition, and that MyShield will encourage people from underdeveloped countries to believe in their own skills and learn or improve their self-care skills to reduce health risks.
As a standalone app, MyShield includes 6 major menus and various subcategories directly related to self-care training. In order to see how MyShield helped the participants, we conducted pretests before the initial use of the app. After participants used MyShield for 45 days, we conducted posttests to see if using the app helped them enhance their self-care skills. Both tests used a self-care inventory questionnaire to assess the participants’ self-care levels. All participants showed improvement; those who had shown poor self-care skills in the pretest improved much more than those with higher self-care awareness (
In the COVID-19 era, mobile apps are particularly useful when their design does not limit their use to a particular group or particular members of society, but rather allows them to be used by all society’s members, including young people, older adults, and people with physical disabilities. This issue is so crucial that it is emphasized as one of social justice and human rights [
Islam et al [
MyShield’s strength is in its interface, which had a satisfaction rating of 95.9%. According to the participants, the app organized information well, displayed progress, provided health information in a comprehensive manner, and let its users perform all its functions in an appropriate way. Access to health care services and educational materials is a unique feature of health apps [
The MAUQ results showed that the app met the health and care needs of individuals and helped them to improve their self-care skills by providing them with relevant information. We consider that such a systematic approach, taking into account people’s needs and limitations, reaches far beyond the confines of many contributions of COVID-19 self-care apps.
The study had a small number of participants. The number, however, was large enough to represent the app’s user groups in aspects such as education, gender, and age. However, we could have specifically included more older participants, most of whom are unfamiliar with health care apps on smartphones. This would have required a much larger study group. Our study designed the app specifically to address the needs of underdeveloped countries, but we conducted our survey in Iran, a more developed country than the target audience of this app. However, most participants—selected through purposive sampling—had little knowledge about self-care, so they can be considered a fair representation of people from underdeveloped countries.
Another limitation was the length of time (45 days) during which the participants had the opportunity to use MyShield. Budget limitations prevented us from extending the study beyond 45 days. Perhaps if the participants used the MyShield app for a longer period of time, the self-care inventory would have improved. In addition, the app was available for Android only, automatically excluding all iOS (ie, Apple) users. A future study may address these issues.
This study demonstrates that using a standalone mobile app based on a standard educational model can improve people’s self-care skills. Improving self-care skills in underdeveloped countries with mobile health apps is a rather simple, inexpensive, and effective solution. It does, however, require a way to reach people and to convince them to use such an app. We consider that the design and development of MyShield can be used as a practical and realistic model for the development of mHealth apps. According to our findings, standard educational models combined with existing designs (eg, user-centered or interactive designs) for mobile health apps can meet most requirements of mobile educational apps.
As our research shows, MyShield can help people from both underdeveloped and developing countries, where the fight against COVID-19 is particularly difficult due to economics. We developed MyShield using a special educational design method to enable people to better learn to improve their self-care skills, thus helping to better protect themselves against COVID-19.
Self-care inventory.
analysis, design, development, implementation, and evaluation
Mobile Health App Usability Questionnaire
mobile health
My Structured Query Language
self-care inventory
The authors would like to thank all the professors and staff of the Tarbiat Modares University who helped us in this study. The second author (M Kozak)—like all the other authors—also thank Howard for his help with English-language editing of the text. In addition, the first author of this paper (HRS) as well as all other authors would like to thank Mr Afshin Babajani for his help with the design of the MyShield app. Finally, we consider it necessary to dedicate this research work to the medical staff and all those who have been risking their lives to save others. A grant from the Romanian National Authority for Scientific Research and Innovation to MA and CH was partially used to support this project (PN-III-P4-ID-PCCF-2016-0084).
HRS conceived and designed the mobile app and drafted the manuscript. ZM and AG collected and interpreted the data. M Kozak participated in designing the evaluation, performed parts of the statistical analysis, and helped revise the manuscript. MA and CH reevaluated the data, revised the manuscript, and performed the statistical analysis. M Karajizadeh and MH reanalyzed the statistical data. All authors read and approved the final manuscript.
None declared.