Abdulrahman M Jabour, 1 Wajiha Rehman, 1 Sumaira Idrees, 1 Hemalatha Thanganadar, 1 Kiani Hira, 2 Mohammad A Alarifi3
1Departments of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia; Maternal, Newborn and Child Health Research Network, Islamabad, Pakistan; 3D Chamber of Radiological Sciences, Applied Medical Science College, King Saud University, Riyadh, Saudi Arabia
Background: Research has documented the important role of health care professionals in encouraging their patients to use and implement mobile health systems. Healthcare professionals who use and do not believe in cellular health systems are more likely to encourage and empower their patients to use them. Similarly, students in health-related matters using mobile health applications may continue to do so when joining staff.
Purpose: The purpose of this study was to assess the level of acceptance of mobile health applications for students in health colleges, to identify the types of health applications used by health students, and to identify barriers to the use of cellular health applications.
Methods: A brief descriptive study was conducted among university students. Students were invited to participate in independent research from five health colleges. The study included questions about the usage pattern, the purpose of the health-related application being used, and the barriers to adoption. The analysis includes descriptive statistics using SPSS.
Results: 383 students participated in the study. Gender comparisons showed that the majority of female students used 59.8% of health-related applications compared to 49% of male students. The general goal of using cellular health apps was to track 72.5% physical activity followed by a calorie count of 44% calories. We also identified the frequency and duration of use and the potential impact factors students intended to use.
Conclusion: Requests related to health and nutrition were so common that it could be explained that we included only a group of elders. Reported levels of practical use, accessibility and ease of use suggest that students will continue to use it.
Keywords: mHealth, mobile phones, behavior change, health promotion, exercise, nutrition, obesity, youth and students
There is a growing interest in using a mobile health system to improve service delivery.1,2 With the increasing use of mobile devices and internet access, mobile health apps are now more readily available.3,4 The number of health-related apps in Apple and Google Play stores has exceeded 97,000 and an additional 1000 new applications are added per month.5 The number of cellular health approvals has been highlighted by the COVID epidemic-19.6 Among the many factors that can affect cell phone health acceptance is the readiness and willingness of the user to use it.7
While smartphone programs can promise to manage many of the chronic health conditions, studies have repeatedly reported barriers related to its adoption and use.3,8 In addition to increased Internet and smartphone access, studies have repeatedly published seeking to understand user acceptance and the type of applications or services they will be interested in.9 10
Advancing general recommendations that require the acceptance of discerning users, researchers focused on investigating the acquisition of specific users and age groups.8,11-15 For example, digital segregation has been reported as a major barrier to the acceptance of diabetes-related applications.13 As diabetes is more common in older patients, not applicable to the new generation. Therefore, understanding the pattern and use of each user group is essential to improving user engagement and user-centered application development.
To include mobile health applications in the delivery of care, researchers highlight the importance of the admission of mobile health care professionals.3,16,17 The study reported the important role of health care professionals in assisting the use of patients and their acceptance of mobile health applications.18 Healthcare professionals are more likely to promote health. encourage their patients to use mobile life if they use it for themselves or in good condition. Studies that have examined the acceptance of general information technology or cellular health have shown that practical, easy-to-use, and accessible detection are strong predictors of discovery and purpose.22–24 Those studies have revealed many promoters and barriers to cell phone access applications among healthcare professionals.3,9 Research and the attitude of leading health care providers among medical students as they are future health care professionals.14,15,19–21 Although many previous studies focus on medical students, little is known about students in other health care fields such as nurses, dentists, and health educators and healthcare professionals.
A study investigating the use of health-related applications among students has inconsistent results. In the UK, 79.8% of students said they had a health-related request and that iOS users were more likely to use these apps compared to users of other apps.21 One study of university students at the University of Bordeaux in France found that only 34.9% of respondents downloaded applications related to health. .26 A study conducted in Greece found that 57.7% of medical students have one to five doctor requests on their mobile devices.14 In Saudi Arabia, the general use of health-related applications was unusual. Of those surveyed, 89.1% of users reported having a health-related request. About 73% were temporary users of this type of application and only 27% reported using this type of application at least once a day. 27
To further our understanding of the use of healthcare in the future and the use of mobile health care, we will focus on university students in health colleges. The objectives of our study are as follows:
Identify the level of access to mobile health applications for students at health colleges.
Identify the types of health applications used by health students.
Identify barriers to the use of mobile health applications.
How it works
We have searched the literature with the appropriate testing tools and none of these available surveys have met our specific needs. Therefore, we have improved our assessment tools by adopting and modifying the tools used in previous studies.3,9,20,21,26 The study collected demographic data of students including gender, age, and level of learning. The research also includes questions about the following: usage pattern, application name, type of application used, preferences regarding applications, barriers, and facilitators (Appendix 1; Table S1).
A team of local specialists (one statistician, two health informatics, and two medical doctors) examined the face and nature of the content of the questionnaire we conducted using the Lawshe verification method. 28,29 During this process, some questions were rearranged and rearranged to improve the relevance of the content of the questionnaire. To test the reliability of the questionnaire, we used the Kappa agreement rate and the Cronbach alpha. We found significant and balanced results for Kappa and Cronbach’s alpha greater than 0.5 indicating the reliability and consistency of the questionnaire.
Data Collection and Analysis
The study was conducted by students of medical college at Jazan University in Saudi Arabia. After obtaining the approval of the Institutional Review Board (reference number REC41 / 4/082), students were invited to participate in a self-administered survey. Participants in the study included male and female students at Public Health, Nursing, Pharmacy, Applied Medical and Medical College. Students were recruited with a simple sample by inviting students to participate during the break. The study was conducted in accordance with the Declaration of Helsinki and participants were informed of the details of the study and asked if they agreed to participate in the study. Written consent was also given along with research. The target sample size was 368 to 95% CI. The questionnaire was translated into Arabic and distributed on paper. Data was later transferred to Microsoft Excel for analysis. The analysis was performed using Microsoft Excel and the Statistical Package of Social Sciences SPSS V.21. Analysis includes descriptive analysis, Mann-Whitney tests, and chi squared.
A total of 383 students participated in the study. All participants were college graduates and the majority of participants were 20 years of age or younger, more than 66% were women and the remaining 34% were men. All study participants have a smartphone. The total percentage of students currently having a health-related request was 56% (n = 215/383). The gender distribution of those currently with health-related applications was 49% for men and 59.8% for women.
Results show that (81%, n = 311/383) of respondents have an iPhone and the remaining (19%, n = 72/383) use other apps including Android. The majority of study participants who had a health-related application had three or fewer applications (80%, n = 173/215). Very few participants reported having more than three applications.
Reasons for downloading health applications are shown in Figure 1. When students were asked about their specific applications, most of the applications were in the strength and exercise category (Appendix 2; Table S2). Students were also asked about the importance of their applications. Our results showed that 71% of respondents agreed that mobile applications reduce the cost of treatment and personal health management. Of the remaining respondents, 23% were unsure whether the applications would reduce their costs and reduce health care management and 3% disagreed with the statement. No significant differences were found between male and female in visual performance (P = 0.355). We also calculated chi square tests to compare differences in student ratings for visible use in all mobile phone users, physical activity, calorie counting, weight loss, chronic disease management, menstruation and none showed a difference with P = 0.987, P = 0.285, P = 0.555, P = 0.810, and P = 0.440 respectively.
The use of the mobile app was tested on a number of questions. Application usage time varies. Our study found that 28% used the application for six months, 18% applied for the application for 7 to 12 months, 20.6% applied for the application for one to two years, and 17% accepted the application for more than two years . We also found that 72.3% of students used the application at least twice a week (Table 1). The Mann-Whitney study showed that students using mobile applications to calculate calories or lose weight reported higher frequency and duration of use compared to other purposes such as following physical activity or recording the menstrual cycle (Table 2).
Table 1 Frequency of Health Related Applications Used Among University Students
Table 2 Comparing Differences in Frequency of Application Users with Long-Term Users Daily Using Applications for a Different Use
Of the potential features that students found useful, 47% (n = 102) chose “easy use”, 36% (n = 77) chose “up-to-date information”, and 3% (n = 6) chose “easy” accessible ”. When participants were asked if they had ever paid for a mobile application, only 11% answered “yes” and about half of those who responded said they paid less than 50 Saudi riyals (13 USD) per request. The results showed that Arabic was the preferred language of the participants (62%; n = 134), followed by English (32%, n = 69), and bilingual (6%, n = 12). The most common reason for not using the app consistently was time (57.6%, n = 124) followed by “hard to use” (23.2%, n = 50) (Table 3).
Participants who did not download health applications were given statements asking why they did not download applications. For those who did not download the apps (168/383, 43%), the top three reasons for not downloading were “not interested in health apps” (78/168, 46%), followed by “My health is good and you don’t need a health app” (34/168,20% ), and “difficulty of use” (21 / 168,12%).
In this study we examined the acceptance of mobile health applications among university students. We also examined the type of cellular health application used by students, as well as the barriers that prevent them from using health-related programs.
With the growing rate of chronic diseases such as obesity and diabetes, many studies have reported an important role for mobile health applications in the management and prevention of diseases. In addition to the rapid advances and technological advances in mobile health systems, user resistance and low utilization remain a problem.8,10,13 Healthcare professionals play a critical role in motivating and motivating patients to use mobile health applications. healthcare professionals who use a mobile health app and who are visually impaired are more likely to improve the health plans that go with their patients. Understanding the acceptance of mobile health applications among students at health-related colleges is equally important as they are future health professionals.
Both perceived usefulness, ease of use, and accessibility are strong predictions of the user’s intention to use and adopt information technology.22-24 Our study found that 71% of users agreed that the health system could help reduce health-related costs and improve their health. Nor did we find differences in physical activity between the sexes or between groups that use mobile apps for a variety of purposes such as physical activity, calorie counting, and weight loss, chronic illness, or psychological tracking. We also found that all respondents have access to smartphones, demonstrating the high power of smartphone technology in accessing this age group. Furthermore, our results show that many of the digital isolation and barriers to access to technology reported in previous studies do not apply to this age group. Another important prediction of the user’s intention to use and adopt information technology is ease of use.24 We found that only 12% of those who did not have a health-related app reported the reason for not using it was a complex application.
In addition to the high number of smartphone users, we found that less than half (56%) students did not download a health-related app. This result was consistent with other studies conducted in the US (58%) and Greece (57.7%) on this topic.14,26 Another study reported a different number of health-related application owners among students ranging from 34.9% in France to 79.8% in the UK. 21,25 Although similar in age and level of education for educated people, there has been a significant difference in the level of admission.
To identify the type of applications related to student health, we have asked them to select a section that describes the purpose of the application and to design a specific application that they recommend. We found that most respondents used the app to track body activity, weight loss, calorie counting, and tracking the menstrual cycle. The most widely used applications were MyFitnessPal, Stepz, Sehati, Fitbit and Hayat. Although many published articles on mobile health applications discuss the importance of these tools in treating chronic diseases such as diabetes and high blood pressure, our results show that only 8% to 9% of students using these types of applications used applications for this purpose. The explanation for this low consumption among our people is due to the age of our study (
Another recommendation when designing university-age students is to focus more on promoting and strengthening rather than on managing chronic diseases. This will also guide the design process for each type of application to suit the target group. For example, chronic disease management programs will need to focus on simplicity and ease of use to reach older generations while calorie-related energy and programs can add more functions to meet the needs of younger users.
Another recommendation for future studies is to use the power of various health care professionals in promoting the adoption and use of cellular health. With a strong focus on physicians and nurses, we recommend exploring ways in which other health care professionals would like to participate in promoting and promoting the acceptance of leading health applications.
This study provided insight into the level of acceptance of health-related applications among university students in health colleges. Most of the programs students received were related to body mass index and calorie intake. As students take cell phone health applications at an early age and find them useful, they are more likely to continue using cellular health-related programs and promote them in the future. Promoting the acceptance of these types of applications to young people on a large scale can be a great way to protect health because obesity and diabetes are a public health burden on the world. Investing in applications to identify a smaller number of people can be more profitable than traditional methods because programs can be made up of large audiences at no additional cost and programs can be built in a way to monitor user data and measure intervention interventions. One of the limitations of our study is that it is done at one university. In future studies, we recommend that you expand the study to more people to evaluate the feasibility of our results. We also recommend adding groups to focus on a deeper understanding of the student’s ideas and factors that may affect their level of adoption.
The authors would like to thank all the students who participated in this study.
All authors contribute to study, writing and editing. Leading author AJ oversees project design, implementation and analysis. The second author WR oversees the data collection process, as well as participant management. All authors carefully reviewed, edited, and approved the final manuscript.
No financial resources can be announced.
The authors report that there is no conflict of interest in this work and they have no financial, technical, or personal interests that could affect the work described in this manuscript.
1. Free C, Phillips G, Watson L, et al. Use of mobile health technology to improve health service delivery processes: systematic reviews and meta-analyzes. PLoS Med. 2013; 10 (1): e1001363. doi: 10.1371 / journal.pmed.1001363
2. Marcolino MS, Oliveira JAQ, D’Agostino M, Ribeiro AL, Alkmim MBM, Novillo-Ortiz D. Impact of mhealth interventions: a systematic review of systematic reviews. JMIR Health Health. 2018; 6 (1): e23. doi: 10.2196 / mhealth.8873
3. Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health acceptance by health workers: a systematic review. J Am Med Inform Assoc. 2015; 23 (1): 212-220. i-doi: 10.1093 / jamia / ocv052
4. Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A national action plan to support e-health consumer engagement. Health Aff. 2013; 32 (2): 376-384. doi: 10.1377 / hlthaff.2012.1216
5. UPeng W, Kanthawala S, Yuan S, Hussain SA. Quality testing of user ideas for mobile health apps. BMC Public Health. 2016; 16. doi: 10.1186 / s12889-016-3808-0
6. Bokolo AJ. Use of telemedicine and eHealth technology for medical services in response to the COVID epidemic – 19. Health Technol (Berl). 2021; 11 (2): 359–366. doi: 10.1007 / s12553-020-00516-4
7. Anthony B. Impact of telehealth solution and digital care during the COVID-19 epidemic: a comprehensive review of literature. Inform Health Care. 2021; 46 (1): 68-83. doi: 10.1080 / 17538157.2020.1839467
8. LeRouge C, Van Slyke C, Seale D, Wright K. Baby boomers ’adoption of consumer health technologies: readiness and barriers to research. J Med Internet Res. 2014; 16 (9): e200. doi: 10.2196 / jmir.3049
9. Kwon M, Mun K, D’Angelo J, McLeod DM, Lee J. Integrating mobile communications technology for public health: identifying the potential participation of the health app. 65th Annual World Communication Conference, Caribe Hilton, San Juan, Puerto Rico; 21 May 2015; Puerto Rico.
10. Fahad Aldhaban TUD, Harmon R. Assessing the adoption and use of smartphone technology in emerging regions. Paper presented at: Management of Engineering and Technology (PICMET) 2015 Portland International Conference on; 2016; 2355–2370; Portland.
Wang Y, Min J, Khuri J, et al. Assessment Effective community interventions and treatment of obesity and management: a systematic review of systematic reviews. JMIR Health Health. 2020; 8 (4): e15400. doi: 10.2196 / 15400
12. Winter SJ, Sheats JL, King AC. The use of behavioral and psychological change strategies in the prevention and treatment of heart disease in adults: a comprehensive review. Prog Cardiovasc Dis. 2016; 58 (6): 605-612. i-doi: 10.1016 / j.pcad.2016.02.005
13. Jabour A, Jones JF. Facilitators and barriers to patient engagement with their health records: a systematic review. Paper presented at: International Conference on Global Access to Computer and Employee Communication; 2013.
14. Chatzipavlou I, Misirlis N, Vlachopoulou M. Smartphone medical application: a study among medical students at Aristotle University of Thessaloniki. MCIS 2015 2015.
15. Cho J, Quinlan MM, Park D, Noh GY. Decisions to get smartphone health apps among college students. I am J J Health Behav. 2014; 38: 860-870. doi: 10.5993 / AJHB.38.6.8
16. Leigh S, Ashall-Payne L, Andrews T. Barriers and Facilitators in the Reception of Mobile Health among Health Workers from the United Kingdom: a unique choice of options. JMIR Health Health. 2020; 8 (7): e17704. DOI: 10.2196 / 17704
17. Gagnon MP, Desmarais M, Labrecque M, et al. Systematic review of factors that contribute to the adoption of information and communication technology by health care professionals. UJ Med Syst. 2012; 36 (1): 241-277. DOI: 10.1007 / s10916-010-9473-4
18. Miyamoto SW, Henderson S, young HM, Pande A, Han JJ. Tracking health data is not enough: quality assessment of the role of health care partnerships and mHealth technologies to promote physical performance and maintain behavioral change. JMIR mHealth iHealth. 2016; 4 (1): e5. doi: 10.2196 / health.4814
19. Jebraeily M, Fazlollahi ZZ, Rahimi B. The most common smartphone applications used by medical students and restrictions on their use. Acta Informatica Medica. 2017; 25 (4): 232-235. i-doi: 10.5455 / aim.2017.25.232-235
20. Quant C, Altieri L, Torres J, Craft N. Identification and application of medical applications among medical students in the United States: a summary survey. Int J Telemed Appl. 2016; 2016: 5. doi: 10.1155 / 2016/3929741
21. Payne KB, Wharrad H, Watts K. Smartphone and medical-related application use among medical students and junior doctors in the United Kingdom (UK): a regional survey. Performance of BMC Med Inform Decis. 2012; 12. DOI: 10.1186 / 1472-6947-12-121
22. Garavand A, Samadbeik M, Nadri H, Rahimi B, Asadi H. Practical factors in the acceptance of mobile health applications among medical science students using the UTAUT model. Methods Med Med. 2019; 58 (04/05): 131-139. doi: 10.1055 / s-0040-1701607
23. Mittal A, Aggarwal A, Mittal R. Predicting admission of university students through mobile news applications: the role of hedonic value recognition and media promotion. Int J E-Serv Phone Appl. 2020; (4): 42-59. DOI: 10.4018 / IJESMA.2020100103
24. Larcker DF, Lessig VP. The practical use of information: a psychological test. Decis Sci. 1980; 11 (1): 121-134. DOI: 10.1111 / j.1540-5915.1980.tb01130.x
25. Montagni I, Cariou T, Feuillet T, Langlois E, Tzourio C. Exploring the use of digital life and the ideas of university students: a field research study. JMIR mHealth iHealth. 2018; 6 (3): e65. doi: 10.2196 / health.9131
26. Krebs P, Duncan DT. Use of the health app among us cell phone owners: a national survey. JMIR mHealth iHealth. 2015; 3: e101. DOI: 10.2196 / health.4924
27. Sayedalamin Z, Alshuaibi A, Almutairi O, Baghaffar M, Jameel T, Baig M. The use of telephone-related medical applications among medical students at King Abdulaziz University, Jeddah: a cross-sectional study. J Influencing Public Health. 2016; 9: 691-697. DOI: 10.1016 / j.jiph.2016.08.006
28. Law CH. How to measure content authenticity. Pers Psychol. 1975; 28 (4): 563-575. DOI: 10.1111 / j.1744-6570.1975.tb01393.x
29. Taherdoost H. Performance and reliability of the research tool; how to test the validity of a questionnaire/research study. How to assess the validity of a questionnaire/research survey (August 10, 2016). 2016.