Cogni i e Accessibili y in Use Expe ience
Assessmen o Mobile Heal h: A Re iew
Lau a MONTOYAa,1, Oc a io RIVERA-ROMERO a, and
En ique DORRONZORO-ZUBIETEa
a Depa amen o Elec onic Technology, Uni e sidad de Se illa, Spain
ORCiD ID: Lau a Mon oya h ps://o cid.o g/0009-0004-8953-2448, Oc a io Ri e a-
Rome o h ps://o cid.o g/0000-0001-7212-9805, En ique Do onzo o-Zubie e
h ps://o cid.o g/0000-0001-8478-9851
Abs ac . Wi h an inc easingly aging popula ion, cogni i e impai men (CI)
p e alence is a majo conce n in heal hca e. The in e na ional s anda d o heal h
echnologies speci ies equi emen s o design cogni i ely accessible p oduc s
aimed o suppo people wi h CI ega dless o age. While Use Expe ience (UX)
design amewo ks like he Honeycomb de ine accessibili y as a dimension o be
conside ed, li le is known abou how cogni i e accessibili y (CA) is being
ega ded in he UX assessmen o mobile heal h (mHeal h). We conduc ed a
seconda y analysis om a b oade e iew on UX assessmen o in e ac i e
mHeal h echnologies ocusing on CA conside a ion in hose a ge ed o people
wi h, o a isk o CI. Nine pape s we e analyzed. Mos common adap a ions o he
UX assessmen p ocedu e we e o in ol e ca egi e s, conduc ing in e iews in
pe son and in na u alis ic se ings and ime conside a ions. Only one s udy u ilized
an adap ed alida ed e sion o mHeal h echnology ques ionnai e. Conside a ions
o CA included means o mo i a ion, simple design conside a ions and means o
ep esen a ion and unde s anding. While some guidelines o CA a e being
ega ded, esul s o he assessmen s show a gap be ween wha is impo an o
pa ien s and wha was conside ed in he e alua ion ins umen s. De eloping
mHeal h speci ic UX ques ionnai es could help in unde s anding he needs o
people wi h CI and guide he design o accessible echnologies.
Keywo ds. Use Expe ience, Mobile Heal h, Cogni i e impai men s, Accessibili y
1. In oduc ion
Cogni i e impai men (CI) is a majo conce n d i en by he an icipa ed ise in
p e alence o disease and disabili y associa ed wi h he global end o popula ion
aging [1]. Mobile heal h echnologies (mHeal h) a e inc easingly gene a ing in e es o
hei abili y o moni o , assis s, and suppo sel -managemen o indi iduals wi h CI o
hose a isk o declining cogni i ely o e ime. Memo y loss, a en ion de ici s as well
as a igue may, howe e , hinde he in e ac ion and adhe ence o hese echnologies.
Indeed, esea ch e ealed ha cogni i ely olde adul s show di e en phone usage
pa e ns such as use o ewe apps and longe imes o comple e asks [2]. Assessing he
1 Co esponding Au ho : Lau a Mon oya, Depa men o Elec onic Technology, ETSII, Uni e sidad de
Se illa, Se ille, Spain; E-mail: lmon [email protected].
In elligen Heal h Sys ems – F om Technology o Da a and Knowledge
E. And ikopoulou e al. (Eds.)
© 2025 The Au ho s.
This a icle is published online wi h Open Access by IOS P ess and dis ibu ed unde he e ms
o he C ea i e Commons A ibu ion Non-Comme cial License 4.0 (CC BY-NC 4.0).
doi:10.3233/SHTI250516
969
expe ience o people wi h CI in he in e ac ion wi h mHeal h solu ions is he e o e
c ucial o guide he design o accessible and use - iendly mHeal h echnologies.
The In e na ional O ganiza ion o S anda diza ion (ISO) posi s cogni i e
accessibili y (CA) as a equi emen o he design o all in e ac i e and assis i e
echnologies [3]. CA e e s o he abili y o sys ems o be used by indi iduals wi h
di e se cogni i e needs and capabili ies o achie e speci ic goals in a ious con ex s
[3]. Ensu ing simplici y and unde s andabili y, o e ing s ong suppo , os e ing
au onomy and ensu ing sa e y is e en mo e essen ial o mHeal h designed o people
wi h o a isk o cogni i e decline.
Use expe ience (UX) assessmen is key o unde s anding whe he hese
equi emen s a e being success ully implemen ed. While UX design amewo ks such
as he Honeycomb by Mo ille [4] posi accessibili y as a key elemen o be conside ed
in he design o mHeal h solu ions, li le is known abou how cogni i e unc ion is
being ega ded in UX in mHeal h assessmen s. This pape aims o explo e whe he and
how CA is being conside ed in UX assessmen s o in e ac i e mHeal h echnologies
a ge ed o people wi h, o a isk o CI.
2. Me hod
A sys ema ic e iew was conduc ed ollowing he P e e ed Repo ing I ems o
Sys ema ic Re iews and Me a-Analysis (PRISMA) guidelines [5]. This was a
seconda y analysis, pa o a b oade e iew we p e iously conduc ed on UX
e alua ions o in e ac i e mHeal h echnologies. PubMed, APA PsycIn o, IEEE Xplo e,
ACM Digi al Lib a y da abases we e sea ched using using keywo ds a ound h ee
ca ego ies: Mobile Heal h, UX and E alua ion. We included pape s in English
language wi h a ailable access o ull ex ha explici ly conduc ed UX e alua ions o
in e ac i e mHeal h echnologies a ge ed o adul s wi h CI o a isk o su e ing
cogni i e decline ei he because o a neu ological condi ion o aging. Condi ions no
causing di ec ly CI such as a ec i e o sleep diso de s we e excluded. A icles we e
excluded i a ge use s we e heal h ca e p o essionals o o mal ca egi e s and hose
whose UX e alua ion was made by expe s, s akeholde s, o heal h p o essionals.
Fo each included s udy, we collec ed da a on a ge popula ion, ype and pu pose
o he assessed mHeal h solu ion, UX e alua ion me hods and ools, adap a ions o he
UX e alua ion me hods o cogni i e skills o he a ge popula ion, and cogni i e
accessibili y aspec s conside ed in he UX e alua ion and epo ed in he esul s. We
used he ISO-21801-1:2020 [3] o iden i y he aspec s o CA: “Flexibili y o Use”
(FU), “Means o Exp essions” (ME), “Means o Mo i a ion” (MM), “Means o
Rep esen a ion and Unde s andings” (MRU), “O ganiza ion, Planning and Time
Managemen ” (OPTM), “Suppo needed o Comple ion o Tasks/Assis ance wi h
E o s” (SCTAE), “Simple, Unde s andable and Logical Design” (SULD), Focus,
A en ion and Feedback’’ (FAF), “Spa ial O ien a ion and Unde s anding o Values and
Sizes’’ (SOUVS).
3. Resul s
Nine pape s we e iden i ied o mee he inclusion c i e ia and selec ed o analysis [6-
14]. Eigh wo ks add essed olde o elde ly adul s ( ange o ages om 60-90) [6-9, 11-
L. Mon oya e al. / Cogni i e Accessibili y in Use Expe ience Assessmen o Mobile Heal h970
14] and one o adul s ( om a ound 36 o 60) wi h a isk o CI [10]. The mHeal h
echnologies comp ised apps (6/9) [6,8,10,12-14] and in eg a ed sys ems (e.g.,
wea ables and app) (3/9) [7,9,11] and hey a ge ed seden a ism [12], gene al ca e [8],
ail y [14], adhe ence o ea men [6,10], demen ia [9], cogni i e decline de ec ion
[13] and all p e en ion [7,11]. Th ee di e en me hods we e used o e alua e UX in
hese s udies, su eys using ques ionnai es (7/9) [6-8,10,11,13,14], in e iews (4/9) [7,
8,11,12] and ocus g oups (1/9) [9]. The mos used ques ionnai e was he UEQ (3/9)
[6,8,10], ollowed by pu pose-buil ques ionnai e (2/9) [6,14], and he SUS (2/9) [7,
11]. Only one pape used a alida ed adap ed e sion o a ques ionnai e o hei
popula ion, namely, he SUS-S [13]. A emp s o adap he UX assessmen o people a
isk o being cogni i ely impai ed a e summa ized in Table 1.
The mos used adap a ions we e lexibili y in he ime o use he de ice and
in ol ing amily membe s o ca egi e s (5/9). Table 2 shows he aspec s conside ed in
he selec ed s udies. The mos conside ed aspec was “Means o Mo i a ion” (9/9)
ollowed by SULD conside ed in 5 s udies.
Table 1. Adap a ions o he UX assessmen me hods used in he included s udies.
Re .
Adap a ion o UX assessmen me hod
[6]
Time managemen ; In ol emen o amilies
[7]
Time managemen
[8]
Guided app in e ac ion wi h a esea che ; Ca egi e s in i ed o social suppo
[9]
Assess cogni i e ese e and echnical p o iciency; Assis ance o ca egi e s
[10]
P omo ion o au onomy; Real-li e se ing
[11]
Time managemen
[12]
Leng h and o ma ; Flexibili y; Time managemen
[13]
Time managemen ; Adap ed ques ionnai e o elde s
[14]
Assess digi al skills; Allow ca egi e s o be p esen ; Compa ison wi h pape o ma
Table 2. Cogni i e accessibili y aspec s conside ed in he selec ed s udies. Aspec s conside ed in he
e alua ion a e ep esen ed by poin s while hose ha aised in he epo ed esul s a e ep esen ed by c osses.
Re .
FU
ME
MM
MRU
OPTM
SCTAE
SULD
FAF
SOUVS
[6]
E alua ion
●
●
Resul s
X
X
[7]
E alua ion
●
Resul s
X
X
X
[8]
E alua ion
●
●
●
Resul s
X
X
X
X
X
[9]
E alua ion
●
●
●
Resul s
X
X
[10]
E alua ion
●
●
●
Resul s
X
[11]
E alua ion
●
Resul s
X
[12]
E alua ion
●
●
Resul s
X
X
X
[13]
E alua ion
●
●
●
Resul s
X
X
X
X
X
[14]
E alua ion
●
●
●
●
Resul s
X
L. Mon oya e al. / Cogni i e Accessibili y in Use Expe ience Assessmen o Mobile Heal h 971
4. Discussion and Conclusions
This pape aimed o explo e how CA is being ega ded in he assessmen s o he
expe ience wi h mHeal h echnologies o people wi h, o a isk o CI. Nine pape s
we e e iewed o look o ac o s o CA conside ed in he p ocess and assessmen o
use expe ience. Mos o he pape s a ge ed people a isk o cogni i e decline and
only wo pape s we e speci ic o people wi h CI. Fo he assessmen p ocedu es, he
adap a ions obse ed mainly en ailed in ol ing ca egi e s o pa ien ’s suppo ,
choosing na u alis ic en i onmen s, ime conside a ions and p o iding al e na i e
con en ional me hods. Common conside a ions o CA included means o mo i a ion,
simple design conside a ions and means o ep esen a ion and unde s anding.
A inding wo h men ioning was he lack o use o heal h speci ic ques ionnai es,
despi e all s udies in ol ed pa ien s a isk o cogni i e decline. Only Young e al.,
2024 u ilized an adap ed ques ionnai e o elde s [13]. While some dimensions ela ed
o CA we e conside ed, aspec s ha p o ed o be impo an o use s we e no . Fo
ins ance, need o assis ance and enhanced eedback a e e o s we e common
complains. These indings could be explained by pos e o slowing ela ed o aging
[15]. Fu he mo e, in e es ingly, o mo e complex mHeal h sys ems in ol ing mo e
han one de ice, use s ended o delega e pa o he sys em o ca egi e s, aligning wi h
insigh s on cogni i ely impai ed people p e e ence o using less apps [2].
Unde s anding cogni i e abili ies o use s is hus c ucial o achie ing accessible
designs.
While all s udies implemen ed a leas one measu e o enhance he accessibili y o
he UX assessmen , only a s udy o pa ien s wi h demen ia [9] assessed he cogni i e
s a us o use s. UX assessmen s e ealed, howe e , issues ela ed o lack o con idence
wi h use ’s own skills [13] o o ge ulness [6] as ba ie s o adhe ing o he use o
mHeal h in pa ien s a isk o CI. Gi en he u ili y o hese pape s was o enhance
adhe ence o ea men , i migh ha e been bene icial o unde s and and conside he
cogni i e s a us o pa ien s. Mo eo e , longi udinal assessmen migh be key o adap o
changing cogni i e demands o use s and gua an ee he accessibili y o echnology o e
ime.
5. Conclusions and Limi a ions
This e iew o how CA is being ega ded in UX assessmen s o people wi h o a isk
o CI highligh s he need o mo e conside a ions and a en ion o use ’s s a e and needs.
Unde s anding CI use expe ience could maximize he use ulness and usabili y o hese
echnologies bene i ing he accep ance and adhe ence o adul s wi h CI. This s udy
p esen s some limi a ions: No all da abases ha e been sea ched, so he e may be
ele an a icles ha ha e no been s udied. Some au ho s may ha e conside ed some
aspec s o CA wi hou explici ly epo ing i in he pape .
Acknowledgemen s
G an PID2021-125528OB-I00 unded by MICIU/AEI/10.13039/501100011033 and
by “ERDF A way o making Eu ope”
L. Mon oya e al. / Cogni i e Accessibili y in Use Expe ience Assessmen o Mobile Heal h972
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