O iginal Pape
Use Expe ience o and Adhe ence o a Sma phone App o
Main ain Beha io Change and Sel -Managemen in Pa ien s Wi h
Wo k-Rela ed Skin Diseases: Mul is ep, Single-A m Feasibili y
S udy
Nele Ris ow1,2, MEd; Annika Wilke1,2, PD D ; Ch is oph Skudlik1,2, P o D Med; Swen Mal e John1,2, P o D Med;
Michaela Ludewig3, P o D
1Depa men o De ma ology, En i onmen al Medicine and Heal h Theo y, Ins i u e o Heal h Resea ch and Educa ion, Osnab ück Uni e si y,
Osnab ück, Ge many
2Ins i u e o In e disciplina y De ma ological P e en ion and Rehabili a ion (iDe m) a he Osnab ück Uni e si y, Osnab ück, Ge many
3Depa men Heal h Sciences, Hochschule Bochum, Bochum, Ge many
Co esponding Au ho :
Nele Ris ow, MEd
Depa men o De ma ology, En i onmen al Medicine and Heal h Theo y
Ins i u e o Heal h Resea ch and Educa ion
Osnab ück Uni e si y
Am Finkenhügel 7a
Osnab ück, 49076
Ge many
Phone: 49 541 969 7410
Fax: 49 541 969 2445
Email: ne is o[email p o ec ed]
Abs ac
Backg ound: Sma phone apps a e a g owing ield suppo ing he p e en ion o ch onic diseases. The use expe ience (UX)
is an impo an p edic o o app use and should be conside ed in mobile heal h esea ch. Long- e m skin p o ec ion beha io is
impo an o hose wi h wo k- ela ed skin diseases. Howe e , al e ing heal h beha io is complex and equi es a high le el o
sel -managemen . We de eloped a main enance p og am consis ing o he Mein Hau schu z im All ag (MiA; “My skin p o ec ion
in e e yday li e”) app combined wi h an indi idual ace- o- ace goal-se ing in e iew o suppo pa ien s in he implemen a ion
o skin p o ec ion beha io a e inpa ien ehabili a ion.
Objec i e: The objec i es o his pape a e o (1) desc ibe he in e en ion in a s anda dized manne ; (2) e alua e he UX,
subjec i e quali y, and pe cei ed impac o he MiA app; and (3) e alua e he adhe ence o he MiA app.
Me hods: We ollowed a use -cen e ed and mul is age i e a i e p ocess in 2 s eps ha combined quali a i e and quan i a i e
da a. The main enance p og am was es ed o e 12 weeks a e discha ge om ehabili a ion. The UX, subjec i e quali y, and
pe cei ed impac we e e alua ed o ma i ely based on he use e sion o he Mobile Applica ion Ra ing Scale a e 12 weeks
(T2). Adhe ence was measu ed using he equency o in e ac ions wi h he app.
Resul s: In o al, 42 pa ien s ook pa (wi h a d opou a e o n=18, 43% a T2). The a e age age was 49.5 (SD 13.1) yea s, and
57% (24/42) we e male. We ound high a ings o he UX, wi h an a e age sco e o 80.18 (SD 8.94) ou o a heo e ical maximum
o 100, bu he e we e a ew excep ions in he usabili y and in e ac ion wi h he app. The app was mos equen ly a ed wi h 4
ou o 5 s a s (15/24, 65%), which indica es a high subjec i e quali y. Fu he mo e, he app seemed o in luence impo an
de e minan s o implemen skin p o ec ion beha io . Adhe ence o skin p o ec ion acking was highe o e he s udy pe iod han
adhe ence o skin documen a ion and goal assessmen . The numbe o adhe en pa icipan s o skin p o ec ion acking was highe
in he skin ca e and skin cleansing ca ego ies (28/42, 67% each) compa ed o he skin p o ec ion ca ego y (13/42, 31%) on day
1 and dec eased un il day 84 in all dimensions (12/42, 29% each o skin ca e and skin cleansing; 9/42, 21% o skin p o ec ion).
Conclusions: The esul s in e ms o adhe ence me he expec a ions and we e consis en wi h hose o o he s udies e alua ing
he use o apps o ch onic diseases. In e ac ion wi h he app could be inc eased using a i icial in elligence o de e mine eczema
se e i y ia pho os. I should be in es iga ed which subg oups ha e di icul ies wi h usabili y o indi idualize he suppo o a
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g ea e deg ee du ing onboa ding. The e is a need o u he esea ch ega ding he e ec i eness o he MiA app on skin p o ec ion
beha io , quali y o li e, and eczema se e i y.
(JMIR Fo m Res 2025;9:e66791) doi: 10.2196/66791
KEYWORDS
use expe ience; mobile heal h; mHeal h; app; sma phone; complex in e en ion; Templa e o In e en ion Desc ip ion and
Replica ion; beha io change echniques; beha io change; skin diseases; occupa ional de ma ology; a i icial in elligence
In oduc ion
Backg ound
Sma phone apps ha e ecen ly become a g owing ield in he
heal h ca e sec o , ga ne ing inc easing a en ion and impo ance
in heal h esea ch. The use o such echnologies can help
op imize b oad and loca ion-independen heal h ca e in eal
ime and suppo he p e en ion o ch onic diseases and heal h
p omo ion o imp o e adhe ence o he apy, quali y o li e, and
clinical ou comes in he long e m [1,2]. Sma phone apps no
only help moni o heal h da a [3,4] bu also help change heal h
beha io and de elop new habi s. Fo his pu pose, heal h
beha io apps o e he po en ial o echnically in eg a e a a ie y
o beha io change echniques (BCTs) [1,5,6]. BCTs a e based
on heal h psychology knowledge abou he mechanisms o
beha io change p ocesses [7]. The mos common BCTs in
beha io change apps a e, o example, sel -moni o ing by
acking he du a ion and equency o a beha io and eedback
on he beha io o ou comes by isualizing he p og ess
g aphically [1,5,6,8]. Feedback and he isualiza ion o success
also inc ease mo i a ion in he use s, which plays an impo an
ole in he long- e m success o beha io change [5]. Beha io
change apps can also be used o se goals and moni o hei
achie emen . Au oma ic eminde s p o ide p omp s and suppo
he de elopmen o ou ines in e e yday li e. W i en, isual,
and audio in o ma ion can show use s how o pe o m he
beha io [1,5,6,8].
Rele ance o Use Expe ience
A known and widely discussed p oblem in esea ch on beha io
change apps is a low adhe ence and engagemen when using
hese echnologies [2,9-11]. To add ess hese p oblems, use
expe ience (UX) is becoming inc easingly impo an in mobile
heal h esea ch [12-15]. UX is an o e a ching holis ic concep
and co e s all emo ional, cogni i e, and physical expe iences
ha use s unde go when in e ac ing wi h so wa e p oduc s such
as apps [12,16-18]. As shown in Figu e 1, a high UX when
using an app o he i s ime is associa ed wi h he willingness
o con inue using i and ecommend i o o he s in he sho
e m. A high UX leads o inc eased adhe ence and app use in
he long e m and, hus, can also imp o e clinical ou comes and
he e ec i eness o heal h- ela ed in e en ions [14,19-21].
The e o e, he in es iga ion o UX in he con ex o digi al
echnologies in pa ien ca e is o g ea impo ance and should
be conside ed ea ly du ing he de elopmen p ocess [14,15,22].
Thus, a ho ough o ma i e e alua ion o he UX should p ecede
a summa i e e alua ion o op imize he app om he end use ’s
pe spec i e [14].
Figu e 1. Theo e ical model o explain he in luence o use expe ience (UX) and i s 5 dimensions—con en , usabili y, aes he ic, us , and eelings
and emo ions—on he in en ion and ecommenda ion o use he app (p oximal) esul s, as well as he e isi ing he app and long- e m use o he app
(dis al) esul s as he basis o his s udy.
As a mul idimensional cons uc , UX comp ises a ious
dimensions ha can di e depending on he unde lying model,
unde s anding, and con ex [15,17,19]. Acco ding o Thielsch
and Salaschek [21], he dimensions con en , usabili y, and
aes he ics a e pa icula ly impo an in a esea ch- ela ed
con ex . In addi ion, eelings and emo ions ha a ise h ough
in e ac ion wi h he echnical medium a e desc ibed as an
impo an aspec o UX [15,16]. As pe sonal da a a e collec ed,
passed on, and s o ed in digi al ca e s uc u es, us in he
echnology is ano he p edic o o u u e app use [21].
Beha io Change and Sel -Managemen Apps o
Pa ien s Wi h Ch onic Skin Diseases
Apps o suppo beha io change and disease-speci ic
sel -managemen ha e also been de eloped and e alua ed in
he con ex o ch onic skin diseases. These a e usually aimed
a speci ic g oups, such as pa en s o child en wi h a opic
de ma i is (AD) [23,24]; pa ien s wi h AD [25,26]; o people
wi h speci ic a eas o he skin a ec ed, such as hand and oo
eczema [27]. Weigand e al [27] de eloped he i s sma phone
app in Ge many speci ically o hand and oo eczema, wi h
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which pa ien s can moni o and manage hei disease ollowing
a pa ien educa ional in e en ion by pho og aphing hei skin,
acking hei quali y o li e and symp oms, and cha ing wi h
hei de ma ologis .
Howe e , hus a , such echnology does no exis o
wo k- ela ed skin diseases (WRSDs) e en hough hey ha e
been among he mos common wo k- ela ed diseases in
Ge many o decades [28]. Up o 90% o all diagnosed cases
a ec he hands in he o m o i i an o alle gic con ac eczema,
which o en occu s in combina ion wi h a gene ic p edisposi ion
o AD [29-32]. Wo k- ela ed hand eczema is usually caused by
haza dous ac i i ies in he wo kplace (eg, skin con ac wi h
alle gens and i i an s, we wo k, high handwashing equencies,
and mechanical s ess). Wo ke s in he heal h ca e,
me alwo king, hai d essing, and cons uc ion sec o s a e a a
pa icula ly high isk, which esul s in high p e alence a es
[30,31]. Due o he high ele ance o WRSDs, he Ge man
Social Acciden Insu ance has de eloped a complex and
hie a chical mul is ep p ocedu e o pa ien s wi h WRSDs, wi h
di e en ou pa ien and inpa ien p e en ion measu es depending
on he se e i y o he skin disease. In he case o se e e o
ecu en skin diseases, pa ien s a e o e ed o pa icipa e in an
inpa ien in e p o essional ehabili a ion p og am wi h a du a ion
o 3 weeks. In Ge man occupa ional de ma ology, his p og am
is also known as e ia y indi idual p e en ion (TIP) [29,33].
An impo an elemen o TIP a e heal h educa ional in e en ions
[34] wi h he aim o gaining disease-speci ic knowledge and
inc easing he mo i a ion o implemen and op imize indi idual
skin p o ec ion beha io . In addi ion, indi idual s a egies o
skin p o ec ion beha io a e de eloped wi h occupa ional
he apis s and p ac iced as pa o a wo kplace simula ion in
occupa ional he apy. To es o e he skin ba ie and educe he
isk o ecu ence o hand eczema, i is impo an o implemen
skin p o ec ion beha io (eg, egula use o skin p o ec ion and
skin ca e p oduc s as well as educing he equency o
handwashing by using mild de e gen s) in he long e m [34-36].
Howe e , changing skin p o ec ion beha io is complex and
equi es a high le el o sel -managemen a e pa icipa ing in
he TIP as he new beha io mus be success ully ans e ed
o and implemen ed in he p o essional and p i a e con ex s. A
s uc u ed main enance p og am ha suppo s pa ien s in his
subsequen implemen a ion o skin p o ec ion beha io does
no ye exis [34]. To ill his gap, we de eloped he Mein
Hau schu z im All ag (MiA) app (MiA ansla es o “My skin
p o ec ion in e e yday li e”) o suppo he sel -managemen o
pa ien s wi h WRSDs a e he TIP [37].
Objec i es o This S udy
The aim o his s udy was o e alua e he UX o and adhe ence
o he MiA app and pilo he easibili y o an app-based
main enance p og am in ou clinical se ing. In his publica ion,
we epo he ollowing esul s: (1) desc ip ion o he
in e en ion in a s anda dized manne ; (2) UX, subjec i e
quali y, and pe cei ed impac o he MiA app; and (3) adhe ence
o he MiA app.
Me hods
O e iew
The occupa ional de ma ology main enance p og am is a
complex in e en ion consis ing o se e al in e ac ing
componen s (Mul imedia Appendix 1). Acco ding o he Medical
Resea ch Council’s amewo k, he de elopmen o complex
in e en ions is based on a 4-s age p ocess consis ing o
de elopmen [37], easibili y, e alua ion, and implemen a ion
[38]. This s udy ocuses on easibili y (phase 2).
In e en ion
The main enance p og am is o e ed by he Ins i u e o
In e disciplina y De ma ological P e en ion and Rehabili a ion
(iDe m), Osnab ück, Ge many, which is a specialized cen e in
Ge many o inpa ien and ou pa ien in e p o essional ea men
o pa ien s wi h WRSDs.
The main enance p og am consis s o 2 main elemen s:
indi idual goal-se ing in e iew and he MiA app. The
sys ema ic de elopmen o hese elemen s is desc ibed in de ail
elsewhe e [37].
The indi idual goal-se ing in e iew is conduc ed du ing he
inpa ien s ay by a heal h educa o ace- o- ace 5 o 6 days
be o e discha ge. The goals, which a e de ined by he pa ien s,
a e en e ed in o he app on he coaching pla o m by he heal h
educa o and can be iewed by pa ien s ia he app. Du ing he
subsequen onboa ding, pa ien s ecei e an in oduc ion and
explana ions o he a ious app unc ions. Pa ien s a e also gi en
access o a ideo ia a QR code ha shows he app wi h
sc eensho s and explains he app’s unc ions.
MiA is a ully au oma ed app wi h ee access o s udy
pa icipan s and consis s o 6 componen s ocusing ei he on
in e ac ion o in o ma ion. The sma phone-based componen s
wi h in e ac i e na u e a e named My Skin P o ec ion Goals
(Ge man: Meine Hau schu z-Ziele), My Skin P o ec ion
Beha io (Ge man: Mein Hau schu z-Ve hal en), and My Skin
Documen a ion (Ge man: Meine Hau dokumen a ion). The
sma phone-based componen s To Lis en (Ge man: Hö enswe ),
Skin P o ec ion 101 (Ge man: Das Hau schu z 1x1), and My
Accoun abili ies (Ge man: Meine Zus ändigkei en) p o ide
di e en in o ma ion abou he skin disease in di e en modes
o deli e y (podcas s, ex boxes, and ideos; Figu e 2). In
addi ion, use s au oma ically ecei e a eminde message i no
in o ma ion has been en e ed in o he app o a pe iod o 14
days.
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Figu e 2. (A) O e iew o he menu; (B) o e iew o he My Skin P o ec ion Beha io componen wi h he op ion o en e he equencies o skin
cleansing (g een line) and applica ions o skin ca e c eam ( ed line) and skin p o ec ion c eam (blue line); (C) o e iew o he My Skin Documen a ion
componen , which allows o aking pic u es o he on and back side o he igh and le hand ha can be enla ged and o which pe sonal no es can
be added; (D) o e iew o he My Skin P o ec ion Goals componen wi h he o e iew o he goal achie emen ; (E) To Lis en componen and 4 podcas
episodes; (F) o e iew o he Skin P o ec ion 101 componen wi h di e en ques ions and an example un olded answe ; (G) o e iew o he My
Accoun abili ies componen wi h di e en ques ions and an exempla y un olded answe ; and (H) p esen a ion o he esea ch ques ionnai e wi h he 6
ca ego ies, whe eby ca ego ies 1 o 3 (sociodemog aphic da a, skin p o ec ion beha io , and ques ions abou he o ganiza ion) can be comple ed
immedia ely and ca ego ies 4 o 6 (skin p o ec ion beha io , app e alua ion, and impac o he app) a e ac i a ed a e 12 weeks o use.
Mul imedia Appendix 1 p o ides a mo e de ailed desc ip ion
o each componen acco ding o he Templa e o In e en ion
Desc ip ion and Replica ion checklis [39,40], including wha ,
why, how o en, and when componen s a e unlocked du ing he
main enance p og am and whe e and which ailo ing op ions
a e a ailable. Table 1 desc ibes he con en s o he ac i e
componen s o he in e en ion in a s anda dized manne using
he Beha io Change Technique Taxonomy e sion 1 [7,41].
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Table 1. Beha io change echniques (BCTs) in he 12-week occupa ional de ma ology main enance p og am o imp o ing heal h beha io change
in pa ien s wi h wo k- ela ed skin diseases based on he BCT Taxonomy e sion 1 [7,41].
BCTsDesc ip ionComponen
Face- o- ace in e en ion
Fo mula ion o indi idual skin p o ec-
ion goals
Indi idual goal-se -
ing in e iew •1.1: goal se ing (beha io )
MiAaapp
Moni o ing o indi idual skin p o ec-
ion goals and assessmen o hei
achie emen
My Skin P o ec ion
Goals •1.5: e iew beha io goals
Visualiza ion o goal achie emen o e
ime using a ows
My Skin P o ec ion
Goals •1.6: disc epancy be ween cu en beha io and goal
Mo i a ing eedback messages depend-
ing on he e alua ion o he goal
My Skin P o ec ion
Goals •3.1: social suppo (unspeci ied)
T acking o skin p o ec ion beha io
and moni o ing he p og ess
My Skin P o ec ion
Beha io •2.3: sel -moni o ing o beha io
Reco ding and obse ing he skin con-
di ion
My Skin Documen a-
ion •2.5: moni o ing o ou comes o beha io wi hou eedback
In o ma ion abou he skin disease, as-
socia ed di icul ies, and s a egies
To Lis en •Episode 1: 4.1—ins uc ion on how o pe o m he beha io and 15.1— e bal
pe suasion abou capabili y
•Episode 2: 5.1—in o ma ion abou heal h consequences, 5.2—salience o
consequences, 8.2—beha io subs i u ion, 12.4—dis ac ion, and
15.1— e bal pe suasion abou capabili y
•Episode 3: 8.2—beha io subs i u ion, 5.1—in o ma ion abou heal h conse-
quences, 5.2—salience o consequences, 4.2—in o ma ion abou an eceden s,
and 15.1— e bal pe suasion abou capabili y
•Episode 4: 3.1—social suppo (unspeci ied), 3.3—social suppo (emo ional),
and 15.1— e bal pe suasion abou capabili y
In o ma ion abou semina con en on
skin p o ec ion, i ching, and s ess
Skin P o ec ion 101 •4.1: ins uc ion on how o pe o m he beha io
•5.1: in o ma ion abou heal h consequences
In o ma ion abou o ganiza ional issues
ela ed o ca e and esponsibili ies
My Accoun abili ies •5.3: in o m abou social and en i onmen al consequences
aMiA: Mein Hau schu z im All ag (My skin p o ec ion in e e yday li e).
E hical Conside a ions
This s udy was app o ed by he E hics Commi ee o Osnab ück
Uni e si y (E hics-50/2022 and E hics-15/2023). All pa ien s
assessed o eligibili y we e in o med e bally and in w i ing
abou he s udy and i s olun a y na u e. All pa icipan s had o
sign a decla a ion o consen o ake pa in he s udy. The
pa icipan s we e in o med ha da a collec ion would be
pseudonymized and ha he e alua ion and publica ion o he
esul s would be anonymous. They ecei ed no compensa ion
o hei pa icipa ion.
Inclusion C i e ia and S udy Design
Rec ui men ook place a iDe m in Osnab ück on he ou h
day du ing he TIP. S udy in o ma ion was p o ided in pa ien
g oups as 7 o 9 new pa ien s a e usually admi ed o he TIP
each week. A e all pa ien s had been ully in o med abou he
s udy, hey we e gi en su icien ime o decide whe he o
pa icipa e. Subsequen ly, in e es ed pa ien s ecei ed he w i en
s udy in o ma ion and decla a ion o consen . The inclusion
c i e ia we e (1) signed decla a ion o consen o s udy
pa icipa ion; (2) legal age (>18 yea s); (3) su icien Ge man
language skills o unde s and he app con en , pa icipa e in
ocus g oups, and comple e ques ionnai es; and (4) access o
an in e ne -enabled sma phone ( o s ep 2).
This s udy ollowed a use -cen e ed and mul is age i e a i e
app oach, which is a well-known and widesp ead p ocedu e in
he de elopmen o echnologies in heal h ca e and UX esea ch
[42,43]. This app oach allows o he conside a ion o he
opinions and eedback o he a ge g oup as u u e use s o he
app in a pa icipa o y manne [23,44-46]. As illus a ed in Figu e
3, he en i e p ocess consis ed o 2 s eps wi h bo h quali a i e
and quan i a i e da a collec ion.
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Figu e 3. S udy p ocess o mul is age i e a i e es ing o he app-based main enance p og am o pa ien s wi h wo k- ela ed skin diseases consis ing
o (1) i e a i e de elopmen and es ing and (2) 12-week es ing and pilo ing. MiA: Mein Hau schu z im All ag (My skin p o ec ion in e e yday li e);
TIP: e ia y indi idual p e en ion; UX: use expe ience.
Ins umen
Va ious ins umen s ha e been de eloped o assess he UX o
mobile heal h apps. Among hem, he use e sion o he Mobile
Applica ion Ra ing Scale (uMARS) is a well-known and eliable
ins umen ha measu es he UX o heal h apps om he use ’s
pe spec i e [47]. The uMARS is based on he Mobile
Applica ion Ra ing Scale, which is used o assess he quali y o
apps by clinical o echnical expe s [48,49]. The uMARS is
made up o 16 i ems and comp ises he UX dimensions o
engagemen , unc ionali y, aes he ics, and in o ma ion quali y.
The scales o subjec i e quali y and pe cei ed impac assess
addi ional in o ma ion abou ecommenda ion; willingness o
use and pay o he app; and in o ma ion ega ding awa eness
and knowledge o and in en ion o beha io change. Fo his
s udy, an ins umen o s ep 1 and s ep 2 was de eloped based
on he uMARS and he model shown in Figu e 1.
S a is ical analyses o he quan i a i e da a we e ca ied ou
using SPSS ( e sion 28; IBM Co p). We calcula ed a sco e o
all 5 UX dimensions as well as a sco e o all UX i ems.
Adhe ence o he My Skin P o ec ion Beha io , My Skin
Documen a ion, and My Goal Achie emen unc ions was
de e mined based on he adhe ence alues in Mul imedia
Appendix 1 and by dicho omizing he da a in o adhe en and
nonadhe en . Fo con inuous da a (eg, age and UX), we
calcula ed he mean, median, IQR, and SD. We p esen
ca ego ical da a (eg, gende , subjec i e quali y, and pe cei ed
impac ) in equencies and pe cen ages.
S ep 1: I e a i e De elopmen and Tes ing o
In e en ion Componen s
O e iew
In he i s s ep, he main enance p og am was es ed by 4
di e en pa ien g oups du ing pa icipa ion in he TIP a he
iDe m in Osnab ück be ween No embe 2022 and No embe
2023. Pa ien s we e ec ui ed on he ou h day o he TIP wi h
a subsequen es phase o 2 weeks. Du ing he es phase,
pa ien s we e asked o documen hei o e all imp ession as
well as posi i e aspec s and aspec s equi ing imp o emen o
he es ed componen in a s anda dized documen a ion o m.
The documen a ion o ms we e no e alua ed by he esea che s
as hey me ely se ed as p epa a ion o he pa ien s hemsel es
o he ocus g oup discussions. Each g oup es ed and e alua ed
speci ic main enance componen s as ollows: g oup 1 e alua ed
To lis en, g oup 2 e alua ed he ace- o- ace goal se ing
in e iew, g oup 3 e alua ed My Skin P o ec ion Beha io and
My Accoun abili ies on he app, and g oup 4 e alua ed Skin
P o ec ion 101 and My Skin Documen a ion on he app.
Me hods o Da a Collec ion in S ep 1
A e he es phase, he pa ien s comple ed a sho quan i a i e
ques ionnai e ha assessed hei o e all imp ession o he
main enance componen s es ed using selec ed i ems om he
uMARS. The ocus o s ep 1 was quali a i e da a collec ed ia
4 subsequen ocus g oup discussions. The aim o he ocus
g oup discussions was o eco d posi i e and nega i e aspec s
o he es ed componen s, iden i y p oblems and challenges
ega ding hei use, and join ly de elop oppo uni ies o
imp o emen s.
The ocus g oup discussions we e conduc ed by 2 mode a o s
(NR and ML) based on guiding ques ions ega ding
con en - ela ed, me hodological, and echnical aspec s. The
guiding ques ions se ed as o ien a ion. Addi ions o o
deepening o he ques ions and opics ha a ose in he cou se
o he discussions we e pe mi ed. The in e iews we e eco ded
using an audio eco de (Olympus LS-P4 linea pulse-code
modula ion eco de ). Knowledge mapping was chosen o da a
analysis as i allows o he combina ion o da a collec ion and
da a p ocessing [50]. The esul s we e w i en down in keywo ds
on mode a ion ca ds and clus e ed on a me aplan boa d. The
pa icipan s alida ed he esul s o comple eness and
co ec ness o each opic. In addi ion, expe iences om he
es phase and key esul s we e documen ed by a esea ch
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assis an in a p o ocol. Aspec s o he componen s ha needed
o be imp o ed we e hen e ised in he nex i e a ion.
S ep 2: Pilo -Tes ing and Assessing he UX
O e iew
In he second s ep, he en i e main enance p og am, consis ing
o he ace- o- ace goal-se ing in e iew and he MiA app wi h
all i s componen s, was es ed by pa ien s and o ma i ely
e alua ed. Rec ui men ook place o e a pe iod o 10 weeks
om Janua y 2024 o Ma ch 2024. Pa ien s who olun a ily
ag eed o pa icipa e we e hen gi en an appoin men o he
goal-se ing in e iew as a one- o-one mee ing and he
subsequen onboa ding o he app in he hi d week. The app
was es ed o e a pe iod o 12 weeks a e discha ge om he
TIP, wi h 2 addi ional weeks o ill ou he second ques ionnai e.
Pa ien s who did no comple e he ques ionnai e wi hin hese 2
weeks ecei ed a eminde in he o m o a pape ques ionnai e
wi h a p epaid e u n en elope by pos .
Me hods o Da a Collec ion in S ep 2
O e iew
The e alua ion was ca ied ou using a quan i a i e ques ionnai e
consis ing o 6 blocks. Blocks 1 o 3 we e a ailable immedia ely
a e egis a ion, and blocks 4 o 6 we e ac i a ed a e he
main enance pe iod o 12 weeks a e discha ge. In o al, he
ins umen consis ed o 85 ques ions abou sociodemog aphic
da a; skin p o ec ion beha io be o e and a e he ehabili a ion
p og am; and e alua ion o he UX, subjec i e quali y, and
pe cei ed e ec s, as well as ques ions abou he s uc u al,
p ocess, and ou come quali y o he in e en ion.
In addi ion o closed-ended ques ions, he ques ionnai e also
included open-ended ques ions o allow he pa icipan s o
p o ide u he de ails abou he indi idual unc ions beyond
he closed-ended ques ions [15]. The comp ehensibili y o he
ques ions and he ime equi ed o comple ion we e de e mined
in a p e es wi h 16 pa ien s be o e he s udy. In his publica ion,
we epo he esul s on sociodemog aphic da a, UX e alua ion,
subjec i e quali y, and pe cei ed impac o he in e en ion.
UX E alua ion
To assess he UX, he ele an i ems o he uMARS we e
assigned o he UX dimensions shown in Figu e 1 and
supplemen ed wi h addi ional aspec s as equi ed. We measu ed
eelings and emo ions using 5 i ems (eg, “I ind he app
en e aining” o “The app o e s me enough op ions o cus omise
i o my pe sonal equi emen s and needs”), con en using 4
i ems (eg, “Is he con en o he app ele an o you?” o “A e
he ex s unde s andable?”), usabili y using 6 i ems (eg, “How
well and quickly do he app’s applica ions [bu ons, menus]
espond?” o “How easy was i o you o lea n how o use he
app?”), aes he ic using 2 i ems (“How high a e he quali y and
esolu ion o he images and ex s?” and “How would you a e
he o e all appea ance o he app?”), and us using 3 i ems
(eg, “The in o ma ion in he app appea s o come om a c edible
sou ce” and “A e you conce ned ha da a you ha e en e ed in o
he app could be uploaded o hi d pa ies?”). All ques ions we e
answe ed on 5-poin Like scales ha di e ed in hei con en
depending on he dimension and i em.
Subjec i e Quali y and Pe cei ed Impac
Bo h aspec s we e assessed using he uMARS [47]. Subjec i e
quali y was measu ed using he i ems ela ed o
ecommenda ion, willingness o use in he ollowing 12 mon hs,
and willingness o pay and o e all a ing by s a s.
The pe cei ed impac scale comp ised 5 closed-ended ques ions
on awa eness and knowledge o and mo i a ion o skin
p o ec ion beha io ; encou agemen o seek o suppo ; and
enabling skin p o ec ion beha io on a 5-poin Like scale and
a supplemen a y open-ended ques ion on which unc ions we e
pa icula ly help ul o implemen ing skin p o ec ion beha io .
Adhe ence
An impo an esul o his s udy was he analysis o he
equency o use o indi idual componen s as his ep esen ed
a cen al c i e ion o adhe ence o he in e en ion. We used a
simple de ini ion acco ding o Donkin e al [51] and unde s ood
adhe ence as “ he deg ee o which he use ollowed he
p og amme as i was designed” [51]. This de ini ion has al eady
been applied in he con ex o o he digi al heal h in e en ions
[45]. In his s udy, adhe ence was de e mined by he equency
wi h which he skin p o ec ion beha io was en e ed, how o en
pho os we e aken, and how o en he goals we e assessed.
Adhe ence was high i he componen My Skin P o ec ion
Beha io was used daily and he unc ions My Skin
Documen a ion and My Skin P o ec ion Goals we e used
weekly.
Resul s
S ep 1
S udy Pa icipan s
A o al o 23 pa ien s ook pa in he es ing o he in e en ion
componen s in s ep 1, o whom 10 (43%) we e emale and 13
(57%) we e male. The a e age age o he pa icipan s was 51
(SD 11; ange 27-62) yea s.
The pa ien s wo ked in heal h ca e (8/23, 35%), he me alwo k
indus y (4/23, 17%), hai d essing (3/23, 13%), cons uc ion
(2/23, 9%), o o he p o essions (6/23, 26%).
Main Resul s
The esul s o s ep 1 we e used o i e a i e de elopmen o
u he op imize he in e en ion o phase 2. Fo example, in
he My Skin P o ec ion Beha io unc ion, he scale o he days
and equencies in he diag am was oo small. This was adjus ed
and enla ged in he e ision. In he My Skin Documen a ion
unc ion, e e y en y was au oma ically sa ed in he commen
unc ion. This always hinde ed u he inpu o a ew seconds.
A bu on was added so ha use s could sa e hei commen s a
he end by hemsel es. Pa ien s also highligh ed ha he app
had a simple s uc u e and eminded hem o apps hey al eady
knew, had a good usabili y and isual p esen a ion, and was
ac ual wi hou play ul elemen s. A mo e de ailed p esen a ion
o he esul s o s ep 1 and he associa ed modi ica ions o s ep
2 can be ound in Mul imedia Appendix 2.
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S ep 2
S udy Pa icipan s
O e 10 weeks (s udy pe iod o s ep 2), a o al o 79 pa ien s
pa icipa ed in he TIP p og am, o whom 42 (53%) ag eed o
ake pa in he in e en ion and ga e in o med consen o s udy
pa icipa ion. The main easons o nonpa icipa ion we e no
in e es o no subjec i ely el need o he in e en ion (Figu e
4).
All 42 pa ien s ook pa in he indi idual goal-se ing in e iew
and ecei ed access o he MiA app o he 12-week es ing
phase. A T1, all pa icipan s comple ed he ques ionnai es
(42/42, 100% esponse a e), and a T2, he esponse a e was
57% (24/42). Table 2 summa izes he sociodemog aphic da a
o he pa ien s en olled in his s udy.
Figu e 4. Flowcha o he s udy popula ion in s ep 2, including assessmen o eligibili y, pa icipa ion, and ollow-up a T1 and T2. MiA: Mein
Hau schu z im All ag (My skin p o ec ion in e e yday li e); TIP: e ia y indi idual p e en ion.
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Table 2. Sociodemog aphic da a o he s udy pa icipan s a T1 (N=42).
ValuesSociodemog aphics
Sex, n (%)
24 (57)Male
18 (43)Female
Age (y)
49.5 (13.1)Values, mean (SD)
55.0 (18.6)Values, median (IQR)
Occupa ional ca ego ies, n (%)
17 (40)Heal h ca e p o essions
9 (21)Me alwo k indus y
5 (12)Cons uc ion
1 (2)Hai d essing
2 (5)Food p ocessing
5 (12)O he
1 (2)Pensione
2 (5)Cu en ly unemployed
Highes educa ional le el, n (%)
9 (21)Seconda y school o elemen a y school–lea ing ce i ica e
15 (36)In e media e school–lea ing ce i ica e o seconda y school–lea ing ce i ica e
3 (7)
“Meis e ”a
5 (12)College ce i ica e
7 (17)Gene al highe educa ion en ance quali ica ion o A-le els
1 (2)Bachelo ’s deg ee
2 (5)Mas e ’s deg ee o diploma
Employmen s a us, n (%)
4 (10)Sel -employed
35 (83)Employed
3 (7)Unemployed
Pa ne ship, n (%)
32 (76)Yes
10 (24)No
aPe son wi h a highe oca ional quali ica ion in a c a , also known as “mas e c a sman” o “mas e c a swoman.”
UX Resul s
The a e age UX sco e, wi h a heo e ical minimum o 20 and
a heo e ical maximum o 100, was 80.18 (SD 8.94). Figu e 5
shows he esul s o he assessmen o he UX om he us ,
con en , aes he ic, usabili y, and eelings and emo ions
dimensions. The aw da a o hese i ems can be ound in
Mul imedia Appendix 3. The esul s show o e all posi i e
a ings (sco es o 4 and 5). The eelings and emo ions dimension
s ood ou , wi h compa a i ely equen medium a ings and no
a ings o 5 on 60% (3/5) o he i ems. Fu he mo e, he i em
“How easy was i o you o lea n how o use he app?” in he
usabili y dimension was he only i em wi h a sco e o 1 by 2%
(1/42) o he pa icipan s.
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Abb e ia ions
AD: a opic de ma i is
BCT: beha io change echnique
iDe m: Ins i u e o In e disciplina y De ma ological P e en ion and Rehabili a ion
MiA: Mein Hau schu z im All ag (“My skin p o ec ion in e e yday li e”)
TIP: e ia y indi idual p e en ion
uMARS: use e sion o he Mobile Applica ion Ra ing Scale
UX: use expe ience
WRSD: wo k- ela ed skin disease
Edi ed by A Ma agani; submi ed 24.09.24; pee - e iewed by K S awa z; commen s o au ho 03.02.25; e ised e sion ecei ed
24.02.25; accep ed 25.02.25; published 18.04.25
Please ci e as:
Ris ow N, Wilke A, Skudlik C, John SM, Ludewig M
Use Expe ience o and Adhe ence o a Sma phone App o Main ain Beha io Change and Sel -Managemen in Pa ien s Wi h
Wo k-Rela ed Skin Diseases: Mul is ep, Single-A m Feasibili y S udy
JMIR Fo m Res 2025;9:e66791
URL: h ps:// o ma i e.jmi .o g/2025/1/e66791
doi: 10.2196/66791
PMID:
©Nele Ris ow, Annika Wilke, Ch is oph Skudlik, Swen Mal e John, Michaela Ludewig. O iginally published in JMIR Fo ma i e
Resea ch (h ps:// o ma i e.jmi .o g), 18.04.2025. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e
Commons A ibu ion License (h ps://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and
ep oduc ion in any medium, p o ided he o iginal wo k, i s published in JMIR Fo ma i e Resea ch, is p ope ly ci ed. The
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