User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study

Original Paper User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study Nele Ristow1,2, MEd; Annika Wilke1,2, PD Dr; Christoph Skudlik1,2, Prof Dr Med; Swen Malte John1,2, Prof Dr Med; Michaela Ludewig3, Prof Dr 1Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, Osnabrück University, Osnabrück, Germany 2Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, Germany 3Department Health Sciences, Hochschule Bochum, Bochum, Germany Corresponding Author: Nele Ristow, MEd Department of Dermatology, Environmental Medicine and Health Theory Institute for Health Research and Education Osnabrück University Am Finkenhügel 7a Osnabrück, 49076 Germany Phone: 49 541 969 7410 Fax: 49 541 969 2445 Email: neristo[email protected] Abstract Background: Smartphone apps are a growing field supporting the prevention of chronic diseases. The user experience (UX) is an important predictor of app use and should be considered in mobile health research. Long-term skin protection behavior is important for those with work-related skin diseases. However, altering health behavior is complex and requires a high level of self-management. We developed a maintenance program consisting of the Mein Hautschutz im Alltag (MiA; “My skin protection in everyday life”) app combined with an individual face-to-face goal-setting interview to support patients in the implementation of skin protection behavior after inpatient rehabilitation. Objective: The objectives of this paper are to (1) describe the intervention in a standardized manner; (2) evaluate the UX, subjective quality, and perceived impact of the MiA app; and (3) evaluate the adherence to the MiA app. Methods: We followed a user-centered and multistage iterative process in 2 steps that combined qualitative and quantitative data. The maintenance program was tested over 12 weeks after discharge from rehabilitation. The UX, subjective quality, and perceived impact were evaluated formatively based on the user version of the Mobile Application Rating Scale after 12 weeks (T2). Adherence was measured using the frequency of interactions with the app. Results: In total, 42 patients took part (with a dropout rate of n=18, 43% at T2). The average age was 49.5 (SD 13.1) years, and 57% (24/42) were male. We found high ratings for the UX, with an average score of 80.18 (SD 8.94) out of a theoretical maximum of 100, but there were a few exceptions in the usability and interaction with the app. The app was most frequently rated with 4 out of 5 stars (15/24, 65%), which indicates a high subjective quality. Furthermore, the app seemed to influence important determinants to implement skin protection behavior. Adherence to skin protection tracking was higher over the study period than adherence to skin documentation and goal assessment. The number of adherent participants to skin protection tracking was higher in the skin care and skin cleansing categories (28/42, 67% each) compared to the skin protection category (13/42, 31%) on day 1 and decreased until day 84 in all dimensions (12/42, 29% each for skin care and skin cleansing; 9/42, 21% for skin protection). Conclusions: The results in terms of adherence met the expectations and were consistent with those of other studies evaluating the use of apps for chronic diseases. Interaction with the app could be increased using artificial intelligence to determine eczema severity via photos. It should be investigated which subgroups have difficulties with usability to individualize the support to a JMIR Form Res 2025 | vol. 9 | e66791 | p. 1https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX greater degree during onboarding. There is a need for further research regarding the effectiveness of the MiA app on skin protection behavior, quality of life, and eczema severity. (JMIR Form Res 2025;9:e66791) doi: 10.2196/66791 KEYWORDS user experience; mobile health; mHealth; app; smartphone; complex intervention; Template for Intervention Description and Replication; behavior change techniques; behavior change; skin diseases; occupational dermatology; artificial intelligence Introduction Background Smartphone apps have recently become a growing field in the health care sector, garnering increasing attention and importance in health research. The use of such technologies can help optimize broad and location-independent health care in real time and support the prevention of chronic diseases and health promotion to improve adherence to therapy, quality of life, and clinical outcomes in the long term [1,2]. Smartphone apps not only help monitor health data [3,4] but also help change health behavior and develop new habits. For this purpose, health behavior apps offer the potential to technically integrate a variety of behavior change techniques (BCTs) [1,5,6]. BCTs are based on health psychology knowledge about the mechanisms of behavior change processes [7]. The most common BCTs in behavior change apps are, for example, self-monitoring by tracking the duration and frequency of a behavior and feedback on the behavior or outcomes by visualizing the progress graphically [1,5,6,8]. Feedback and the visualization of success also increase motivation in the users, which plays an important role in the long-term success of behavior change [5]. Behavior change apps can also be used to set goals and monitor their achievement. Automatic reminders provide prompts and support the development of routines in everyday life. Written, visual, and audio information can show users how to perform the behavior [1,5,6,8]. Relevance of User Experience A known and widely discussed problem in research on behavior change apps is a low adherence and engagement when using these technologies [2,9-11]. To address these problems, user experience (UX) is becoming increasingly important in mobile health research [12-15]. UX is an overarching holistic concept and covers all emotional, cognitive, and physical experiences that users undergo when interacting with software products such as apps [12,16-18]. As shown in Figure 1, a high UX when using an app for the first time is associated with the willingness to continue using it and recommend it to others in the short term. A high UX leads to increased adherence and app use in the long term and, thus, can also improve clinical outcomes and the effectiveness of health-related interventions [14,19-21]. Therefore, the investigation of UX in the context of digital technologies in patient care is of great importance and should be considered early during the development process [14,15,22]. Thus, a thorough formative evaluation of the UX should precede a summative evaluation to optimize the app from the end user’s perspective [14]. Figure 1. Theoretical model to explain the influence of user experience (UX) and its 5 dimensions—content, usability, aesthetic, trust, and feelings and emotions—on the intention and recommendation to use the app (proximal) results, as well as the revisiting the app and long-term use of the app (distal) results as the basis for this study. As a multidimensional construct, UX comprises various dimensions that can differ depending on the underlying model, understanding, and context [15,17,19]. According to Thielsch and Salaschek [21], the dimensions content, usability, and aesthetics are particularly important in a research-related context. In addition, feelings and emotions that arise through interaction with the technical medium are described as an important aspect of UX [15,16]. As personal data are collected, passed on, and stored in digital care structures, trust in the technology is another predictor of future app use [21]. Behavior Change and Self-Management Apps for Patients With Chronic Skin Diseases Apps to support behavior change and disease-specific self-management have also been developed and evaluated in the context of chronic skin diseases. These are usually aimed at specific groups, such as parents of children with atopic dermatitis (AD) [23,24]; patients with AD [25,26]; or people with specific areas of the skin affected, such as hand and foot eczema [27]. Weigandt et al [27] developed the first smartphone app in Germany specifically for hand and foot eczema, with JMIR Form Res 2025 | vol. 9 | e66791 | p. 2https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX which patients can monitor and manage their disease following a patient educational intervention by photographing their skin, tracking their quality of life and symptoms, and chatting with their dermatologist. However, thus far, such technology does not exist for work-related skin diseases (WRSDs) even though they have been among the most common work-related diseases in Germany for decades [28]. Up to 90% of all diagnosed cases affect the hands in the form of irritant or allergic contact eczema, which often occurs in combination with a genetic predisposition to AD [29-32]. Work-related hand eczema is usually caused by hazardous activities in the workplace (eg, skin contact with allergens and irritants, wet work, high handwashing frequencies, and mechanical stress). Workers in the health care, metalworking, hairdressing, and construction sectors are at a particularly high risk, which results in high prevalence rates [30,31]. Due to the high relevance of WRSDs, the German Social Accident Insurance has developed a complex and hierarchical multistep procedure for patients with WRSDs, with different outpatient and inpatient prevention measures depending on the severity of the skin disease. In the case of severe or recurrent skin diseases, patients are offered to participate in an inpatient interprofessional rehabilitation program with a duration of 3 weeks. In German occupational dermatology, this program is also known as tertiary individual prevention (TIP) [29,33]. An important element of TIP are health educational interventions [34] with the aim of gaining disease-specific knowledge and increasing the motivation to implement and optimize individual skin protection behavior. In addition, individual strategies for skin protection behavior are developed with occupational therapists and practiced as part of a workplace simulation in occupational therapy. To restore the skin barrier and reduce the risk of recurrence of hand eczema, it is important to implement skin protection behavior (eg, regular use of skin protection and skin care products as well as reducing the frequency of handwashing by using mild detergents) in the long term [34-36]. However, changing skin protection behavior is complex and requires a high level of self-management after participating in the TIP as the new behavior must be successfully transferred to and implemented in the professional and private contexts. A structured maintenance program that supports patients in this subsequent implementation of skin protection behavior does not yet exist [34]. To fill this gap, we developed the Mein Hautschutz im Alltag (MiA) app (MiA translates to “My skin protection in everyday life”) to support the self-management of patients with WRSDs after the TIP [37]. Objectives of This Study The aim of this study was to evaluate the UX of and adherence to the MiA app and pilot the feasibility of an app-based maintenance program in our clinical setting. In this publication, we report the following results: (1) description of the intervention in a standardized manner; (2) UX, subjective quality, and perceived impact of the MiA app; and (3) adherence to the MiA app. Methods Overview The occupational dermatology maintenance program is a complex intervention consisting of several interacting components (Multimedia Appendix 1). According to the Medical Research Council’s framework, the development of complex interventions is based on a 4-stage process consisting of development [37], feasibility, evaluation, and implementation [38]. This study focuses on feasibility (phase 2). Intervention The maintenance program is offered by the Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Osnabrück, Germany, which is a specialized center in Germany for inpatient and outpatient interprofessional treatment of patients with WRSDs. The maintenance program consists of 2 main elements: individual goal-setting interview and the MiA app. The systematic development of these elements is described in detail elsewhere [37]. The individual goal-setting interview is conducted during the inpatient stay by a health educator face-to-face 5 or 6 days before discharge. The goals, which are defined by the patients, are entered into the app on the coaching platform by the health educator and can be viewed by patients via the app. During the subsequent onboarding, patients receive an introduction and explanations of the various app functions. Patients are also given access to a video via a QR code that shows the app with screenshots and explains the app’s functions. MiA is a fully automated app with free access for study participants and consists of 6 components focusing either on interaction or information. The smartphone-based components with interactive nature are named My Skin Protection Goals (German: Meine Hautschutz-Ziele), My Skin Protection Behavior (German: Mein Hautschutz-Verhalten), and My Skin Documentation (German: Meine Hautdokumentation). The smartphone-based components To Listen (German: Hörenswert), Skin Protection 101 (German: Das Hautschutz 1x1), and My Accountabilities (German: Meine Zuständigkeiten) provide different information about the skin disease in different modes of delivery (podcasts, textboxes, and videos; Figure 2). In addition, users automatically receive a reminder message if no information has been entered into the app for a period of 14 days. JMIR Form Res 2025 | vol. 9 | e66791 | p. 3https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Figure 2. (A) Overview of the menu; (B) overview of the My Skin Protection Behavior component with the option to enter the frequencies of skin cleansing (green line) and applications of skin care cream (red line) and skin protection cream (blue line); (C) overview of the My Skin Documentation component, which allows for taking pictures of the front and back side of the right and left hand that can be enlarged and to which personal notes can be added; (D) overview of the My Skin Protection Goals component with the overview of the goal achievement; (E) To Listen component and 4 podcast episodes; (F) overview of the Skin Protection 101 component with different questions and an example unfolded answer; (G) overview of the My Accountabilities component with different questions and an exemplary unfolded answer; and (H) presentation of the research questionnaire with the 6 categories, whereby categories 1 to 3 (sociodemographic data, skin protection behavior, and questions about the organization) can be completed immediately and categories 4 to 6 (skin protection behavior, app evaluation, and impact of the app) are activated after 12 weeks of use. Multimedia Appendix 1 provides a more detailed description of each component according to the Template for Intervention Description and Replication checklist [39,40], including what, why, how often, and when components are unlocked during the maintenance program and where and which tailoring options are available. Table 1 describes the contents of the active components of the intervention in a standardized manner using the Behavior Change Technique Taxonomy version 1 [7,41]. JMIR Form Res 2025 | vol. 9 | e66791 | p. 4https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Table 1. Behavior change techniques (BCTs) in the 12-week occupational dermatology maintenance program for improving health behavior change in patients with work-related skin diseases based on the BCT Taxonomy version 1 [7,41]. BCTsDescriptionComponent Face-to-face intervention Formulation of individual skin protection goals Individual goal-setting interview •1.1: goal setting (behavior) MiAaapp Monitoring of individual skin protection goals and assessment of their achievement My Skin Protection Goals •1.5: review behavior goals Visualization of goal achievement over time using arrows My Skin Protection Goals •1.6: discrepancy between current behavior and goal Motivating feedback messages depending on the evaluation of the goal My Skin Protection Goals •3.1: social support (unspecified) Tracking of skin protection behavior and monitoring the progress My Skin Protection Behavior •2.3: self-monitoring of behavior Recording and observing the skin condition My Skin Documentation •2.5: monitoring of outcomes of behavior without feedback Information about the skin disease, associated difficulties, and strategies To Listen •Episode 1: 4.1—instruction on how to perform the behavior and 15.1—verbal persuasion about capability •Episode 2: 5.1—information about health consequences, 5.2—salience of consequences, 8.2—behavior substitution, 12.4—distraction, and 15.1—verbal persuasion about capability •Episode 3: 8.2—behavior substitution, 5.1—information about health consequences, 5.2—salience of consequences, 4.2—information about antecedents, and 15.1—verbal persuasion about capability •Episode 4: 3.1—social support (unspecified), 3.3—social support (emotional), and 15.1—verbal persuasion about capability Information about seminar content on skin protection, itching, and stress Skin Protection 101 •4.1: instruction on how to perform the behavior •5.1: information about health consequences Information about organizational issues related to care and responsibilities My Accountabilities •5.3: inform about social and environmental consequences aMiA: Mein Hautschutz im Alltag (My skin protection in everyday life). Ethical Considerations This study was approved by the Ethics Committee of Osnabrück University (Ethics-50/2022 and Ethics-15/2023). All patients assessed for eligibility were informed verbally and in writing about the study and its voluntary nature. All participants had to sign a declaration of consent to take part in the study. The participants were informed that data collection would be pseudonymized and that the evaluation and publication of the results would be anonymous. They received no compensation for their participation. Inclusion Criteria and Study Design Recruitment took place at iDerm in Osnabrück on the fourth day during the TIP. Study information was provided in patient groups as 7 to 9 new patients are usually admitted to the TIP each week. After all patients had been fully informed about the study, they were given sufficient time to decide whether to participate. Subsequently, interested patients received the written study information and declaration of consent. The inclusion criteria were (1) signed declaration of consent for study participation; (2) legal age (>18 years); (3) sufficient German language skills to understand the app content, participate in focus groups, and complete questionnaires; and (4) access to an internet-enabled smartphone (for step 2). This study followed a user-centered and multistage iterative approach, which is a well-known and widespread procedure in the development of technologies in health care and UX research [42,43]. This approach allows for the consideration of the opinions and feedback of the target group as future users of the app in a participatory manner [23,44-46]. As illustrated in Figure 3, the entire process consisted of 2 steps with both qualitative and quantitative data collection. JMIR Form Res 2025 | vol. 9 | e66791 | p. 5https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Figure 3. Study process of multistage iterative testing of the app-based maintenance program for patients with work-related skin diseases consisting of (1) iterative development and testing and (2) 12-week testing and piloting. MiA: Mein Hautschutz im Alltag (My skin protection in everyday life); TIP: tertiary individual prevention; UX: user experience. Instrument Various instruments have been developed to assess the UX of mobile health apps. Among them, the user version of the Mobile Application Rating Scale (uMARS) is a well-known and reliable instrument that measures the UX of health apps from the user’s perspective [47]. The uMARS is based on the Mobile Application Rating Scale, which is used to assess the quality of apps by clinical or technical experts [48,49]. The uMARS is made up of 16 items and comprises the UX dimensions of engagement, functionality, aesthetics, and information quality. The scales of subjective quality and perceived impact assess additional information about recommendation; willingness to use and pay for the app; and information regarding awareness and knowledge of and intention for behavior change. For this study, an instrument for step 1 and step 2 was developed based on the uMARS and the model shown in Figure 1. Statistical analyses of the quantitative data were carried out using SPSS (version 28; IBM Corp). We calculated a score for all 5 UX dimensions as well as a score for all UX items. Adherence to the My Skin Protection Behavior, My Skin Documentation, and My Goal Achievement functions was determined based on the adherence values in Multimedia Appendix 1 and by dichotomizing the data into adherent and nonadherent. For continuous data (eg, age and UX), we calculated the mean, median, IQR, and SD. We present categorical data (eg, gender, subjective quality, and perceived impact) in frequencies and percentages. Step 1: Iterative Development and Testing of Intervention Components Overview In the first step, the maintenance program was tested by 4 different patient groups during participation in the TIP at the iDerm in Osnabrück between November 2022 and November 2023. Patients were recruited on the fourth day of the TIP with a subsequent test phase of 2 weeks. During the test phase, patients were asked to document their overall impression as well as positive aspects and aspects requiring improvement of the tested component in a standardized documentation form. The documentation forms were not evaluated by the researchers as they merely served as preparation for the patients themselves for the focus group discussions. Each group tested and evaluated specific maintenance components as follows: group 1 evaluated To listen, group 2 evaluated the face-to-face goal setting interview, group 3 evaluated My Skin Protection Behavior and My Accountabilities on the app, and group 4 evaluated Skin Protection 101 and My Skin Documentation on the app. Methods of Data Collection in Step 1 After the test phase, the patients completed a short quantitative questionnaire that assessed their overall impression of the maintenance components tested using selected items from the uMARS. The focus of step 1 was qualitative data collected via 4 subsequent focus group discussions. The aim of the focus group discussions was to record positive and negative aspects of the tested components, identify problems and challenges regarding their use, and jointly develop opportunities for improvements. The focus group discussions were conducted by 2 moderators (NR and ML) based on guiding questions regarding content-related, methodological, and technical aspects. The guiding questions served as orientation. Additions to or deepening of the questions and topics that arose in the course of the discussions were permitted. The interviews were recorded using an audio recorder (Olympus LS-P4 linear pulse-code modulation recorder). Knowledge mapping was chosen for data analysis as it allows for the combination of data collection and data processing [50]. The results were written down in keywords on moderation cards and clustered on a metaplan board. The participants validated the results for completeness and correctness for each topic. In addition, experiences from the test phase and key results were documented by a research JMIR Form Res 2025 | vol. 9 | e66791 | p. 6https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX assistant in a protocol. Aspects of the components that needed to be improved were then revised in the next iteration. Step 2: Pilot-Testing and Assessing the UX Overview In the second step, the entire maintenance program, consisting of the face-to-face goal-setting interview and the MiA app with all its components, was tested by patients and formatively evaluated. Recruitment took place over a period of 10 weeks from January 2024 to March 2024. Patients who voluntarily agreed to participate were then given an appointment for the goal-setting interview as a one-to-one meeting and the subsequent onboarding to the app in the third week. The app was tested over a period of 12 weeks after discharge from the TIP, with 2 additional weeks to fill out the second questionnaire. Patients who did not complete the questionnaire within these 2 weeks received a reminder in the form of a paper questionnaire with a prepaid return envelope by post. Methods of Data Collection in Step 2 Overview The evaluation was carried out using a quantitative questionnaire consisting of 6 blocks. Blocks 1 to 3 were available immediately after registration, and blocks 4 to 6 were activated after the maintenance period of 12 weeks after discharge. In total, the instrument consisted of 85 questions about sociodemographic data; skin protection behavior before and after the rehabilitation program; and evaluation of the UX, subjective quality, and perceived effects, as well as questions about the structural, process, and outcome quality of the intervention. In addition to closed-ended questions, the questionnaire also included open-ended questions to allow the participants to provide further details about the individual functions beyond the closed-ended questions [15]. The comprehensibility of the questions and the time required for completion were determined in a pretest with 16 patients before the study. In this publication, we report the results on sociodemographic data, UX evaluation, subjective quality, and perceived impact of the intervention. UX Evaluation To assess the UX, the relevant items of the uMARS were assigned to the UX dimensions shown in Figure 1 and supplemented with additional aspects as required. We measured feelings and emotions using 5 items (eg, “I find the app entertaining” or “The app offers me enough options to customise it to my personal requirements and needs”), content using 4 items (eg, “Is the content of the app relevant to you?” or “Are the texts understandable?”), usability using 6 items (eg, “How well and quickly do the app’s applications [buttons, menus] respond?” or “How easy was it for you to learn how to use the app?”), aesthetic using 2 items (“How high are the quality and resolution of the images and texts?” and “How would you rate the overall appearance of the app?”), and trust using 3 items (eg, “The information in the app appears to come from a credible source” and “Are you concerned that data you have entered into the app could be uploaded to third parties?”). All questions were answered on 5-point Likert scales that differed in their content depending on the dimension and item. Subjective Quality and Perceived Impact Both aspects were assessed using the uMARS [47]. Subjective quality was measured using the items related to recommendation, willingness to use in the following 12 months, and willingness to pay and overall rating by stars. The perceived impact scale comprised 5 closed-ended questions on awareness and knowledge of and motivation for skin protection behavior; encouragement to seek for support; and enabling skin protection behavior on a 5-point Likert scale and a supplementary open-ended question on which functions were particularly helpful for implementing skin protection behavior. Adherence An important result for this study was the analysis of the frequency of use of individual components as this represented a central criterion for adherence to the intervention. We used a simple definition according to Donkin et al [51] and understood adherence as “the degree to which the user followed the programme as it was designed” [51]. This definition has already been applied in the context of other digital health interventions [45]. In this study, adherence was determined by the frequency with which the skin protection behavior was entered, how often photos were taken, and how often the goals were assessed. Adherence was high if the component My Skin Protection Behavior was used daily and the functions My Skin Documentation and My Skin Protection Goals were used weekly. Results Step 1 Study Participants A total of 23 patients took part in the testing of the intervention components in step 1, of whom 10 (43%) were female and 13 (57%) were male. The average age of the participants was 51 (SD 11; range 27-62) years. The patients worked in health care (8/23, 35%), the metalwork industry (4/23, 17%), hairdressing (3/23, 13%), construction (2/23, 9%), or other professions (6/23, 26%). Main Results The results of step 1 were used for iterative development to further optimize the intervention for phase 2. For example, in the My Skin Protection Behavior function, the scale of the days and frequencies in the diagram was too small. This was adjusted and enlarged in the revision. In the My Skin Documentation function, every entry was automatically saved in the comment function. This always hindered further input for a few seconds. A button was added so that users could save their comments at the end by themselves. Patients also highlighted that the app had a simple structure and reminded them of apps they already knew, had a good usability and visual presentation, and was factual without playful elements. A more detailed presentation of the results of step 1 and the associated modifications for step 2 can be found in Multimedia Appendix 2. JMIR Form Res 2025 | vol. 9 | e66791 | p. 7https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Step 2 Study Participants Over 10 weeks (study period for step 2), a total of 79 patients participated in the TIP program, of whom 42 (53%) agreed to take part in the intervention and gave informed consent for study participation. The main reasons for nonparticipation were no interest or no subjectively felt need for the intervention (Figure 4). All 42 patients took part in the individual goal-setting interview and received access to the MiA app for the 12-week testing phase. At T1, all participants completed the questionnaires (42/42, 100% response rate), and at T2, the response rate was 57% (24/42). Table 2 summarizes the sociodemographic data of the patients enrolled in this study. Figure 4. Flowchart of the study population in step 2, including assessment for eligibility, participation, and follow-up at T1 and T2. MiA: Mein Hautschutz im Alltag (My skin protection in everyday life); TIP: tertiary individual prevention. JMIR Form Res 2025 | vol. 9 | e66791 | p. 8https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Table 2. Sociodemographic data of the study participants at T1 (N=42). ValuesSociodemographics Sex, n (%) 24 (57)Male 18 (43)Female Age (y) 49.5 (13.1)Values, mean (SD) 55.0 (18.6)Values, median (IQR) Occupational categories, n (%) 17 (40)Health care professions 9 (21)Metalwork industry 5 (12)Construction 1 (2)Hairdressing 2 (5)Food processing 5 (12)Other 1 (2)Pensioner 2 (5)Currently unemployed Highest educational level, n (%) 9 (21)Secondary school or elementary school–leaving certificate 15 (36)Intermediate school–leaving certificate or secondary school–leaving certificate 3 (7) “Meister”a 5 (12)College certificate 7 (17)General higher education entrance qualification or A-levels 1 (2)Bachelor’s degree 2 (5)Master’s degree or diploma Employment status, n (%) 4 (10)Self-employed 35 (83)Employed 3 (7)Unemployed Partnership, n (%) 32 (76)Yes 10 (24)No aPerson with a higher vocational qualification in a craft, also known as “master craftsman” or “master craftswoman.” UX Results The average UX score, with a theoretical minimum of 20 and a theoretical maximum of 100, was 80.18 (SD 8.94). Figure 5 shows the results for the assessment of the UX from the trust, content, aesthetic, usability, and feelings and emotions dimensions. The raw data for these items can be found in Multimedia Appendix 3. The results show overall positive ratings (scores of 4 and 5). The feelings and emotions dimension stood out, with comparatively frequent medium ratings and no ratings of 5 on 60% (3/5) of the items. Furthermore, the item “How easy was it for you to learn how to use the app?” in the usability dimension was the only item with a score of 1 by 2% (1/42) of the participants. JMIR Form Res 2025 | vol. 9 | e66791 | p. 9https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX 2. Meyerowitz-Katz G, Ravi S, Arnolda L, Feng X, Maberly G, Astell-Burt T. Rates of attrition and dropout in app-based interventions for chronic disease: systematic review and meta-analysis. J Med Internet Res. Sep 29, 2020;22(9):e20283. 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[FREE Full text] [doi: 10.17061/phrp3222211] [Medline: 35702744] JMIR Form Res 2025 | vol. 9 | e66791 | p. 18https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX Abbreviations AD: atopic dermatitis BCT: behavior change technique iDerm: Institute for Interdisciplinary Dermatological Prevention and Rehabilitation MiA: Mein Hautschutz im Alltag (“My skin protection in everyday life”) TIP: tertiary individual prevention uMARS: user version of the Mobile Application Rating Scale UX: user experience WRSD: work-related skin disease Edited by A Mavragani; submitted 24.09.24; peer-reviewed by K Stawarz; comments to author 03.02.25; revised version received 24.02.25; accepted 25.02.25; published 18.04.25 Please cite as: Ristow N, Wilke A, Skudlik C, John SM, Ludewig M User Experience of and Adherence to a Smartphone App to Maintain Behavior Change and Self-Management in Patients With Work-Related Skin Diseases: Multistep, Single-Arm Feasibility Study JMIR Form Res 2025;9:e66791 URL: https://formative.jmir.org/2025/1/e66791 doi: 10.2196/66791 PMID: ©Nele Ristow, Annika Wilke, Christoph Skudlik, Swen Malte John, Michaela Ludewig. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.04.2025. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included. JMIR Form Res 2025 | vol. 9 | e66791 | p. 19https://formative.jmir.org/2025/1/e66791 (page number not for citation purposes) Ristow et alJMIR FORMATIVE RESEARCH XSL • FO RenderX