Page 113 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Chapter 4 preferences, capacities, values, and goals of potential future users who do not have good access to internet and digital technology or who are not well skilled in using this technology, would be explored and taken into account during each stage of development of eHealth tools, eHealth could potentially reduce health inequalities \[14\]. The development of a specific form of eHealth technology, called mobile health (mHealth) technology, seems especially promising when it comes to reducing health inequalities \[15,5,16,17\]. MHealth has been defined by the Global Observatory for eHealth of the World Health Organization as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices” \[18\]. A recent project called eSalud showed that mHealth can be cost effective, help to overcome cultural and language barriers and provide health information and services to low health access areas \[15\]. Furthermore, recent publications indicate that the digital divide is narrowing because of the increased ownership of mobile devices such as smartphones and tablets \[5,16,17\]. Still, having access to internet and digital technology does not automatically mean that people are able and willing to use it effectively to increase their health nor that different people use it in the same way \[14, 19, 20,21,22,23,24,25\]. Recent studies found ethnic and socioeconomic differences in mHealth usage \[19,20\] and it is known that older people use mHealth differently from younger people \[14\]. And though the gap of people owning tablets and smartphones between groups is closing, still a substantial amount of people do not own such devices. For instance the percentage of Dutch citizens of 65 years and older owning a tablet computer in 2017 was 55.2% versus 75.8% citizens of 12-25 years of age \[26\]. Considering that vulnerable groups, like people with low income and low education, bear a disproportionate burden of disease \[27,28\] and the amount of healthcare visits increases with age \[29\] it is to be expected that a relatively large amount of care recipients do not have a lot of experience using mobile technology. To fulfill the promise of mHealth technology contributing to reduction of health inequalities, it is very important to carefully test the usability of mHealth applications in research populations which include members of the target populations that are at risk of being excluded from usage of the tested tool. 112