Guide to mHealth implementation

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GUIDE TO mHEALTH IMPLEMENTATION

A six-step implementation guide to support effective, user-centered mHealth adoption

start

FR

Last Update: July 2025

Six key steps for implementation

Introduction to this guide

COLLABORATE WITH INTERESTED PARTIES

Glossary and acronyms

EVALUATE THE IMPLEMENTATION AND ADJUST

ADAPT THE MHEALTH TOOL

Patient-Reported Outcome Measures

PROMOTE THE MHEALTH TOOL

PLAN MHEALTH INTEGRATION

Contact us, cite this guide or give us feedback

PROVIDE TRAINING AND TECHNICAL SUPPORT

FR

Introduction

This guide outlines 6-steps for implementing mobile health (mHealth) tools into clinical practice.

What is mHealth?

How to read this guide

Why this guide was developed

Theorized mechanism:

How this guide was developed

About the Boxes:

Who should read this guide

Additional resources

Explore:

What is NOT in this guide

Click here to navigate step-by-step

FR

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Collaborate with interested parties

Collaboration during mHealth tool implementation helps stakeholders understand its value and be motivated to implement and promote it.

How to follow this step:

Set up the implementation team

Why follow this step?

• Leadership will be more likely to perceive the tool as useful and facilitate its implementation and promotion

• Intended users will perceive the tool as useful, easy to use, and be motivated to use it and promote it

Form a diverse team of key stakeholders committed to and involved in planning and executing the mHealth tool's implementation.

Read more

Collaborate at each key step

Decide, together, everyone’s role and collaborate at all steps of the mHealth tool implementation project.

Read more

Sensitize leadership

Highlight the importance of leadership support for the mHealth tool, as inadequate backing can lead to unresolved user concerns and limited adoption.

Additional resources

Read more

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Extra Resources on Collaborating with Interested Parties

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Adapt the mHealth tool to address user needs and preferences

The mHealth tool’s purpose, functions, features, content, layout, and interface need to be adapted to meet intended user needs and preferences.

How to follow this step:

Assess user concerns, needs, and preferences

Define segments of intended users

Why follow this step?If the tool is adapted to user needs and preferences, then users will perceive the tool as personally useful to them, trustworthy, easy to use, and responsive to their specific needs and preferences. However, several barriers to patients, caregivers, and clinicians may limit tool use. Without adaptation, users may not use the tool.

Read more

Read more

Use an iterative process to adapt and test

Adapt to varied and evolving user needs

Read more

Read more

Several boxes are referenced in Step 2. Access them all here:

Additional resources

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Box G. User concerns that negatively influence mHealth tool use: impact on patient health outcomes

Boxes A to M

Box H. Clinician user concerns that negatively influence mHealth tool use: impact on health inequities

Box A. User perceived benefits of mHealth tools that positively influence use

Box I. Clinician user concerns that negatively influence mHealth tool use: impact on job security, autonomy, professional development

Box B. Attitudes and beliefs about mHealth tools that negatively influence use

Box C. User concerns that negatively influence mHealth tool use: Data privacy and security

Box J. Strategies to increase user perceived trustworthiness of the mHealth tool

Box K. Possible adaptations to mHealth tool informational content, layout, and interface that positively influence use

Box D. Clinician user concerns that negatively influence their mHealth tool use: data quality, validity, and reliability

Box E. User concerns that negatively influence mHealth tool use: impact on healthcare practices and patient-clinician relationships

Box L. Customization options that positively influence use

Box M. Data display methods that positively influence use

Box F. Technical issues with mHealth tools that negatively influence use

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Extra Resources on Adapting to User Needs and Preferences

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Plan how mhealth use integrates into user routines

Ensure the mHealth tool fits smoothly into the daily routines of patients, caregivers, and clinicians.

How to follow this step:

Plan the mHealth tool implementation to complement current workflow patterns, daily routines, and needs.

See example strategies in Box N.

Why follow this step? If the implementation team considers how the mHealth tool will integrate into personal and clinical routines of intended users, then: Users will perceive the tool fits easily into their current practices

Modify roles or create new ones to facilitate mHealth tool use and to provide training and technical support for users.

See example strategies in Box O.

Consider the needs and preferences of patient and caregiver users when planning clinician workflows and allocating roles and responsibilities

Sensitize leadership to their role in facilitating the implementation

Several boxes are referenced in the Step 3 'How' section. Access them here:

See example strategies in Box P.

Additional resources

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Boxes N-P

Box N. Strategies to facilitate mHealth tool integration into professional and personal routines

Box O. Human resources and roles to support mHealth tool implementation and positively influence use

Box P. Strategies for leadership to support and positively influence use

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Extra Resources on Harmonizing mHealth tool implementation with User Routines

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Provide ongoing mHealth tool training and technical support

Equip users with the knowledge and support needed to confidently use the mHealth tool.

How to follow this step:

Identify inteded user segments and assess their mHealth training and technical support needs

Why follow this step? If the implementation team provides ongoing mHealth tool training and technical support, then: Intended users will perceive the mHealth tool as easy to use and thus, have confidence in their skills and ability to use it Otherwise users may perceive the tool as difficult to access and use

Additionally, draw upon results of intended user assessment.

Adapt mHealth tool training and technical support to the varied needs of user segments

See Box Q for training content and delivery modalities.

Complement training with a combination of technical support and other strategies.

See examples in Box R.

Encourage leadership to facilitate training and technical support

This requires leadership to perceive an added value to using an mHealth tool (See Step 5)

Several boxes are referenced in the Step 4 'How' section. Access them here:

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Boxes Q-R

Box Q. mHealth training content and delivery modalities that positively influence use

Box R. Types and modalities of mHealth tool technical and other support that positively influence use

Plan for integration

Ongoing support

Evaluate the implementation

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Promote the mhealth tool

To increase mHealth tool adoption, we must promote its perceived added value and reduce false negative perceptions

How to follow this step:

Define the target audience

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Why follow this step?

• Leadership will view the mHealth tool as trustworthy and beneficial for patient care, increasing their willingness to endorse it.

• Clinicians will find it useful, trustworthy, and easy to use within workflows, leading them to promote it to colleagues and patients.
• Patients and caregivers will see it as advantageous, trustworthy, and easy to integrate into daily life, motivating them to use and recommend it.

Identify multiple communication channels to reach each audience segment

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Develop promotional messages that are adapted to the characteristics and interests audience segments

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Box S is referenced in the Step 5 'How' section. Access it here:

Additional resources

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Extra Resources on mHealth Tool Promotion

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Evaluate the implementation and adjust

Conduct continuous evaluation to identify what’s working, what needs improvement, and how user and leadership perceptions are evolving.

How to follow this step:

Why follow this step? If the implementation team conducts cycles of evaluation, then:

• Perceptions of intended users and leadership and, thus, increase their motivation to use the mHealth tool, their confidence and comfort using it, and their willingness to endorse it.

Understanding the perceptions of intended users and leadership that influence their behaviours can help to

• Identify the implementation strategies that are working and should be maintained

• Understand how to modify implementation strategies to achieve desired effects.

• Identify implementation strategies that are not working and can be stopped.

• Maximize the benefits of using the mHealth tool while minimizing risks.

Evaluate implementation of the mHealth tool

Revisit previous steps to adjust according to evaluation results

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Boxes T and U are referenced in the Step 6 'How' section. Access them here:

Additional resources

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Boxes T-U

Box T. Example process indicators

Box U. Example outcome indicators

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Extra Resources on Evaluating the implementation

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

The case of eproms

PROMs

• Patient-reported outcome measures (PROMs) are self-report questionnaires
• PROMS can be used to assess patient physical, mental, or social health.
• Electronic PROMs (ePROMs) can be implemented within mobile applications or patient portals
• (e.g., to assess the effectiveness of care or to monitor patient health and well-being)
• ePROMs must be brief (to avoid burnout), user-friendly, and generate simple, interpretable reports

How to apply the 6 steps to ePROMs:PROMs follow the same process outlined in Step 1: Collaboration. The following describes how to conduct Step 2 to Step 6 in the PROM context

Step 3: Plan how mHealth use will integrate into user routines

Step 2: reporting and presenting data

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Step 4: Provide ongoing mHealth tool training and technical support

Step 5: Promote the mHealth tool

Step 6: Evaluate the implementation & adjust, as needed

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Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

cite this document

Contact us

Bush, P. L., Chu, D., Engler, K. C., Lussier, S., Barnett, T. A., & Lebouché, B. (2024). A 6-Step Guide to mHealth Implementation. Unité de soutien SSA Québec.

Please feel free to contact us regarding any questions, comments, or suggestions.

paula.bush@mcgill.ca

https://ssaquebec.ca/

About us

We welcome your feedback! Follow this link to:

We are a team of clinical, patient, and academic partners with varied content and methodological expertise and experience as developers, implementers, and users of mHealth tools.

Help us make this guide better!

FR

Last Update: July 2025

Plan for integration

Ongoing support

Evaluate the implementation

Adapt to users

Promote the tool

Collaborate

Bibliography

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A Scoping Review and General User's Guide for Facilitating the Successful Use of eHealth Programs for Diabetes in Clinical Care. Diabetes Technol Ther. 2021;23:133-145. doi: https://dx.doi.org/10.1089/dia.2020.0383 Franco-Trigo L, Fernandez-Llimos F, Martínez-Martínez F, Benrimoj SI, Sabater-Hernández D. Stakeholder analysis in health innovation planning processes: A systematic scoping review. Health Policy. 2020;124:1083-1099. doi: https://doi.org/10.1016/j.healthpol.2020.06.012 Gelkopf M, Mazor Y, Roe D. A systematic review of patient-reported outcome measurement (PROM) and provider assessment in mental health: goals, implementation, setting, measurement characteristics and barriers. Int J Qual Health Care. 2021;33:05. doi: https://dx.doi.org/10.1093/intqhc/mzz133 Grant J, Green L, Mason B. Basic research and health: a reassessment of the scientific basis for the support of biomedical science. Research Evaluation. 2003;12:217-224. doi: 10.3152/147154403781776618 Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review. J Med Internet Res. 2015;17:e52. doi: 10.2196/jmir.3951 Hancock SL, Ryan OF, Marion V, Kramer S, Kelly P, Breen S, Cadilhac DA. Feedback of patient-reported outcomes to healthcare professionals for comparing health service performance: a scoping review. BMJ Open. 2020;10:e038190. doi: https://dx.doi.org/10.1136/bmjopen-2020-038190 Hassan AYI. Challenges and Recommendations for the Deployment of Information and Communication Technology Solutions for Informal Caregivers: Scoping Review. JMIR Aging. 2020;3:e20310. doi: https://dx.doi.org/10.2196/20310 Istepanian RSH. Mobile Health (m-Health) in Retrospect: The Known Unknowns. Int J Environ Res Public Health. 2022;19. doi: 10.3390/ijerph19073747

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J Telemed Telecare. 2018;24:22-30. doi: 10.1177/1357633x16673538 Meirte J, Hellemans N, Anthonissen M, Denteneer L, Maertens K, Moortgat P, Van Daele U. Benefits and Disadvantages of Electronic Patient-reported Outcome Measures: Systematic Review. JMIR Perioper Med. 2020;3:e15588. doi: https://dx.doi.org/10.2196/15588 Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine. 2011;104:510-520. doi: 10.1258/jrsm.2011.110180 Mosteller F. Innovation and Evaluation. Science. 1981;211:881-886. doi:10.1126/science.6781066 Najm A, Nikiphorou E, Kostine M, Richez C, Pauling JD, Finckh A, Ritschl V, Prior Y, Balazova P, Stones S, et al. EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases. 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Adm Policy Ment Health. 2011;38:65-76. doi: 10.1007/s10488-010-0319-7 Reed MS, Graves A, Dandy N, Posthumus H, Hubacek K, Morris J, Prell C, Quinn CH, Stringer LC. Who's in and why? A typology of stakeholder analysis methods for natural resource management. Journal of Environmental Management. 2009;90:1933-1949. doi: https://doi.org/10.1016/j.jenvman.2009.01.001 Sipanoun P, Oulton K, Gibson F, Wray J. The experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting: a systematic review. Int J Med Inform. 2022;160:104691. doi: 10.1016/j.ijmedinf.2022.104691 Slater H, Campbell JM, Stinson JN, Burley MM, Briggs AM. End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review. J Med Internet Res. 2017;19:e406. doi: https://dx.doi.org/10.2196/jmir.8888 Stome LN, Wilhelmsen CR, Kvaerner KJ. Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review. 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Plan how mHealth use will integrate into user routines

• Develop a clear, efficient system for processing ePROM data.
• Develop protocols for harmonizing new ePROMs to help integrate these tools into clinical practice.

Glossary

Acronyms

CFIR: Consolidated Framework for Implementation Research EMR: Electronic Medical Record EPOC: Effective Practice and Organization of Care (Cochrane) GPS: Global Positioning System IT: Integrated Technology mHealth: Mobile Health OECD: Organisation for Economic Cooperation and Development PROM: Patient Reported Outcome Measure

Acceptability

Interface

Adapt

Interoperability

Appropriate

Layout

Caregiver

Leadership

Champion

mHealth

Clinician

Patient

Stakeholder analysis

Collaborate

Customizable

Superuser

Feasibility

Usability

Feature

User

Function

Implementation

Interested parties

How promotion of the mHealth tool influences use.

Develop promotional messages that are adapted to the characteristics and interests of audience segments

• Draw on the results of the intended user assessment (refer to Step 2).
• Adapt messages to the characteristics, needs, concerns, and interests of the audience segments.

• Aim to increase knowledge about the mHealth tool, its functions, and benefits.

What to address in promotional messages:

• Purpose, functions, and benefits of the mHealth tool 
• Misconceptions that intended users have about the mHealth tool

• What intended users can and cannot expect from the tool

• The support leadership is providing for the mHealth tool implementation
• How user concerns were considered in the adaptation of the tool and in the implementation strategies

See examples in Box C, Box D, Box E, Box G, Box H, and Box I

Step 4: Provide ongoing mHealth tool training and technical support

• Provide training to clinicians to interpret ePROM data.
• Clarify threshold values of ePROM scores (i.e., actionable triggers).

• Provide support to patients for completing ePROMs

Potential consequences of skipping this step...

Intended users may not see the mHealth tool as useful, relevant, or reliable, and may struggle to use its features. This can lead to low confidence, frustration, resistance, and unwillingness to promote it; ultimately resulting in limited or no use.

Box C. User concerns that negatively influence mHealth tool use: data privacy and security

📦

Clinician Users

Patient & Caregiver Users

Concerns about privacy, confidentiality, and security, including:

• Computer viruses, security breaches
• Data storage and data leaks

• Data sharing through ill-suited channels
• Data access and misuse or manipulation, including concerns that:
• Caregivers could influence treatment decisions or have access to information the patient does not wish to share
• Clinicians could exclude patients based on their data
• Unauthorized or third-party access could lead to:
• Surveillance of undocumented immigrants
• Denial of medical claims
• Increased stigmatization
• Reduced employment prospects or social acceptance

Perception that mHealth tools are more prone to data security issues (e.g., hackers), compared with other forms of digital health tools, given their portability and accessibility from personal devicesConcern that data (e.g., PROMs) will be used for service eligibility or cost containment Concerns about breaching patient privacy

🔓

🛡️

💸

👁️‍🗨️

Potential implementation team members include:

• Intended mHealth tool users
• Information technology and other support staff
• Managers and decision-makers
• Digital technology designers

Assemble a diversity of individuals who agree on the need to implement the mHealth tool and who are:

Interested in planning and conducting the implementation steps

Instrumental to the tool's successful implementation

Revisit previous steps to adjust according to evaluation results

• Eliminate or mitigate hurdles
• Maximize success factors

• Modify training or promotional methods

Box L. Customization options that positively influence use

📦

Include customization options that allow users to:

• Select font size, layout, and user interface
• Tailor to their cultural and social identity
• Customize data reporting (e.g., numeric or visual analogue scales, number of response options)
• Select delivery mode (e.g., text, web-based SMS) and timing of messages, alerts, prompts, and recommendations. 
• Switch features on and off, personalize goals, upload photographs or other content, bypass beginner-level features. 
• Customize the clinical information displayed.
• Modify the capabilities of the mHealth tool to their specific and evolving needs

🎨

Box M. Data display methods that positively influence use

📦

Use unambiguous and descriptive labels, titles, and annotations to avoid confusion associated with inconsistencies across instruments e.g.,

• Mild/moderate/severe
• Green arrows for better scores and red arrows for worse scores
• Traffic-light colours to colour code thresholds

Avoid mixing the directions of scores that are displayed.  Use line graphs and bar graphs rather than 3D graphical elements. 

• Line graphs should present a maximum of four lines.
• Bar graphs should present a maximum of six bars.

Include written explanations of graphs. Include clinically significant differences and confidence intervals. Display a reference population to use as a comparison, e.g.,

• Context to help interpret ePROM scores

📊

🔄

📈

💬

📉

👥

User motivation, comfort, and confidence to use the mHealth tool will...

Decrease if they:

Increase if they:

• feel competent to perform the tasks it requires
• find it easy to integrate into their routines
• consider that it saves them time
• can customize it
• consider the informational content easy to understand and use

• do not find it useful relative to the status quo
• feel negative emotions when using it
• feel overwhelmed by large quantities of informational content
• lack trust in its technology, informational content, or clinical benefit

Why follow these 6 steps?

This graphic illustrates how people’s perceptions of an mHealth tool, such as its usefulness, ease of use, and trustworthiness, influence their reactions, like feeling confident, motivated, and willing to use or endorse it. These reactions, in turn, shape their behaviours, such as promoting the tool, supporting its implementation, and using it routinely. The 6 implementation steps in this guide are designed to create the positive perceptions that lead to sustained and meaningful mHealth use. 👉 Look for this graphic at each step; it will help you see how your efforts at that step will support long-term adoption.

Step 2: Data reporting and presention

• Use graphics, dashboards, threshold lines, colour codes, and other user-friendly formats.
• Adjust data display format according to the data and its intended purpose
• Consider using data display examples in Box K.
• Facilitate sharing data and actionable results with multiple members of the care team.
• Provide practical, actionable, and timely feedback. Examples include alerts, reminders for follow-up, clinical pathways, treatment algorithms.
• Avoid feedback delays because information may be discounted as irrelevant
• Avoid too much feedback because information could be ignored due to ‘alert fatigue’
• Include functions that are automatically activated based on ePROM scores
• For example, patient scores above a given threshold trigger referrals or prescriptions to be sent.

Box D. Clinician user concerns that negatively influence mHealth tool use: data quality, validity, and reliability

📦

Concerns that self-reported data are of poor quality or unreliable for reasons, including:

• Data entry errors 

• Perceived inadequacy of data collection instruments (e.g., PROMs are too subjective or have low psychometric properties )

• Lack of validation of self-report data with EMR 

• Incomplete data due to, for example:
• Unwillingness of some health system staff to use technology-based interventions 
• Difficulty acquiring informed consent from patients 

Collaborate at every step

Write your title here

Write your title here

Agree on appropriate tool

Write your title here

Write your title here

Write your title here

Adapt, test, and improve tool

Assess targeted users' needs

Facilitate integration of tool into users' routines

Write your title here

Write your title here

Promote the tool

Provide user training and support

Evaluate the implementation and adjust plan

How adaptation of the mHealth tool to address user needs and preferences can impact tool use.

Box J. Strategies to increase user perceived trustworthiness of the mHealth tool

📦

Prioritize system security and flexible access settings that users can change. For example:

• Use secure, password-protected data collection systems. 
• Use unique login information so proxies cannot access other online information (e.g., bank) of the patient.
• Include adaptable proxy settings, for example:
• The ability to change access permissions
• Proxy access to records after consent or in case of emergency
• Allow for varied levels of access for different types of personal information, for example
• Sensitive versus non-sensitive information

Be transparent in terms of the developer, funding sources, conflicts of interest, content validation process, version updates, and data ownership, security and access. For example:

• Include the TRUSTe security seal on home pages. 
• Maintain up to date educational content and patient data, and include date of latest update. 
• Include evidence-based content and cite information sources that are trusted, scientifically justifiable, and scientifically accurate.
• e.g. Provide information about the psychometric properties of data collection instruments. 
• Indicate that the medical content has been validated by relevant experts.
• Include features that combine the utility of the Internet with the expertise of medical professionals. 
• e.g. Refer patients to care-support hotlines.
• Explain what data are being collected and why. 
• Communicate studies that demonstrate the effectiveness of the mHealth tool. 
• Include a feature that allows patients to monitor who has accessed their records. 
• Ensure patient and caregivers know with whom they are communicating.

🔑

📖

Prioritize mHealth tool accuracy. For instance, ensure:

• Correct generation of alerts 
• Accurate disease monitoring

🎯

Box B. Attitudes and beliefs about mHealth tools that negatively influence use

📦

All Users

Patient & Caregiver Users

Doubt about the need for the mHealth tool, given their current health status, self-management behaviours, or health services use  Preference for health information provided through friends, families, and internet sites, over that provided in the mHealth tool Preference to not be accountable for their health and for healthcare professionals to remain in charge of it

Doubt in the tool’s added value to the clinical encounter or clinical care  e.g.,:

• Belief that PROM results highlight issues already known to the clinical team
• Belief that PROMs are only useful for research

Preference for in-person, rather than virtual clinician-patient interactions e.g.,:

• Belief that mHealth hinders patient-clinician communication and relationships

Belief that the mHealth tool will impede professional relationships and communications with the care team Perception that mHealth tool use is burdensome, tedious, monotonous General disinterest, dislike, or fear of technology

🤔

🗣️

🤝

👩‍⚕️

🔗

💤

Use an iterative process to conduct user centred testing and continue to adapt the features, content, and layout to evolving user needs.

Conduct user centred testing and adapt the tool accordingly. Encourage feedback from users and adapt the tool accordingly. Consider attending staff meetings to provide updates and gather feedback.  Collaborate with information technology experts and champions to identify and solve user problems efficiently.

🧪

USER CENTRED TESTING: Assessing what people say and do

💬

Potential options:

• A think aloud protocol to understand how people use the tool
• A survey to collect user satisfaction data
• A card sorting activity with targeted user groups to audit information architecture
• Focus groups, individual interviews, or expert consultations to generate insight on user experiences
• Workshops to present the mHealth tool and allow users to use it in real-time, collect live user feedback

📅

🧑‍💻

Box N. Strategies to facilitate mHealth tool integration into professional and personal routines

Patient and caregiver users

All users

• Adapt workflows and schedules to limit cognitive load and information overload
• Reorganize and adapt mHealth-related work processes to complement existing routines
• Define and communicate all modified roles and responsibilities and associated expectations of leadership and colleagues
• Contact patients only when clinically relevant situations occur
• Standardize processes
• Automate relevant functions

• Make mHealth-related tasks brief
• I.e., Use short PROMs or other questionnaires that can be completed quickly
• Allow users to complete data collection questionnaires on their devices and on their own time
• Allow users to progress at their own pace
• Accommodate mobility or other functional limitations of users

Box R. Types and modalities of mHealth tool technical and other support that positively influence use

Who should provide the support

When and where should support be provided

What kind of support should be provided?

• Dedicated personnel or coach (e.g., digital coordinator, practice facilitator)
• Superusers 

• Peers (e.g., peer-to-peer support function integrated in the mHealth tool platform) 

• Family, co-workers, or caregivers 

• To operate and trouble-shoot data collection system 
• To read, understand and interpret reports of results (e.g., for patients, explanations of clinically important differences in PROM results) 

• For initial set up, e.g., create user account, activate portal 

• Continuously
• During pre-implementation and ongoing thereafter
• During clinical hours, at night, on weekends/holidays
• Support should be on-site, online, in-person, patient portals or by phone

Example: With instructions and other informational content in print and electronic formats Through a website with easy access to tools and forms

Box K. Possible adaptations to mHealth tool informational content, layout, and interface that positively influence use

📦

Make informational content easily accessible, dynamic, and flexible.  Include hyperlinks to additional information or educational material, such as laboratory results presented with explanations and context.  Include instructions where needed and make them available in print and electronic formats.  Adapt interface and layout to user needs, such as those tied to: culture, education, age, gender, technological skills, social and geographic situations. Develop an accompanying website for those who do not own a smartphone.

🗣️

Use clear language. Avoid:

• Messages perceived as condescending or impersonal 
• Delivering too much information at once (overwhelming) 

Adapt informational content to needs and preferences of users. For example:

• Language proficiency and literacy and numeracy levels 
• Preferences or needs for visual, textual, video, or audio content (e.g., colour contrast or text and icon size)
• Past behaviours (e.g., avoid information that could trigger negative emotions or that focuses on negative aspects of past behaviours that cannot be modified) 

🔄

📚

🔗

📝

🎧

🌍

🌐

Box Q. mHealth training content and delivery modalities that positively influence use

Training delivery

Training adaptations

Training content

Training objectives

• Deliver in home, online modules to peers/volunteers, family
• Integrate training in daily routines
• Offer hands-on demonstrations

Attend to varied and evolving needs:

• Tailor training to variable skills and comfort with technology
• Offer distinct training for local champions and superusers
• Offer refresher/booster sessions

• Increase understanding of the benefit of using the tool
• Improve skills and confidence in skills to use it

• Decrease fear of technology

• Teach skills regarding:
• downloading the app, account creation, log-in, navigation
• Internet, health literacy
• Integration of tool into practice and routines
• Address ethico-legal, privacy considerations

Identify multiple communication channels to reach each audience segment

Communication channels

Examples

• Identify individuals with a positive influence on their peers
• Engage these influencial peers to promote mHealth tool, enhance their trust in it, and to encourage and endorse use (Box S)
• Tailor the format and delivery of promotional messages and audience segments

• Events that target audiences typically attend (e.g., medical conferences)
• Hands-on demonstrations where and when users will be easily reached
• Information sessions in various locations, including online
• Encouragement from clinical personnel to colleagues and patients
• Social media, other websites that audience segments use
• Informative pamphlets, training material in print/electronic form

Events Interpersonal Media

Box A. User perceived benefits of mHealth tools that positively influence use

📦

The mHealth tool provides useful, quality, and timely information

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📊

The mHealth tool facilitates patient self-management behaviours and professional care practices

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💪

The mHealth tool improves access to care-related information including via patient-clinician and patient-patient communication

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💬

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

The mHealth tool is convenient, easy to use, and acceptable

📱

The mHealth tool improves quality and efficiency of care

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📈

How mHealth tool training and technical support impact use.

Design & Functionality Principles

User Differences & Preferences

Age-related: Younger users may have a more positive attitude towards mHealth tools than older ones.

Include only the features and functions that users perceive as relevant and acceptable. [Box A]

📌

🧒

Include adaptations to increase user perceived trustworthiness of the mHealth tool and its informational content. [Box J]

🔒

Reminders: Some users will want to receive reminders, while others will find them intrusive or annoying.

🔔

Make the layout and interface user-friendly, minimalist, self-explanatory, and intuitive to users of varying needs. [Box K]

📱

Interactivity: Some users will be motivated by gamification or peer-to-peer interactions, while others may find these features off-putting.

🎮

Include informational content users perceive as practical, helpful, relevant, and easy to understand. [Box K]

🧭

Include customization options so users can tailor the tool to their evolving needs, preferences, situations, and characteristics. [Box L]

🎨

Accessibility: Vulnerable population groups, such as people with low literacy, single parents, those with low socioeconomic status, or the elderly are more likely to use mHealth tools that allow for direct communication with providers and that include varied audio-visual content.

⚙️

Consider the literacy, numeracy, technological skills, sensory abilities, motor control, and other physical, visual, auditory, cognitive, or intellectual capabilities of intended users.

🧰

See supporting Boxes here:

Use a structured approach

Conduct a stakeholder analysis to identify relevant user groups Collect data through interviews, consultations, or questionnaires

👥

📋

What you should assess

Explore Attitudes and Beliefs Identify beliefs that may support use (see Box A) Identify beliefs that may hinder use (see Box B) Identify Common User Concerns Privacy and security (Box C) Content quality and accuracy (Box D) Technical issues (Box F) Account for User Characteristics Clinical profiles and functional limitations Previous experiences with mHealth tools (positive and negative)

Understand Perceived Impacts On patient-clinician relationships (Box E) On health outcomes (Box G) On health equity (Box H) On self-management capacity, care pathways, and clinical workflows On clinician/staff roles, including job security, autonomy, and personal development (Box I)

🤝

🏥

⚖️

🔄

🔐

👩‍⚕️

📚

⚙️

See supporting Boxes here:

📊

🧭

Box E. User concerns that negatively influence mHealth tool use: impact on healthcare delivery

📦

Clinician Users

Patient & Caregiver Users

mHealth tool use:

• will compromise routine clinical appointments 
• will replace other support measures for informal caregivers 
• is impersonal 
• may result in loss of government funded care 

The mHealth tool will divert from other responsibilities, interfere with clinical time mHealth tool implementation is not feasible given lack of workflows, administrative support, and infrastructure to support integration of the associated increased workload mHealth tool use is inappropriate for some patients

🕒

⚠️

🏗️

How collaboration with interested parties impacts mHealth tool use.

Box I. Clinician user concerns that negatively influence mHealth tool use: impact on job security, autonomy, professional development

📦

Concerns that the mHealth tool:

• Is a threat to their livelihood (e.g., if patient treatment plans and outcomes are accessible to others, they may be subject to external control or criticism). 
• Substitutes, rather than complements, their clinical practice
• Will force them to renegotiate their professional identities (informed patients may undermine the care team’s authority and credibility) 
• Will lead managers to interfere with clinical practice 
• Invades their privacy 
• Will change the scope of their practice (e.g., add responsibilities and liability) 

⚠️

Step 5: Promote the mHealth tool

• Explain, to all users, the purpose of the ePROM data and the relevance of the ePROM questionnaire.

Barriers to use for patients, caregivers, and clinician users

Clinician users

Patient and caregiver users

• Perceived lack of evidence for clinical benefit, efficacy, and effectiveness of the mHealth tool
• Limited belief in mHealth tool's effect on clinical practice, patient care, or patient health outcomes (e.g., reliability for clinical decisions)
• Negative impact on workload
• Career, legal, and data privacy and security concers

• Informational content is inaccurate or unclear
• Leads to uncertainty for quality and trustworthiness

• Content is out-of-date
• Patients may perceive self-identification options (e.g., gender) as inadequate
• May lead to perceived clinician insensitivity and discourage patients from returning

Potential consequences of skipping this step...

Leadership may not perceive any advantage to using the mHealth tool, relative to the status quo. Consequently, they will be less willing to endorse the tool and, thus, less likely to facilitate its implementation or to actively promote its use among clinicians. Intended users may not perceive any advantage to using the mHealth tool, relative to the status quo. Moreover, they may find the tool difficult to use. Consequently, they may consider it to be more trouble than it is worth and, thus, less inclined to actively promote the mHealth tool among other intended users or to use it.

Box S. Strategies to engage influential peers in promoting the mHealth tool

Message

Activity

Audience

Messenger

• Patients, family, caregivers

Address: value of tracking personal health information and its reliability

Collaboratve approach where caregivers / nurses / case managers assist users or recommend tool

• Clinicians

Provide inter-professional support, collaboration, coordination Collect, disseminate, or use ePROM data Establish a practice community

• Clinicians

• Clinicians

• Patients, family, friends, and caregivers

• Patients, family, and caregivers

Provide recommendations and encouragement

Conduct mHealth tool reviews

• Scientific societies and renowned healthcare organizations

Provide recommendations

• Clinicians

Box P. Strategies for leadership to support and positively influence use

• Facilitate a combined top-down and bottom-up approach

• Promote benefits of technology
• Encourage personnel to embrace new ways of working (new mHealth tool)
• Allocate human, material, and financial resources
• Facilitate organizational changes that the mHealth tool will entail (e.g., changes in roles, responsibilities, workflow, ethical regulations, impact on billing, etc)
• Offer relevant training
• Develop clear legislation, policies, regulations, frameworks, processes, and guidelines that are aligned with current ones, that address:
• Responsibility for data leaks/sharing of personal information, data governance, and security risks
• Ethical and confidentiality issues and best practices; medico-legal risks
• Legal liability issues with data transfer, remote care protocols,

Box F. Technical issues with mHealth tools that negatively influence use

📦

All Users

• Installation issues
• Login issues
• Output quality (e.g., poor image or video quality)
• Network and connectivity issues (e.g., signal quality and speed, difficulty transferring data between devices, poor Bluetooth connection)
• System errors, failures, and malfunctions (e.g. crashes, screen freezes)
• Lack of program and system updates
• Lack of infrastructure and poor integration of mHealth data with other data (e.g., EMRs)
• Battery life (e.g., high battery consumption), charging problems, or storage issues

Box U. Example outcome indicators

Outcome indicator examples

Example assessment methods

Health outcomes

• Clinical outcomes, holistic elements of health, and patient benefits or experiences

• Quantitative monitoring of changes during the period of mHealth tool use, including test results, quality of life, Charlson Comorbidity Index

Efficiency

• Time savings for users, self-efficacy for patients, burden on clinicians
• Impact of informational content, including caregiver knowledge and skills to manage patient's health, self-management knowledge, and use of informational content
• Patient-caregiver working relationship, patient experiences with primary care, partnership building, and shared-decision making

• Quantitative monitoring, such as Patient Activation Measure, Chronic Disease Self-Efficacy (CDSE)

• Quantitative assessment of reflection on health information, such as The Information Assessment Method (IAM)

• Quantitative assessment to monitor change, such as Consumer Assessment of Healthcare Providers and Systems survey and Patient-Reported Experience Measures

System-oriented changes

• Levels of heatlhcare system utilization, care delivery, care coordination, and financial impact

• Quantitative methods to monitor changes, such as emergency department visits, hospitalizations, and visits to specialists

Step 6: Evaluate the implementation & adjust, as needed

• Deploy ePROMs progressively.
• Evaluate user perspectives and make additional adaptations to the mHealth tool and the PROMs, as needed

• As needed, revisit Step 2. Adapt the mHealth tool to address user needs & preferences.

• Evaluate use and modify implementation processes, as needed

How consideration of intended user routines impacts mHealth tool use.

Box A. User perceived benefits of mHealth tools that positively influence use

📦

The mHealth tool provides useful, quality, and timely information

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📊

The mHealth tool facilitates patient self-management behaviours and professional care practices

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💪

The mHealth tool improves access to care-related information including via patient-clinician and patient-patient communication

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💬

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

The mHealth tool is convenient, easy to use, and acceptable

📱

The mHealth tool improves quality and efficiency of care

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📈

Why sensitize leadership?

How to sensitize leadership:

Inadequate leadership...

...leads to unresolved user concerns

• Highlight the value of the mHealth tool and explain how leadership plays a key role in its success.
• Emphasize the benefits of successful implementation, such as improved care quality, efficiency, and patient engagement.
• Identify potential barriers (e.g., legal, security, workflow disruptions) and present clear, practical solutions.
• Share evidence of user interest and support, including feedback from clinicians, patients, and staff who see the tool as valuable.

• Lack of standardized practices and services

• Lack of legislation, policies, regulation, guidelines, and frameworks

• Clinicians believe the mHealth tool is not valuable and may have medico-legal concerns

• Patients and caregivers have data security concerns

Define the target audience

Potential segmentation characteristics

• Draw on intended user assessment results
• Segment the target audience according to characteristics that may influence how to best promote the mHealth tool to them
• Attend to audience segments who may be less aware of the mHealth tool or harder to reach

Potential target audiences

Knowledgde, attitudes, and beliefs about

• The mHealth tool
• Its integration with professional routines and personal routines

Needs

• Language proficiency
• Digital literacy

• Leadership
• Influential peers
• Patients
• Caregivers
• Family of patients
• Specific clinician groups
• Other interested parties

How implementation evaluation impacts mHealth tool use.

Evaluate implementation of the mHealth tool

• Begin early in the implementation process

• Conduct rapid, continuous cycles of evaluation to identify issues and to improve the mHealth tool and the user experience.

• Conduct research to understand the optimal strategies to implement mHealth tools and promote their value. 

• Evaluate the processes and outcomes of the adaptation, implementation, and promotion.
• See Box T and Box U for example indicators and methods to evaluate them.

• Consider using implementation outcomes outlined by Proctor and colleagues (2011) or in the Consolidated Framework for Implementation Research Outcomes Addendum.

Box T. Example process indicators

Process indicator examples

Example assessment methods

mHealth tool use

• Singular events: i.e., patient portal login
• Sustained mHealth tool use: >1 message/year sent

User satisfaction

• User perceived benefits of mHealth tool

• Consumer Assessment of Healthcare Clinicians and Systems, semi-strucutred interviews, user observations

Ease of use

• Usability, perceived facilitators of use, areas of improvement, and user understanding of tool

• System Usability Scale, qualitative or quantitative methods

Quality of informational content

• perceived accuracy, usefulness, and availability

• Qualitative or quantitative methods

System quality and technical issues

• System performance, system downtime, or difficulties

• Quantitative measures or continuous monitoring

Implementation

• Barriers, facilitators, feasibility; relative effectiveness of strategies for whom, how, and why

Box O. Human resources and roles to support mHealth tool implementation and positively influence use

Roles required for various tasks associated with steps in this guide

Human resources

• Include:
• Project manager
• Practice facilitator
• Local champions
• Superusers
• Research co-ordinator
• External consultant
• Evaluators with expertise to manage large data sets

Step 3

• Identification, registration, and provision of on-site assistance to patients
• Revision of self-scheduled appointments for safety and appropriateness
• Data collection, entry/analysis/interpretation, and administration of PROMs and other questionnaires
• Continuous monitoring of patient data

Step 4

• Inform and educate patients and caregivers on the value/use of mHealth
• Provide on-site training, technical support, and respond to questions

Step 5

• Inform and educate users on value of mHealth

Step 6

• Evaluate the implementation

Why segment users?

Segmenting helps tailor the mHealth tool to different groups, increasing adoption and effectiveness.

🎯

How to segment users:

Use the data you collected from the intended user assessment to inform segmentation. Define Key Segments according to characteristics that inform how to adapt the mHealth tool. These include: Perceived benefits that support use (see Box A) Attitudes and beliefs that hinder use (see Box B) Needs & preferences for informational content, interface, and data display (see Box M)

📋

📊

🚫

🖥️

See supporting Boxes here:

Box H. Clinician user concerns that negatively influence mHealth tool use: impact on health inequities

📦

Concerns about generating or exacerbating inequities, given some patients and caregivers do not use the mHealth tool for reasons such as:

• A lack of access to technology
• Difficulty, inability, or unwillingness to use the mHealth tool or to use it adequately
• Difficulty understanding informational content 

⚠️

Box A. User perceived benefits of mHealth tools that positively influence use

📦

The mHealth tool provides useful, quality, and timely information

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📊

The mHealth tool facilitates patient self-management behaviours and professional care practices

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💪

The mHealth tool improves access to care-related information including via patient-clinician and patient-patient communication

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

💬

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

The mHealth tool is convenient, easy to use, and acceptable

📱

The mHealth tool improves quality and efficiency of care

Patient & Caregiver Perceptions

👥

Clinician Perceptions

🩺

📈

Box G. User concerns that negatively influence mHealth tool use: impact on patient health outcomes.

📦

Clinician Users

Patient & Caregiver Users

Self-monitoring with mHealth may cause anxiety.  The social features of mHealth may lead to social comparison.  The informational content provided may be difficult to understand, misinterpreted, anxiety-provoking, or overwhelming.

Patients may become too dependent on technology and fail to seek medical help in emergencies. Safety may be compromised (e.g., system reliability, clinical content accuracy, and self-diagnosing).  By its impersonal nature, mHealth may be inappropriate for patients with mental health conditions.  mHealth may be inappropriate for those with physical or psychological impairments, severely ill patients. Patient portals may not be empowering for socioeconomically disadvantaged populations.

🚑

😰

⚠️

👥

🤖

🚫

🏚️