Volume 27, Issue 3 (11-2024)
jha 2024, 27(3): 1-16 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Sarbaz M, Mousavi Baigi S F, Salehzade Z, Norouzi Aval R, Esmaeili M, Kimiafar K. Security barriers and facilitators in the use of mobile health applications from the perspective of paramedical students at Mashhad university of medical sciences: a descriptive cross-sectional Study. jha 2024; 27 (3) :1-16
URL: http://jha.iums.ac.ir/article-1-4545-en.html
URL: http://jha.iums.ac.ir/article-1-4545-en.html
Masoumeh Sarbaz1 
, Seyyedeh Fatemeh Mousavi Baigi2 , Zahra Salehzade2 , Reyhane Norouzi Aval2 , Mojtaba Esmaeili1 , Khalil Kimiafar3
, Seyyedeh Fatemeh Mousavi Baigi2 , Zahra Salehzade2 , Reyhane Norouzi Aval2 , Mojtaba Esmaeili1 , Khalil Kimiafar3
1- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad
2- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad & Student Research Committee, Mashhad University of Medical Sciences, Mashhad
3- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad ,kimiafarkh@mums.ac.ir
2- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad & Student Research Committee, Mashhad University of Medical Sciences, Mashhad
3- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad ,
Full-Text [PDF 939 kb]
(89 Downloads)
| Abstract (HTML) (163 Views)
Table 1. Demographic characteristics
Full-Text: (70 Views)
Introduction
Mobile health (mHealth) applications have emerged as effective tools for health management and improving the quality of healthcare services. These applications facilitate access to health information, promote patient self-management, and enhance communication between patients and healthcare providers, thereby transforming healthcare systems worldwide [1]. Furthermore, mHealth technologies, particularly wearable smart devices, enable real-time monitoring of health indicators, offering innovative solutions for disease management and prevention [2,3]. Despite these advantages, concerns regarding data security and privacy remain significant barriers to the widespread adoption of mHealth applications [4]. Studies have indicated that approximately 40% of users refrain from downloading or continuing to use these applications due to fears of data breaches or misuse of personal information [5]. Such security challenges include non-transparent privacy policies, complex security settings, and limited user control over data management [6,7]. Users expect mHealth applications to incorporate features such as data encryption, remote data deletion, and multi-level access controls to enhance security and build trust [8,9].
In Iran, the adoption of smartphones and mHealth applications has expanded rapidly. However, limited information is available regarding users’ security concerns and privacy preferences [10]. Recent domestic studies have highlighted the potential of mHealth applications in enhancing medical education and learning processes among healthcare students. Nevertheless, challenges such as data security, usability issues, and the need for user-friendly features persist [11,12]. Recent research emphasizes that the integration of advanced security features—such as transparent privacy policies, access control mechanisms, and remote data erasure—can increase trust and acceptance of mHealth applications [8,13]. For instance, a 2021 study underscored the pivotal role of security features and user-friendly interfaces in improving the adoption of these technologies [6]. However, comprehensive investigations into the barriers and facilitators affecting the security of mHealth applications, particularly among healthcare and paramedical students in Iran, remain scarce [12, 14-16].
Paramedical students, as future healthcare professionals, play a crucial role in the adoption and promotion of mobile health (mHealth) technologies in clinical settings. This group is not only a potential user for such applications but will also serve as healthcare providers in the future, requiring the ability to ensure and assess patient data security. Understanding their perspectives and concerns regarding the security of mHealth applications can provide valuable insights for developing safer and more optimized applications. Furthermore, given the increasing digitization of healthcare services and the growing role of mHealth applications in education and service delivery, examining paramedical students' viewpoints in this area can help identify existing gaps and propose practical solutions to enhance security and user trust. This study aims to identify the barriers and facilitators related to the security of mHealth applications from the perspective of paramedical students at Mashhad University of Medical Sciences. The study can inform developers and policymakers, enabling them to design more secure and user-friendly mHealth applications while establishing policies that enhance security and privacy standards.
Methods
Study design:This study employed a descriptive, cross-sectional design at Mashhad University of Medical Sciences in 2023.
Population and sample size: The target population comprised paramedical students from various disciplines, including radiology, physiotherapy, laboratory sciences, speech therapy, occupational therapy, health information technology, and social working. A proportional stratified sampling method was employed to ensure representation across disciplines. The initial sample size was estimated to be 87 participants using Cochran's formula, considering a 95% confidence level and a 5% margin of error. However, to compensate for potential respondent attrition and enhance the generalizability of the findings, the final sample size increased to 115 participants.
Data collection instrument: The data were collected using a structured questionnaire adapted from a standardized instrument originally developed by Zhou et al. [17]. The questionnaire underwent a rigorous translation and localization process to meet international scientific standards. It was divided into two main sections to assess perspectives on data security and privacy features in mHealth applications:
Mobile health (mHealth) applications have emerged as effective tools for health management and improving the quality of healthcare services. These applications facilitate access to health information, promote patient self-management, and enhance communication between patients and healthcare providers, thereby transforming healthcare systems worldwide [1]. Furthermore, mHealth technologies, particularly wearable smart devices, enable real-time monitoring of health indicators, offering innovative solutions for disease management and prevention [2,3]. Despite these advantages, concerns regarding data security and privacy remain significant barriers to the widespread adoption of mHealth applications [4]. Studies have indicated that approximately 40% of users refrain from downloading or continuing to use these applications due to fears of data breaches or misuse of personal information [5]. Such security challenges include non-transparent privacy policies, complex security settings, and limited user control over data management [6,7]. Users expect mHealth applications to incorporate features such as data encryption, remote data deletion, and multi-level access controls to enhance security and build trust [8,9].
In Iran, the adoption of smartphones and mHealth applications has expanded rapidly. However, limited information is available regarding users’ security concerns and privacy preferences [10]. Recent domestic studies have highlighted the potential of mHealth applications in enhancing medical education and learning processes among healthcare students. Nevertheless, challenges such as data security, usability issues, and the need for user-friendly features persist [11,12]. Recent research emphasizes that the integration of advanced security features—such as transparent privacy policies, access control mechanisms, and remote data erasure—can increase trust and acceptance of mHealth applications [8,13]. For instance, a 2021 study underscored the pivotal role of security features and user-friendly interfaces in improving the adoption of these technologies [6]. However, comprehensive investigations into the barriers and facilitators affecting the security of mHealth applications, particularly among healthcare and paramedical students in Iran, remain scarce [12, 14-16].
Paramedical students, as future healthcare professionals, play a crucial role in the adoption and promotion of mobile health (mHealth) technologies in clinical settings. This group is not only a potential user for such applications but will also serve as healthcare providers in the future, requiring the ability to ensure and assess patient data security. Understanding their perspectives and concerns regarding the security of mHealth applications can provide valuable insights for developing safer and more optimized applications. Furthermore, given the increasing digitization of healthcare services and the growing role of mHealth applications in education and service delivery, examining paramedical students' viewpoints in this area can help identify existing gaps and propose practical solutions to enhance security and user trust. This study aims to identify the barriers and facilitators related to the security of mHealth applications from the perspective of paramedical students at Mashhad University of Medical Sciences. The study can inform developers and policymakers, enabling them to design more secure and user-friendly mHealth applications while establishing policies that enhance security and privacy standards.
Methods
Study design:This study employed a descriptive, cross-sectional design at Mashhad University of Medical Sciences in 2023.
Population and sample size: The target population comprised paramedical students from various disciplines, including radiology, physiotherapy, laboratory sciences, speech therapy, occupational therapy, health information technology, and social working. A proportional stratified sampling method was employed to ensure representation across disciplines. The initial sample size was estimated to be 87 participants using Cochran's formula, considering a 95% confidence level and a 5% margin of error. However, to compensate for potential respondent attrition and enhance the generalizability of the findings, the final sample size increased to 115 participants.
Data collection instrument: The data were collected using a structured questionnaire adapted from a standardized instrument originally developed by Zhou et al. [17]. The questionnaire underwent a rigorous translation and localization process to meet international scientific standards. It was divided into two main sections to assess perspectives on data security and privacy features in mHealth applications:
- Closed-ended (quantitative) questions: This section included 14 closed-ended questions based on a 7-point Likert scale (ranging from “Strongly Agree” to “Strongly Disagree”). The questions focused on evaluating students’ attitudes regarding data security, privacy, and protective features of mHealth applications, such as data encryption, remote data deletion, access control, and privacy policies.
- Open-ended (qualitative) questions: This section consisted of four open-ended questions designed to explore participants’ deeper insights and qualitative perspectives regarding barriers and facilitators related to security of mHealth applications. These questions addressed key topics, including: barriers to trust in mHealth applications, such as data breaches or unauthorized access; desired security and privacy features, including access permissions management and policy transparency; recommendations for improving security features based on personal experiences and expectations.
Translation and localization process: The questionnaire was translated from English to Persian and then back-translated into English by two bilingual experts to ensure accuracy and semantic equivalence. The translated version was reviewed and refined by a panel of five faculty member from the fields of medical informatics (n = 2), health information management (n = 1), biostatistics (n = 1), and health information technology (n = 1) to ensure cultural relevance and conceptual clarity. Any discrepancies were resolved through consensus, and the final version was validated for content.
The final version of the questionnaire was reviewed by an expert panel consisting of five faculty members: two from medical informatics, one from health information management, one from biostatistics, and one from health information technology. The panel assessed the cultural relevance and conceptual clarity of the content. All discrepancies were resolved by consensus, and the final version was approved for content validity.
Instrument validity and reliability: The validity of the questionnaire was confirmed through face and content validity, assessed by a panel of experts. Reliability was evaluated using the test-retest method over a 10-day interval involving 20 participants. The test-retest reliability of the questionnaire was confirmed with a Pearson correlation coefficient of 0.92, indicating high reliability and consistency.
Data collection procedure: The questionnaires were distributed electronically via university communication platforms and student groups. Participation was voluntary, and informed consent was obtained electronically before completing the questionnaire.
Data analysis: Quantitative data were analyzed using SPSS software (version 26). Descriptive statistics, including frequencies, and percentages were calculated. Qualitative data obtained from open-ended questions were analyzed using thematic analysis based on the framework proposed by Braun and Clarke [18]. The analysis followed six distinct steps: 1) Familiarization with the data: repeated reading of responses to gain an in-depth understanding; 2) Generating initial codes: identifying and coding meaningful segments of data; 3) Searching for themes: grouping codes into potential themes; 4) Reviewing themes: ensuring coherence and relevance of themes to the data; 5) Defining and naming themes: clearly describing and labeling each theme; 6) Producing the final report: organizing findings into a cohesive and structured narrative.To enhance the credibility of qualitative findings, two independent coders reviewed the data, and discrepancies were resolved through group consensus. Additionally, the results were shared with 15 participants to undergo a review and validation process by the contributors, ensuring that the interpretations were confirmed and approved by them.
Results
In this study, 115 paramedical students from various disciplines, including radiology, physiotherapy, laboratory sciences, speech therapy, occupational therapy, health information technology, and social working participated (response rate: 96%). As shown in Table 1, the mean age of the participants was 23.51 years with a standard deviation of 4.2. The majority of participants were female (64.3%) and single (84.3%). The distribution of responses indicated that most participants had prior experience using mHealth applications; however, they expressed concerns regarding the security and privacy of their information within these applications
The final version of the questionnaire was reviewed by an expert panel consisting of five faculty members: two from medical informatics, one from health information management, one from biostatistics, and one from health information technology. The panel assessed the cultural relevance and conceptual clarity of the content. All discrepancies were resolved by consensus, and the final version was approved for content validity.
Instrument validity and reliability: The validity of the questionnaire was confirmed through face and content validity, assessed by a panel of experts. Reliability was evaluated using the test-retest method over a 10-day interval involving 20 participants. The test-retest reliability of the questionnaire was confirmed with a Pearson correlation coefficient of 0.92, indicating high reliability and consistency.
Data collection procedure: The questionnaires were distributed electronically via university communication platforms and student groups. Participation was voluntary, and informed consent was obtained electronically before completing the questionnaire.
Data analysis: Quantitative data were analyzed using SPSS software (version 26). Descriptive statistics, including frequencies, and percentages were calculated. Qualitative data obtained from open-ended questions were analyzed using thematic analysis based on the framework proposed by Braun and Clarke [18]. The analysis followed six distinct steps: 1) Familiarization with the data: repeated reading of responses to gain an in-depth understanding; 2) Generating initial codes: identifying and coding meaningful segments of data; 3) Searching for themes: grouping codes into potential themes; 4) Reviewing themes: ensuring coherence and relevance of themes to the data; 5) Defining and naming themes: clearly describing and labeling each theme; 6) Producing the final report: organizing findings into a cohesive and structured narrative.To enhance the credibility of qualitative findings, two independent coders reviewed the data, and discrepancies were resolved through group consensus. Additionally, the results were shared with 15 participants to undergo a review and validation process by the contributors, ensuring that the interpretations were confirmed and approved by them.
Results
In this study, 115 paramedical students from various disciplines, including radiology, physiotherapy, laboratory sciences, speech therapy, occupational therapy, health information technology, and social working participated (response rate: 96%). As shown in Table 1, the mean age of the participants was 23.51 years with a standard deviation of 4.2. The majority of participants were female (64.3%) and single (84.3%). The distribution of responses indicated that most participants had prior experience using mHealth applications; however, they expressed concerns regarding the security and privacy of their information within these applications
Table 1. Demographic characteristics
| Variable | Frequency (%) / Mean ± SD |
| Age (years) | 23.51 ± 4.2 |
| Gender | |
| Male | 41 (35.7) |
| Female | 74 (64.3) |
| Marital Status | |
| Single | 97 (84.3) |
| Married | 18 (15.7) |
| Field of Study | |
| Physiotherapy | 5 (4.3) |
| Speech Therapy | 15 (13.0) |
| Audiology | 19 (16.5) |
Table 1.Continued
| Variable | Frequency (%) / Mean ± SD |
| Field of Study | |
| Health Information Technology | 37 (32.2) |
| Radiology | 11 (9.6) |
| Laboratory Sciences | 15 (13.0) |
| Social Work | 9 (7.8) |
| Education Level | |
| Bachelor's Degree (Discontinuous) | 1 (0.9) |
| Bachelor's Degree (Continuous) | 99 (86.1) |
| Master's Degree | 14 (12.2) |
| PhD | 1 (0.9) |
Quantitative analysis:Table 2 presents the students' perspectives regarding personal data security and privacy. The majority of students (81.7%) either strongly agreed, agreed, or somewhat agreed that they were concerned about the privacy and security of their personal information in their daily lives. Furthermore, most participants (67.9%) expressed concerns about the privacy and security of their personal information when using mHealth applications. Similarly, 67.9% of students reported being worried about transmitting personal information via mHealth applications due to the potential risk of unauthorized access or tampering. In addition, 70.4% stated that they were unwilling to store personal information, such as name, national ID number, phone number, or email address, in mHealth applications—preferring to use only a unique identifier that is accessible solely by authorized personnel. Moreover, 88.6% of participants agreed that they would prefer their personal health information to be transferred to a centralized database through a highly secure process.
Table 2. students' opinions regarding personal data
| Opinions About Personal Data | Strongly Agree | Agree | Somewhat Agree | Neutral | Somewhat Disagree | Disagree | Strongly Disagree |
| 1. Overall, I am concerned about the privacy and security of my personal information in daily life. | 46 (40.0) | 22(19.1) | 26 (22.6) | 13(11.3) | 7 (6.1) | 1 (0.9) | 0 (0.0) |
| 2. I am concerned about the privacy and security of my personal information when using mHealth apps. | 33 (28.7) | 27(23.5) | 18 (15.7) | 16(13.9) | 11 (9.6) | 8 (7.0) | 2 (1.7) |
| 3. I am concerned that sending personal information through an mHealth app may expose it to manipulation by others. | 26 (22.6) | 24(20.9) | 32 (27.8) | 12(10.4) | 10 (8.7) | 6 (5.2) | 5 (4.3) |
| 4. I am not willing to store my personal information, such as name, phone number, or email, in mHealth apps, except for a unique ID trackable only by authorized personnel. | 39 (33.9) | 27(23.5) | 15 (13.0) | 14(12.2) | 8 (7.0) | 10 (8.7) | 2 (1.7) |
| 5. I want my personal health information to be transferred to a centralized database through a highly secure process. | 61 (53.0) | 29(25.2) | 12 (10.4) | 7 (6.1) | 1 (0.9) | 2 (1.7) | 3 (2.6) |
According to Table 3, the majority of students responded neutrally to the two questions: "Overall, I am satisfied with the privacy and security of the mHealth applications I currently use" and "Developers and healthcare providers have implemented the necessary security and privacy measures, offering a reasonable level of protection for information collected through mHealth applications." This neutrality highlights uncertainty and potential mistrust regarding the adequacy of existing privacy and security safeguards in mHealth technologies. Regarding usage patterns, 42.6% of students reported using mHealth applications to meet their healthcare needs. Furthermore, 52.2% expressed a desire for healthcare providers to adopt mHealth applications for storing and managing their health information, indicating a growing inclination toward integrating these technologies into routine care practices. In addition, 68.7% of students stated they would feel comfortable sharing their health information among their physicians and therapists if such data sharing supported their healthcare management. This finding underscores the importance of secure communication channels and trust in data sharing processes to promote the acceptance and use of mHealth applications in healthcare management.
Table 3. students' opinions about health applications
| Opinions About Health Applications | Strongly Agree | Agree | Somewhat Agree | Neutral | Somewhat Disagree | Disagree | Strongly Disagree |
| 6. Overall, I am satisfied with the privacy and security of the mHealth applications I currently use. | 10 (8.7) | 15 (13.0) | 21 (18.3) | 51 (44.3) | 9 (7.8) | 6 (5.2) | 3 (2.6) |
| 7. Developers and healthcare providers need to ensure privacy and security measures are in place. These measures should provide reasonable protection for the data collected through mHealth applications. | 6 (5.2) | 17 (14.8) | 30 (26.1) | 42 (36.5) | 6 (5.2) | 12 (10.4) | 2 (1.7) |
| 8. I use mHealth applications for my healthcare needs. | 3 (2.6) | 22 (19.1) | 24 (20.9) | 25 (21.7) | 15 (13.0) | 14 (12.2) | 12 (10.4) |
| 9. I want healthcare providers to use mHealth applications to store and manage my health information. | 18 (15.7) | 22 (19.1) | 20 (17.4) | 22 (19.1) | 17 (14.8) | 5 (4.3) | 6 (5.2) |
| 10. I feel comfortable if my health information is shared among doctors and therapists for healthcare purposes. | 14 (12.2) | 28 (24.3) | 37 (32.2) | 21 (18.3) | 8 (7.0) | 3 (2.6) | 4 (3.5) |
According to Table 4, the majority of students (50.4%) strongly agreed that they should have the right to consent to any protected sharing of their health information collected through mHealth applications. Furthermore, 82.6% of students agreed or strongly agreed that they wanted assurances from developers and healthcare providers about how access to mHealth systems is restricted to authorized personnel only. In addition, a substantial proportion of students (77.4%) expressed their preference for having the capability to remotely delete all their health data from their mobile devices in cases of loss or theft.
Table 4. students' opinions about features required in mhealth applications
| Features Required in mHealth Applications | Strongly Agree | Agree | Somewhat Agree | Neutral | Somewhat Disagree | Disagree | Strongly Disagree |
| 11. I should have the right to consent to any protected sharing of my health information collected through mHealth applications. | 58 (50.4) | 33(28.7) | 14 (12.2) | 7 (6.1) | 2 (1.7) | 1 (0.9) | 0 |
| 12. I want to know how developers and healthcare providers ensure that only authorized personnel have access to the mHealth systems I use. | 56 (48.7) | 39(33.9) | 9 (7.8) | 8 (7.0) | 3 (2.6) | 0 | 0 |
| 13. Privacy policies of mHealth applications should explicitly state how privacy policies influence my decision to use the application. | 19 (16.5) | 34(29.6) | 36 (31.3) | 16(13.9) | 4 (3.5) | 3 (2.6) | 0 |
| 14. I want to have access to remotely delete all my health data from my mobile device in case it is lost or stolen. | 19 (16.5) | 34(29.6) | 36 (31.3) | 16(13.9) | 4 (3.5) | 3 (2.6) | 3 (2.6) |
Qualitative analysis: The qualitative data analysis revealed three main themes. 1) Security concerns: This theme focused on users' fears regarding data breaches, potential misuse of personal information, and the lack of transparency in the security policies of mobile health applications. Many participants expressed concerns that their sensitive information might be used without their knowledge or consent. 2) Practical challenges: This theme highlighted the difficulties users faced when utilizing mobile health applications, including complex user interfaces, weak security infrastructures, and challenges in access management. These challenges were particularly more pronounced among users with lower technical literacy, as this group had a limited understanding of how to configure and utilize the security features of these applications and required additional guidance and training. Some participants reported struggling with access control and safeguarding their personal data due to unfamiliarity with security settings. 3) Improvement suggestions: This theme encompassed suggestions aimed at enhancing security and user trust, including advanced encryption, multi-level access control, and the development of transparent privacy policies. Some participants proposed that mobile health applications should offer features enabling users to manage security settings more intuitively and, in emergency situations, remotely erase their health data.
Discussion
The present study investigated the security barriers and facilitators influencing the adoption of mobile health (mHealth) applications among allied health students. Findings based on quantitative and qualitative data analysis identified three main themes: security concerns, practical challenges, and recommendations for improvement. Results highlighted that data security and privacy remain the primary barriers to adopting these technologies. These findings, when compared to international studies, provide critical insights for the development of secure and user-friendly mHealth technologies.
Security concerns: a key priority for users: One of the key findings was the widespread concerns of participants regarding data security and privacy. Quantitative results indicated that more than 82.6% of students emphasized the importance of access control and ensuring data protection. Furthermore, 77.4% of participants expressed a desire for a remote data wipe feature in case of theft or loss of mobile devices. These findings are consistent with those of Krebs and Duncan [5], who reported that 40% of users in the United States avoided installing mHealth applications due to security concerns. Similar studies, including that of Atienza et al. [19], emphasized the relationship between users’ perceptions of data security and trust-building through transparent security policies and access controls. Research conducted by Peng et al. [20] also revealed that younger users are particularly reluctant to share sensitive information via social networks and demand greater control over their data. These findings suggest that mHealth applications must incorporate transparent security policies, advanced encryption mechanisms, and multi-level access controls to build user trust.
Practical challenges: weak infrastructure and system complexity: Qualitative analysis revealed that users, in addition to security concerns, faced practical challenges, such as complex user interfaces, weak security infrastructures, and difficulty in managing access controls. These challenges were particularly more significant among users with lower technical literacy, as this group required more guidance to effectively utilize the security features available in mobile health applications. These findings align with the study by Fadaizadeh et al. [12] which identified high costs, interface complexity, and low reliability as major barriers to mHealth adoption. Similarly, Byambasuren et al. [10] highlighted challenges such as limited access to reliable information and low user awareness, which restricted adoption rates. Moreover, Prasad et al. [21] emphasized the importance of multi-level data management and the ability to remotely delete information in emergencies. Studies by Baigi et al. [22] and Swain et al. [23] further pointed to high costs and infrastructure limitations as significant barriers to widespread adoption of mHealth technologies.
Recommendations for the improvement: enhancing security and user trust: Based on qualitative analysis, participants suggested security enhancements, including advanced encryption, multi-level access controls, and the development of transparent privacy policies. These suggestions are consistent with findings by Simblett et al. [24], who emphasized that advanced security features and access monitoring systems can boost user trust. Additionally, Aljedaani et al. [25] highlighted the importance of developing clear legal frameworks and obtaining security and ethical approvals to enhance user confidence. König et al. [6] introduced a three-level framework that emphasized the role of user motivation, infrastructure, and social interaction in mHealth adoption.
Given the proven efficacy and effectiveness of mHealth applications and the lack of clear security policies in Iran, it is recommended that policymakers develop minimum security frameworks to protect user data. Furthermore, due to
Discussion
The present study investigated the security barriers and facilitators influencing the adoption of mobile health (mHealth) applications among allied health students. Findings based on quantitative and qualitative data analysis identified three main themes: security concerns, practical challenges, and recommendations for improvement. Results highlighted that data security and privacy remain the primary barriers to adopting these technologies. These findings, when compared to international studies, provide critical insights for the development of secure and user-friendly mHealth technologies.
Security concerns: a key priority for users: One of the key findings was the widespread concerns of participants regarding data security and privacy. Quantitative results indicated that more than 82.6% of students emphasized the importance of access control and ensuring data protection. Furthermore, 77.4% of participants expressed a desire for a remote data wipe feature in case of theft or loss of mobile devices. These findings are consistent with those of Krebs and Duncan [5], who reported that 40% of users in the United States avoided installing mHealth applications due to security concerns. Similar studies, including that of Atienza et al. [19], emphasized the relationship between users’ perceptions of data security and trust-building through transparent security policies and access controls. Research conducted by Peng et al. [20] also revealed that younger users are particularly reluctant to share sensitive information via social networks and demand greater control over their data. These findings suggest that mHealth applications must incorporate transparent security policies, advanced encryption mechanisms, and multi-level access controls to build user trust.
Practical challenges: weak infrastructure and system complexity: Qualitative analysis revealed that users, in addition to security concerns, faced practical challenges, such as complex user interfaces, weak security infrastructures, and difficulty in managing access controls. These challenges were particularly more significant among users with lower technical literacy, as this group required more guidance to effectively utilize the security features available in mobile health applications. These findings align with the study by Fadaizadeh et al. [12] which identified high costs, interface complexity, and low reliability as major barriers to mHealth adoption. Similarly, Byambasuren et al. [10] highlighted challenges such as limited access to reliable information and low user awareness, which restricted adoption rates. Moreover, Prasad et al. [21] emphasized the importance of multi-level data management and the ability to remotely delete information in emergencies. Studies by Baigi et al. [22] and Swain et al. [23] further pointed to high costs and infrastructure limitations as significant barriers to widespread adoption of mHealth technologies.
Recommendations for the improvement: enhancing security and user trust: Based on qualitative analysis, participants suggested security enhancements, including advanced encryption, multi-level access controls, and the development of transparent privacy policies. These suggestions are consistent with findings by Simblett et al. [24], who emphasized that advanced security features and access monitoring systems can boost user trust. Additionally, Aljedaani et al. [25] highlighted the importance of developing clear legal frameworks and obtaining security and ethical approvals to enhance user confidence. König et al. [6] introduced a three-level framework that emphasized the role of user motivation, infrastructure, and social interaction in mHealth adoption.
Given the proven efficacy and effectiveness of mHealth applications and the lack of clear security policies in Iran, it is recommended that policymakers develop minimum security frameworks to protect user data. Furthermore, due to
the increasing availability of mHealth applications and the lack of reliable identification systems, evaluating and validating these applications before their deployment is of critical importance. Moreover, security education programs for mobile app users should be expanded to raise awareness about available security features. This will empower users to protect their data and privacy effectively [26-29].
Strengths and limitations: This study, utilizing quantitative and qualitative data, provided comprehensive insights into the security barriers and facilitators of mHealth adoption. However, the generalizability of the results may be limited due to the sample size and the focus on allied health students in one university. Additionally, data on cost-effectiveness and long-term impacts of these technologies were not explored, which should be addressed in future studies.
Conclusion and recommendations for future research: This study demonstrated that security concerns, infrastructure weaknesses, and complex user interfaces are key barriers to the adoption of mHealth technologies. However, the high willingness of users to adopt these applications, provided the improved security features, presents an opportunity for developers and policymakers. The development of secure mHealth technologies requires multi-faceted approaches. A key recommendation is the integration of advanced encryption and multi-level access controls to enhance data protection and user trust. Developing transparent privacy policies is also essential to alleviate user concerns and facilitate adoption.
Furthermore, expanding educational programs and awareness campaigns to enhance users' understanding of data protection strategies and secure usage can increase engagement, particularly among users with limited technical expertise. Given the financial concerns highlighted in this and prior studies, cost-effectiveness evaluations of these applications and the development of scalable deployment models should be prioritized. Finally, designing longitudinal studies to assess the impact of security features and technical capabilities on user behavior and adoption rates can provide deeper insights into barriers and facilitators. Such research can inform the development of robust frameworks for mHealth technologies, ultimately improving the quality of healthcare delivery.
Declerations
Ethical considerations: This study is derived from an approved research project at Mashhad University of Medical Sciences (Ethics Code: IR.MUMS.FHMPM.REC.1401.086).
Funding: This study was financially supported by Mashhad University of Medical Sciences (Project Code: 4002080). The funder had no role in data collection, analysis and manuscript preparation.
Conflict of interest: The authors declared no conflict of interest.
Authors' contributions: MS: Conceptualization and study design, data collection, methodology, data analysis, writing – draft preparation, final approval; SFMB: Data collection, validation, data management, writing – review and editing, visualization, final approval; ZS: Data collection, final approval; RNA: Data collection, final approval; KK (corresponding author): Conceptualization and study design, methodology, study supervision, project administration, funding acquisition, resources, final approval; ME: Data collection, final approval.
Consent for publication: Not applicable.
Data availability: The data can be requested from corresponding author based on a reseanable request.
AI decleration: The English parts of the manuscript was edited using the ChatGPT (developed by OpenAI). All AI-assisted revisions were thoroughly reviewed and approved by the authors to ensure accuracy and appropriateness.
Acknowledgments: We would like to extend our sincere gratitude to all students who participated in this study for their valuable contributions. We also deeply appreciate the Student Research Committee at Mashhad University of Medical Sciences for their scientific and academic support throughout the research process.
Strengths and limitations: This study, utilizing quantitative and qualitative data, provided comprehensive insights into the security barriers and facilitators of mHealth adoption. However, the generalizability of the results may be limited due to the sample size and the focus on allied health students in one university. Additionally, data on cost-effectiveness and long-term impacts of these technologies were not explored, which should be addressed in future studies.
Conclusion and recommendations for future research: This study demonstrated that security concerns, infrastructure weaknesses, and complex user interfaces are key barriers to the adoption of mHealth technologies. However, the high willingness of users to adopt these applications, provided the improved security features, presents an opportunity for developers and policymakers. The development of secure mHealth technologies requires multi-faceted approaches. A key recommendation is the integration of advanced encryption and multi-level access controls to enhance data protection and user trust. Developing transparent privacy policies is also essential to alleviate user concerns and facilitate adoption.
Furthermore, expanding educational programs and awareness campaigns to enhance users' understanding of data protection strategies and secure usage can increase engagement, particularly among users with limited technical expertise. Given the financial concerns highlighted in this and prior studies, cost-effectiveness evaluations of these applications and the development of scalable deployment models should be prioritized. Finally, designing longitudinal studies to assess the impact of security features and technical capabilities on user behavior and adoption rates can provide deeper insights into barriers and facilitators. Such research can inform the development of robust frameworks for mHealth technologies, ultimately improving the quality of healthcare delivery.
Declerations
Ethical considerations: This study is derived from an approved research project at Mashhad University of Medical Sciences (Ethics Code: IR.MUMS.FHMPM.REC.1401.086).
Funding: This study was financially supported by Mashhad University of Medical Sciences (Project Code: 4002080). The funder had no role in data collection, analysis and manuscript preparation.
Conflict of interest: The authors declared no conflict of interest.
Authors' contributions: MS: Conceptualization and study design, data collection, methodology, data analysis, writing – draft preparation, final approval; SFMB: Data collection, validation, data management, writing – review and editing, visualization, final approval; ZS: Data collection, final approval; RNA: Data collection, final approval; KK (corresponding author): Conceptualization and study design, methodology, study supervision, project administration, funding acquisition, resources, final approval; ME: Data collection, final approval.
Consent for publication: Not applicable.
Data availability: The data can be requested from corresponding author based on a reseanable request.
AI decleration: The English parts of the manuscript was edited using the ChatGPT (developed by OpenAI). All AI-assisted revisions were thoroughly reviewed and approved by the authors to ensure accuracy and appropriateness.
Acknowledgments: We would like to extend our sincere gratitude to all students who participated in this study for their valuable contributions. We also deeply appreciate the Student Research Committee at Mashhad University of Medical Sciences for their scientific and academic support throughout the research process.
Type of Study: Research |
Subject:
Health Information Management
Received: 2024/05/24 | Accepted: 2024/09/20 | Published: 2024/12/21
Received: 2024/05/24 | Accepted: 2024/09/20 | Published: 2024/12/21
References
1. Saigí-Rubió F, Borges do Nascimento IJ. The current status of telemedicine technology yse across the WHO European region. Journal of Medical Internet Research. 2022;24(10):e40877. [DOI:10.2196/40877]
2. Sheikhtaheri A, Hashemi N, Hashemi NA. Benefits of using mobile technologies in education from the viewpoints of medical and nursing students. Studies in Health Technology and Informatics. 2018;251:289-292. [DOI:10.3233/978-1-61499-880-8-289]
3. Nemati-Anaraki L, Mousavi S S, AliBeyk M, Mahami-Oskouei M. Medical students knowledge and use of smartphone-based applications. Journal of Health Administration. 2022; 24 (4):84-94.[In Persian]. [DOI:10.52547/jha.24.4.84]
4. Sheikhtaheri A, Kermani F. Use of mobile apps among medical and nursing students in Iran. Studies in Health Technology and Informatics. 2018;248:33-39. [DOI:10.3233/978-1-61499-858-7-33]
5. Krebs P, Duncan DT. Health app use among US mobile phone owners: a national survey. JMIR Mhealth Uhealth. 2015;3(4):e101. [DOI:10.2196/mhealth.4924]
6. König L, Sproesser G, Schupp HT, Renner B. Describing the process of adopting nutrition and fitness apps: Behavior stages and determinants. JMIR Mhealth Uhealth. 2021;9(5):e22513. [DOI:10.2196/mhealth.8261]
7. Sun L, Yang B, Kindt E, Chu J. Privacy barriers in health monitoring: scoping review. Journal of Medical Internet Research Nursing. 2024;2(1):e53592. [DOI:10.2196/53592]
8. Mbunge E, Sibiya MN. Mobile health interventions for improving maternal and child health outcomes in south Africa: a systematic review. Global Health Journal. 2024;9(1):e41. [DOI:10.1016/j.glohj.2024.08.002]
9. Sheikhtaheri A, Taheri Moghadam S. Challenges and facilitators of using smartphones in educational activities: medical and nursing students' perspective. Studies in Health Technology and Informatics. 2022;293:234-241. [DOI:10.3233/SHTI220375]
10. Byambasuren O, Sanders S, Beller E, Glasziou P. Prescribable mHealth apps identified from an overview of systematic reviews. NPJ Digital Medicine. 2018;1:12. [DOI:10.1038/s41746-018-0021-9]
11. Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for smartphone applications in supporting health behavior change: qualitative study. Journal of Medical Internet Research. 2013;15(4):e86. [DOI:10.2196/jmir.2583]
12. Fadaizadeh L, Sanaat M, Yousefi E, Alizadeh N. Mobile health: a comparative study of medical and health applications in Iran. Biomedical and Biotechnology Research Journal (BBRJ). 2022;6(2):249-54. [DOI:10.4103/bbrj.bbrj_31_22]
13. Sun L, Yang B, Kindt E, Chu J. Privacy barriers in health monitoring: scoping review. Journal of Medical Internet Research Nursing. 2024;2(1):e53592.
https://doi.org/10.2196/53592 [DOI:10.2196/53592.]
14. Rachayu I, Riyanto Y, Dewi U, Maiziani F, Ramazan R, Perwitasari S, Wulandari R. Implementation security and privacy in the era of industry 4.0 to protect digital attacks on health profession students: SOAR analysis. Journal of Posthumanism. 2025;5(2):487-501. [DOI:10.63332/joph.v5i2.434]
15. Alipour J, Mehdipour Y, Zakerabasali S, Karimi A. Nurses' perspectives on using mobile health applications in southeastern Iran: Awareness, attitude, and obstacles. PloS One. 2025;20(3):e0316631. [DOI:10.1371/journal.pone.0316631]
16. Ghaddaripouri K, Mousavi Baigi SF, Abbaszadeh A, Mazaheri Habibi MR. Attitude, awareness, and knowledge of telemedicine among medical students: a systematic review of cross-sectional studies. Health Science Reports. 2023;6(3):e1156. [DOI:10.1002/hsr2.1156]
17. Zhou L, Bao J, Watzlaf V, Parmanto B. Barriers to and facilitators of the use of mobile health apps from a security perspective: mixed-methods study. JMIR mHealth and uHealth. 2019 Apr 16;7(4):e11223. [DOI:10.2196/11223]
18. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.
https://doi.org/10.1191/1478088706qp063oa [DOI:10.1191/1478088706qp063oa.]
19. Atienza AA, Zarcadoolas C, Vaughon W, Hughes P, Patel V, Chou WY, Pritts J. Consumer attitudes and perceptions on mHealth privacy and security: findings from a mixed-methods study. Journal of Health Communication. 2015;20(6):673-9. [DOI:10.1080/10810730.2015.1018560]
20. Peng W, Kanthawala S, Yuan S, Hussain SA. A qualitative study of user perceptions of mobile health apps. BMC Public Health. 2016;16:1-1. [DOI:10.1186/s12889-016-3808-0]
21. Prasad A, Sorber J, Stablein T, Anthony D, Kotz D. Understanding sharing preferences and behavior for mHealth devices. In Proceedings of the 2012 ACM workshop on Privacy in the electronic society 2012 Oct 15 (pp. 117-128). [DOI:10.1145/2381966.2381983]
22. Mousavi Baigi SF, Mousavi AS, Kimiafar K, Sarbaz M. Evaluating the cost effectiveness of tele-rehabilitation: a systematic review of randomized clinical trials. Frontiers in Health Informatics. 2022;11. [DOI:10.30699/fhi.v11i1.368]
23. Swain S, Muduli K, Kumar A, Luthra S. Analysis of barriers of mHealth adoption in the context of sustainable operational practices in health care supply chains. International Journal of Industrial Engineering and Operations Management. 2024;6(2):85-116. [DOI:10.1108/IJIEOM-12-2022-0067]
24. Simblett S, Greer B, Matcham F, Curtis H, Polhemus A, Ferrão J, Gamble P, Wykes T. Barriers to and facilitators of engagement with remote measurement technology for managing health: systematic review and content analysis of findings. Journal of Medical Internet Research. 2018;20(7):e10480. [DOI:10.2196/10480]
25. Aljedaani B, Ahmad A, Zahedi M, Ali Babar M. Security awareness of end-users of mobile health applications: an empirical study. InMobiQuitous 2020-17th EAI International Conference on Mobile and Ubiquitous Systems: Computing, Networking and Services 2020 Dec 7 (pp. 125-136). Available form: https://arxiv.org/abs/2008.13009 [DOI:10.1145/3448891.3448952]
26. Breitinger F, Tully-Doyle R, Hassenfeldt C. A survey on smartphone user's security choices, awareness and education. Computers & Security. 2020;88:101647. [DOI:10.1016/j.cose.2019.101647]
27. Aval RN, Baigi SF, Sarbaz M, Kimiafar K. Security, privacy, and confidentiality in electronic prescribing systems: A review study. Frontiers in Health Informatics. 2022;11(1):115. [DOI:10.30699/fhi.v11i1.374]
28. Nasiri S, Sadoughi F, Tadayon M H, Dehnad A. Security and privacy mechanisms of internet of things in healthcare and non-healthcare industry. Journal of Health Administration. 2019; 22 (4):86-105 [In Persian]. Available form: http://jha.iums.ac.ir/article-1-3233-en.html
29. Rezaee R, Khashayar M, Saeedinezhad S, Nasiri M, Zare S. Critical criteria and countermeasures for mobile health developers to ensure mobile health privacy and security: mixed methods study. JMIR mHealth and uHealth. 2023;11:e39055. [DOI:10.2196/39055]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
