# Usability and Cultural Relevance of an mHealth App for Hispanic/Latino Individuals Living With Rheumatoid Arthritis: Protocol for a Mixed Methods Study

## TL;DR

This study evaluates a Spanish-language mHealth app for Hispanic/Latino individuals with rheumatoid arthritis to improve health communication and outcomes.

## Contribution

This is the first study to assess cultural relevance and usability of an mHealth app for Spanish-speaking Hispanic/Latino RA patients.

## Key findings

- The study will evaluate health literacy and digital self-efficacy in Hispanic/Latino RA patients.
- Findings will guide culturally relevant modifications to the RunRA app.
- Results will inform the development of DHIs for underserved populations.

## Abstract

Hispanic and Latino individuals represent 14.6% of rheumatoid arthritis (RA) cases in the United States and experience significant disparities in access to rheumatologic care, disease management, and health outcomes. Mobile health (mHealth) apps are promising tools to improve patient-provider communication and self-management among populations with language and literacy barriers. However, few RA-focused digital health interventions (DHIs) have been culturally adapted for Spanish-speaking Hispanic and Latino individuals.

This study aims to assess the health literacy, eHealth literacy, technology trust, and digital self-efficacy of Hispanic and Latino individuals with RA, and to evaluate the cultural relevance, usability, and patient satisfaction of the Spanish-language RunRA app. Additionally, it will explore health care providers’ perceptions of the app’s usefulness for clinical decision-making and communication with Hispanic and Latino patients.

A prospective, iterative convergent mixed methods design integrated with the Framework for Reporting Adaptations and Modifications–Expanded (FRAME) will be used. We will recruit 25 Hispanic and Latino patients with RA and 7 Spanish-speaking health care professionals. Quantitative data will include standardized questionnaires (SAHL-S, eHEALS, Human-Computer Trust Scale, Digital Self-Efficacy Scale) and app analytics. Qualitative data will be collected via interviews and focus groups using the Cultural Relevance Questionnaire (CRQ), System Usability Scale (SUS), and Mobile Application Rating Scale (uMARS). Data will be analyzed using an independent intramethod strategy, with integration guided by FRAME to inform culturally relevant app modifications.

We anticipate enrolling 32 participants (25 patients and 7 providers). This study will be the first to evaluate the cultural relevance and usability of an mHealth app specifically designed for Spanish-speaking Hispanic and Latino individuals living with RA.

Our long-term goal is to assess the potential for the mHealth app to act as a vehicle for the dissemination of accurate, useful, usable, and understandable health information to populations that experience health disparities and their health care providers. Findings will inform iterative refinements to RunRA and contribute to the development of culturally responsive DHIs aimed at improving communication, shared decision-making, and health outcomes in underserved populations.