1.0 Chapter Overview
This study has been conducted at Sunway University, Kuala Lumpur in Malaysia to understand young users’ experiences of mobile health apps. Participants who involved in this research were mostly university students in Sunway University. Through the qualitative research method, consist of inductive analysis and several data collection method such as purposeful sampling method, snowball sampling method and semi-structured interview with young participants (university students), a theoretical framework of young users’ experiences of using mobile health apps was developed. This chapter consists of the background of the study, problem statement, purpose of the study, research questions, research objectives, significance of the study and scope of the study.
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1.1 Background of the Study
According to Anderson and Rainie (2015) stated that mobile technology increases rapidly because of high demands adopting smartphones and most of the people that have adopted smartphones in Malaysia is younger generation. Besides, younger generation have started to concern about their own health and therefore this comes thousands of new mobile health apps being created every month because of a high demand among young market towards mobile health apps (Lenhart, 2015). However, mobile health apps have divided into many different types of categories that are health and fitness for managing lifestyle, medical apps for general practitioner and patient-focused app for self-monitoring disease (Buolos et al. 2014).
Younger generation in this digital era have preferred to use mobile health apps instead of traditional method to manage their own health because mobile health apps allow young users to communicate with people, customize platform to assists young users to change its health behaviours with least visits with health professionals (Tang, 2015). Since smartphones are carried by young users every single time in a day thus young users are allowed to combine monitoring apps that are health related into their daily routines (Lenhart, 2015). As mobile health apps are well known in young demographic groups, thus this means that young users might also encounter obstacles that inhibited the changing of health behaviours such as limited time, social influence, motivation as well as self-care (O’Dea, 2003) therefore fill up the gaps in dealing with challenges or varieties (Krebs et al. 2007). Applications are able to face different health areas which involves exercise and several styles of changing health behaviours across motivation and also theories (Dute, Bemelmans ; Breda). Hence, young users can search for a specific apps that can satisfy their health requirements and use it which in turn resulted of examining young users’ experience of using mobile health apps in this research as app developers can improve the design of apps in the future and also can improve the effectiveness of the content quality that can approve by young users which would also be leading to continuous use of mobile health apps in long-term by young users (Azar et al., 2013).
In this study, the experiences of young users using mobile health apps will be discussed. Cowan (2013) explored that improving health behaviours is one of the factors that motivates young users to continue use mobile health apps. Therefore, the researcher aimed to investigate other factors that also motivates young users of using mobile health apps as well as the challenges of young users faced while using mobile health apps as it will affect their usage rate in long-term (Dennison et al. 2013).
1.2 Research problem
Lubans et al (2014) stated that there are many research studies have been investigated on the mobile health apps but there is a research gap to understand how mobile technology has affects the young users. Most of the research studies have focused on adults only (Payne et al. 2015) which this has showed that it is not related to younger demographics group who might also have different usage patterns and experiences of mobile technology (Lenhart, 2015). Furthermore, studies have shown that it has concentrated more on effectiveness under the standard conditions instead of effectiveness in the reality world (Wieland et al. 2012) and might expect too much of young users’ intentions to use mobile health apps (Hermawati et al. 2014). However, some studies have illustrated that young users have low usage intentions and not attracted to use mobile health apps anymore after they have a bad experience of using it (Payne at al. 2015). 20 percent of studies have investigated that the poor usage rate of young users using mobile health apps is mostly because of the poor information quality and design of the apps (Zahry, Cheng ; Peng, 2014). Further research studies have tried to understand young users’ experiences of mobile health apps and it is vital to highlight the motivation factors and challenges that will affect their long-term usage (Dute, Bemelmans & Breda, 2016).
1.3 Research Objective
The purpose of this research study is to understand the young users’ experiences using mobile health apps in Malaysia. This research is to investigate young users’ perceptions of using mobile health apps and the factors that motivates young users to use health-related apps frequently. However, to limit the target market thus, this research will be concentrating in Malaysia context only hence, participants that will be selected will be in the area of Sunway University in Kuala Lumpur.
The purpose of conducting this research is because there are limited studies that investigate the understanding of young users’ experiences of using mobile health apps in Malaysia thus Athtinen et al. (2009) stated that perceptions and challenges are the most important factors because when young users have good perceptions of using mobile health apps, it will then motivates young users to continue use mobile health apps but if young users face challenges, it will be demotivating for them to use mobile health apps in the long term.
1.4 Research Questions
1. What is the results on young users’ using mobile health apps?
2. To understand young users’ perceptions of using mobile health apps.
3. To understand the factors that motivate young users using mobile health apps frequently.
4. To understand the challenges of young users using mobile health apps.
1.5 Significance of the study
The purpose of this research is to understand young users’ experiences using mobile health apps but however, there are limited information that have been obtained in this study therefore, this research will be designed as qualitative as the researcher will have a deeper understanding of young users’ experiences, perceptions and challenges of using mobile health apps (Creswell, 2009). However, using qualitative method to conduct this study is because everybody have different views and thoughts and thus there will be no right or wrong answers especially related to one’s experiences thus, it is appropriate to use qualitative method in this research as participants can share more of their own perceptions of experiencing mobile health apps and that the researcher can gain more knowledge and information in this study (Ratner, 2002). This has also resulted that the researcher can understand categorized the motivation factors and challenges of using mobile health apps in Malaysia.
Semi-structured interview will be use in this research as it is a platform for young participants to give their opinions and perceptions when experiencing mobile health apps according to the interview questions (Madill, 2011). Therefore, it will give information to help the understanding of the researcher (Silverman, 2014). Researcher will follow each and every process of data analysis so that the outcome of the data is reliable in this qualitative research study (Thorne, n.d). Nevertheless, the significant of this research is relevant to young users’ experience using mobile health apps in Malaysia which the app developer can understand the major factors that motivate young users’ using mobile health apps frequently and also to discover the challenges that faced by young users’ while using mobile health apps and hence, app developer will better improve on its quality and design process of mobile health apps as to prolong the usage of young users using mobile health apps (Rabin ; Bock, 2011).
1.6 Scope of the research study
In this digital era, the usage rate of mobile technology is increasing tremendously because of high demands of adopting smartphones and hence stimulating an increased production of applications (apps) which including mobile health apps (Anderson ; Rainie, 2015). According to statistics, most of the people that adopt smartphones are younger demographic category, with total of 72 percent of adolescents and young adults in Malaysia aged ranges around thirteen to thirty five own smartphones (Lenhart, 2015) and due to high awareness of mobile health apps among younger demographic groups, thus most of them have downloaded mobile health apps (Madden et al. 2013) However, young users are aware of mobile health apps is because there are over 98,000 mobile health apps that are available in the Google Play Store and App Store and also thousands of new mobile health apps are being introduced every month in the market as well (Becker et al. 2014). Mobile health apps have divided into many different types of categories that are health and fitness for managing lifestyle, medical apps for general practitioner and patient-focused app for self-monitoring disease (Buolos et al. 2014). Studies have shown that fitness apps are the most popular downloaded apps by young users regardless that they are male or female, as studies have shown that male users always go to gym for managing their health whereas female always go on diet and some even go to the gym as they want to look more attractive and to be more healthier (Leyk et al. 2012). Therefore, when fitness apps are available in the app store, it will automatically attracted young users to download it as they perceived that fitness apps can self-monitored their weight which can be considered as a convenient tool since many young users often carry their smartphones around (Leyk et al. 2012). Therefore, young users will be the focal point in this research study as there are a high adoption rate of mobile health apps among young Malaysian market. Hence, it is correct to target young users in the scope of this research study.
Chapter 2 :Literature Review
2.1 Chapter Overview
There are two main parts are involved in this chapter which are overview of mobile health apps in Malaysia context and the theoretical context.
Overview of mobile health apps in Malaysia context has two sub-sections which are definition of mobile health apps and the usage rate of all smartphone users using mobile health apps in Malaysia.
The theoretical context part deliberates theory of planned behaviour and the theory of reasoned action, the values theory and social learning theory, specifically in using mobile health apps. Theory of planned behaviour and theory of reasoned action has one sub-section which is mobile technology options in terms of psychological factors of mobile technology options; social factors of mobile technology options; physical factors of mobile technology options; and economic factors of mobile technology options.
The values theory has one sub-section which is the factors that motivate young users to use mobile health apps frequently in terms of valuable information sources; accomplishing fitness goals and improving health behaviours; management of a medical condition and improving health behaviours; and social influence and social competition.
Furthermore social learning theory has one sub-section which is the challenges that young users faced when using mobile health apps in terms of privacy and security concerns; information quality issues; apps are not updated; and unreliable health information.
2.2 Overview of mobile health apps in Malaysia context
2.2.1 Definition of mobile health
In a broader term, mobile health involves the utilization of smartphone devices and combined with multimedia technologies to deliver portable and wireless healthcare systems (Nacinovich, 2013). Therefore, it can be said that the integration of both mobile communication and multimedia technologies are used to delivery health care service (Mechael, 2009). According to Robert Istepanian (2004) has stated that the term mobile health is being utilized for the developing mobile communications and technologies for healthcare. Based on the National Institutes of Health (2010) has defined mobile health as serving healthcare services through smartphone devices.
According to Akter and Ray (2010) has acknowledged that there are differences between mobile health and e-Health are that, mobile health is required to utilize smartphone devices to access data on diseases’ rates whereas eHealth is a system which function as store, manage and data access. This means that eHealth is the foundation of mobile health (Varshey, 2005). To be more precise, eHealth is defined as technology which is to assists the purpose and provide healthcare services (Oh et al. 2005) but mobile health mainly focus on helping user to access healthcare. However, the definition of mobile health can be view as portable technology which serve the purpose of delivering healthcare services and could reach a wide range of regions, people and even healthcare professionals that previously have limited exposure to specific parts of healthcare (Fiordelli et al. 2013).
2.2.2 The usage rate of all smartphone users using mobile health apps in Malaysia
mHealth apps can be downloaded in smartphones through Google Play Store or App Store which it can be defined as software applications (Longwill, 2012). There are many different types of categories of mobile applications that operate in the smartphones and tablets such as education, entertainment, health, finance, medical and more which most of these apps can be installed in seconds except for entertainment apps as they consume more data thus it will take a longer time to download (Randolph, 2013). However, according to Caroll et.al (2017) has reported that 40 percent of young users have downloaded mobile health apps to gain health knowledge whereas there are 50 percent of smartphone users installed fitness applications to maintain good health. therefore this shows that they knew the importance of having good health because according to Augusten Burroughs has stated that ” when one has good health, one has everything but if one do not care about one’s own health, nothing else matters at all”. Generally, there are two groups of young users have installed mobile health apps which is one is to maintain their weight or to lose weight (Wieland, 2012) and another group of young users aim to gain health knowledge as to prevent any health threats and monitor their health status (Deci & Ryan, 1985). However these two groups of young users share the similar goals which is to achieve good status of health. Young users that are focus more into fitness and nutrition will download similar fitness apps such as myFitnessPal, Weight Loss Fitness, Nike+ Run Club and more which these apps will provide healthcare articles for instance “The false nutrition myths you’re probably still believing” and also providing nutritional information which includes counting calories and organic food recipe as well as offering training programs for specific body parts (Hermawati & Lawson, 2014). Another young users’ group that download mobile health apps are normally having a stronger medical focus for example, medical students that tends to gain more knowledge about diseases (Franko ; Tirrell, 2012) and non-medical students will intend to find out early symptoms of diseases so that they could prevent it and learn about first aid (Gill et al. 2012).
However, there are also a few medical apps that can be downloaded which are to track blood pressure, blood glucose level(Miller et al. 2013) and pregnancy but these mobile health apps are not popular in younger groups as they are targeted for older adults who are above 45 as their health will deteriorate as they aged (Kruse et al. 2016). So, these mobile health apps are to encourage older users to track and manage their health daily and to improve their convenience as older users would not need to go for body check every week which this will make them to have more time to enjoy themselves (Klasnja ; Pratt, 2012). According to Kruse, Mileski and Moreno (2016) has reported that there are moderate amounts of older adults in Malaysia that use mobile health apps to manage their health daily. Apart from that, there are other medical-related health applications that are designed specifically for health care professionals, for example mobile-based ultrasound apps allows practitioners to see images and X-rays which there are also 38 percent of Malaysian practitioners use medical health apps for their convenience (Pew Research Center, 2015). Hence, this has conclude that mobile health apps is quite popular in the young Malaysian market as they occupied the highest percentage of using mobile health apps but in overall, mobile health apps can also be considered as a trend as other users such as older adults and healthcare practitioners use it as well.
2.3 Theoretical Context
2.3.1 Theory of planned behaviour (TPB)
The theory of planned behaviour is mainly use to understand the mobile technology options and health behaviours (Herrmann ; Kim, 2017). Basically, this is a theory to explain human behaviours and connected with related investigations between attitude, subjective norms, perceived behavioural control and behavioural intentions such as healthcare, food choice and more (Ajzen, 1991). The theory demonstrates that the combination of attitude, subjective norms and perceived behavioural control has contributed to one’s intention to involve in the practices.
TPB has commonly been related with the scope of health behaviours and technology choices. Technology choices can be defined as user can choose whether to use mobile websites or mobile apps as they both deliver health information (Lai, 2017). However, this theory also can be used to apply in exercise behaviour with fitness apps which it can be considered as one of the mobile health apps (Rhodes, Jones & Courneya, 2003). TPB model can refer to figure 1 below.
Figure 1: Use of Theory of Planned Behaviour model in mobile health apps
Additionally, the theory of reasoned action is the older version of TPB model which it can also be connected to understand individual’s behaviour towards the use of mobile technology (Ghazizadeh, 2012). Therefore, it is intended to investigate the reason why people rather choose to download mobile health apps compared to using mobile website to search health information.
220.127.116.11 Mobile technology options
There are two options of mobile technology for smartphone users to choose that can gain access to health information which are by mobile health apps or by mobile website (Herrmann ; Kim, 2017). There are a few factors that influence the decision-making of smartphone users which are psychological, social, physical and economic (Lai, 2017). However, this shows that it is important of an individual’s perception of how one views mobile health apps and mobile website for health information. Hence, this comes to the importance of product marketing as it will affects an individual’s intention and attitudes. For example, one perceived that mobile website has more wide ranges of reliable health information to gain access to compared to mobile health apps, which this will affect the intention of one not to download mobile health apps (Hermann ; Kim, 2017).
18.104.22.168 Psychological factors of mobile technology options
• Privacy and security concerns
According to Snell (2018) has reported that cybercriminal activity is one of the largest issues that people will be facing in the next two years therefore, smartphone user will naturally have that perception of mobile web is unsafe. As no one would like any third party to know about what they search for especially health conditions so, smartphone user will mostly prefer to download mobile health apps to search for health information (Xu ; Liu, 2015). Although, mobile website could help user to search wide ranges of information including health but smartphone users have that perception of unsafe (Sarwar ; Soomro, 2013) therefore has influence them to choose mobile health apps.
• Information sources
When comes to health information, people will have that perception of mobile web consists the most reliable information sources as researchers and journal articles can be found through mobile web to support certain aspects of health information which this makes the information sources to be more reliable (National Institutes of Health, 2011). Besides, mobile web can search for many different kinds of health information such as calorie intake, organic food recipe, weight loss program, early symptoms of certain diseases through difference types of website (Germanakos et al. 2005). However, studies have shown that some young users will perceive that mobile health apps provide relevant and reliable information sources as a specific app have concentrated relevant and reliable information to target niche market segment such as MyFitnessPal will provide every information about calorie intakes (Stoyanov et al. 2015).
22.214.171.124 Social factors of mobile technology options
• Peer pressure
Peer pressure can be considered as a direct influence on people by peers or efforts that motivate an individual to follow one another’s behaviour (Carvo-Armengol & Jackson). However, studies have shown that mobile health apps is a trend among young market therefore, this will cause other young users to use mobile health apps as well so to indirectly tell other people that they are updated as well (Zhao, Freeman & Li, 2016). This will helps them to maintain good image in front of others.
126.96.36.199 Physical factors of mobile technology options
Studies have shown that using mobile health apps will tends to cause more stress to smartphone users because of its frequent notifications that will pop out to remind smartphone users to work out daily or eat healthily (Cummings, Borycki & Roehrer). However, mobile health apps are originally designed to provide good intentions which is to motivate users to move forward to their health goals (Higgins, 2016) but sometimes people may not perceive it in that way (Peng et al. 2016) such as there are times when notifications generated by fitness apps to remind users to work out daily but then smartphone users are busy doing their personal things or busy in working which caused them to have no time to exercise daily, therefore the notification that generated will induce more stress to users as they will feel guilty not able to move forwards to their fitness goals, and that caused them not to use mobile health apps anymore (Bateman et al. 2017). Consequently, this will result smartphone users to prefer to use mobile web to search for their own preferences’ health information as they will not have randomly pop-out notifications to remind them to follow healthy behaviours such as exercising and others (Morrison et al. 2017).
According to Arean, Hoaly and Andersson (2016) stated that mobile technology can change users’ mood which has a direct influence over mobile technology choices. Research has shown that mobile health apps are able to track an individual’s progress which this will motivate them to use it frequently and when they are being told by mobile health apps that they are close with their own goals, they will feel more happy which resulted them to continue to use it in the future (Sedrati et al.2016). As for mobile web, smartphone user could not track an individual’s progress which user could be feeling lost and devastated whether that they are moving forward to their goals or not (Deshdeep, 2015). Hence, this showed that when smartphone users are satisfy with using certain mobile technology, it will affect their attitude towards technology and motivation to use the mobile technology (Kim, Kim &Wachter, 2013).
188.8.131.52 Economic and physical factors of mobile technology options
Price will be a factor that will influence users to use mobile health apps or mobile websites. Because some mobile health apps need to pay before it can be downloaded and most of the smartphone users perceived that paid apps have more reliable information than those that are free (Yasini & Marchand, 2015), therefore an individual’s income will be taken in place as a personal factor (Sama et al. 2014). This has resulted that middle to upper class user will be more likely to download paid-apps as they have extra money to spare (Dogtiev, 2018) whereas other smartphone users will prefer to use mobile web to search for health information as it is free.
Accessibility to health information is another factor that will influence smartphone users to use whether mobile health apps or mobile websites (Wallace et al. 2012) However, mobile websites required smartphone users to connect to the internet then only can search for health information whereas some downloaded mobile health apps do not need smartphone users to connect to the internet which also can gain access to health information and tracking progress which this will lead users to feel that it is more convenient for them (Ventola, 2014) and hence affect them to use mobile health apps (Mosa et al. 2012).
2.4 The Theory of Values
The theory of values can be also related to better understand the experience of using mobile health apps, for example, users could tell whether or not the quality and features that provided by mobile health apps are useful when they are being questioned about the content quality and ease of use issues (Payne et al. 2015).These positive reviews such as interesting, beneficial, convenient are important factors that need to be taken in the consideration in the process of creating mobile health apps (Stephan et al. 2017). The purpose of this research study is to understand the motivation factors of an individual of using mobile health apps such as valuable information sources (Mendiola, Kalnicki ; Lindenaur), accomplishing fitness goals and improve health behaviours(Rosner, 2015), management health condition and improve health behaviours (Ernsting et al. 2017) and social influence and social competition (Eikey ; Poole, n.d). However, results have shown that young users that are found to have positive perceptions towards mobile health apps through experiencing mobile health apps will intend to use it frequently which this would improve one’s health behaviour (Peng et al. 2016).
2.4.1 Factors that motivates young users to use mobile health apps frequently
184.108.40.206 Valuable information sources
Smartphones have provided thousands of available mobile health apps that can be downloaded through Google Play Store or App Store (Longwill, 2012) and these apps provided relevant and valuable information sources to young users which has encouraged them to adopt healthy behaviours (Alnsour et al. 2017). Besides, mobile health apps have provided information and advice to young users which they can accessed it “on the go” which this has motivated them to use it continuously, for example video or audio of a fitness instructor providing guidance on an exercise in a fitness app (Dennison et al. 2013). Furthermore, mobile health app developer have hired nutritionist and researcher to help in their mobile health apps so that the information sources can be more reliable and would help young users to move forwards to their set goals. Besides, mobile health apps has provided relevant information to young users as some was designed to target niche market segment (Stoyanov et al. 2015).
220.127.116.11 Accomplishing fitness goal and improve health behaviours
Since most of the downloaded apps are in the category of fitness thus these apps will drive young users to accomplish their fitness goals (Middelweerd et al. 2014) and also helps to improve their health behaviours (Glanz et al. 2008). For example, young users that are interested in fitness will use fitness apps as it allows young users to record a photo diary of daily food and beverage, thus they could track their calories intake and to control its body weight (Yang et al. 2015). For example, MyFitnessPal app allow users to know how much calories should they take per day in order to lose weight or to maintain weight. Hence young users have successfully managed their own weight without spending time to seek for nutritionists’ advices in hospital. Besides, mobile health apps also shared young users’ fitness data on social media which this would motivate young users to pursue their set goals by using fitness apps frequently (Locke & Latham, 1990). For example, as young users uses running apps to record their distance and posted on Facebook, young users would be motivated to run more in the following days because of their egos as users wants to show to the public that they can successfully achieve their desired goal and it may give people a perception that they are determined-type of people that will be successful in life. These has resulted that mobile health apps allow young users to accomplish fitness goals and to change their health behaviours in a better way (Cowan et al. 2013).
18.104.22.168 Management of a medical condition and improve health behaviours
There are a few mobile health applications that have been described that integrate with mobile devices and apps to increase efficiency and young users are able to self-diagnosis and self-monitored especially when young users are in emergency situations (Kamel, 2012). When time is of the essence, mobile health apps can increase efficiency and accessibility to critical specialist care in real time, for example, skin disease, COPD and more. Some unfortunate young users that living with skin disease have used mobile health apps for self-diagnosis without a medical visit as smartphone has camera features which allows young users to take pictures of their skin lesions and send those to the board certified dermatologist’s computer for analysis, therefore dermatologist would give them advice through the apps (Johnston et al. 2013). mHealth apps have also provided convenient tools to help young users to monitor, track, and review attempts to change or improve a health behaviour such as if young user has obesity problems which lead he or her to have high blood glucose level, therefore, young user can download fitness apps to track its weight and to lose weight in order to have a healthy life (Hermawati ; Lawson). Besides, there are other medical-related health apps that is for reporting symptoms (Palmier-Claus et al. 2012) and track users’ records for example, some young users have affected with chronic obstructive pulmonary disease (COPD) which caused their life to be threaten at such a young age. Therefore, for young users’ convenience, mobile health apps allows them to self-monitored its symptoms and if mobile app suspected irregular breathing it will then alert the young user with COPD and he or she will promote their lifestyle behaviour change by doing more endurance exercise as to train its stamina in order to treat shortness of breath (Johnston et al. 2013).
22.214.171.124 Social influence and social competition
Studies have shown that young users get influence easily to use mobile health apps by their peers especially when they saw their friends are using it frequently which caused them to develop curiosity and will then adopt mobile health apps (Kwon et al. 2016). When young users have started to adopt mobile health apps, their health behaviours will started to change because they will have more knowledge about health (Bandura, 1977) and when their health knowledge increases, this is when young users started to adopt healthy lifestyle and research has shown that adopting healthy lifestyle would make young user to feel happy which this has resulted young users to continue to use mobile health apps (Cialdini ; Trost, 1998). Besides, celebrity endorsement also plays a role of motivating young users to use mobile health apps frequently (Chan et al. 2017). For example, when a famous celebrity creates positive reviews on social media about the benefits of using mobile health apps, young users would then be motivated to follow the trend of using mobile health apps frequently as well because they want the same positive effects that celebrity had been through using mobile health apps. Social media sites such as Facebook, Twitter and Instagram are platforms that motivates young users to use mobile health apps frequently (Laranjo et al. 2014). Because social media is a platform for individual to show off their achievements which in turn producing healthy competition among peers (Wicks et al. 2010). For example, young user A and young user B have both downloaded fitness apps and young user A has finally achieved his goals and shared his achievement on to social media which this has motivated young user B to use the fitness apps frequently as to achieve his goal (Foster et al. 2010). Furthermore, these social media sites can be utilized as promoting unique features of certain aspects of mobile health apps which this will attract more young users to use it as well.
2.5 Social Learning Theory
Besides, social learning theory can also be applied in understanding the challenges an individual faced while using mobile health apps which caused individual’s behavioural change (Blair, 1993). In this study, our aim is to investigate the issues that young user faced when using mobile health apps which these influential factors have brought the purpose towards individual’s behavioural change.
2.5.1 Challenges of young users’ faced when using mobile health apps
126.96.36.199 Privacy and security concerns
Young users are worried with its own privacy and safety issues while using mobile health apps as these apps are vulnerable to security attacks, for example the private information that young user has stored in the downloaded mobile health apps might send through online without encryption which this caused any third party to take the private health information without his or her consent (Rachurri et al. 2010). Hence, the third party can discover the specific disease that young user is suffering from. Besides, some mobile health apps have poor security systems which this has affected young users’ personal health information to be leaked to unsecured places, for example server logs, search history and more (Dennison et al. 2013). Additionally, mobile health apps could have collected unencrypted data records such as audio records from sleep monitoring apps and naturally transferred it into an SD card which this SD card may retrieved by unauthorized third party (Martinez-Perez et al. 2014). Furthermore, any third party that have taken young users’ personal health data might change its information that was previously being recorded by using mobile health apps. Nevertheless, mobile health apps might can utilize or connect with any third party such as social media, hosting services and share personal health data (Touati & Tabish, 2013) which this has resulted in violating the law of privacy and security in Malaysia. Hence, because of privacy and security concerns, young users might avoid sharing its own personal health information while utilizing mobile health apps and this has resulted professionals to have insufficient young users’ personal health information, and that lead to having improper analysis of what the young user is actually infected (Zubaydi et al. 2015).
188.8.131.52 Information quality issues
The interference of mobile health have supported healthcare institutions, mobile health developer and all users to distribute and trade health information (Cummings et al. 2013). Nevertheless, it is vital to understand the construct of health information and how it is to be established and delivered as to guarantee that this information is comprehensible and is capable to show to the public (Stoyanov et al. 2015). However, health literacy is one of the challenges that young users have faced when using mobile health apps (Dennison et al. 2013). According to Jusoh (2017) has defined health literacy as the extent to individuals that have the capability to collect, analyse and understand general health information and services they required to generate relevant health choices. Some mobile health apps are successful because of its high health literacy but there are still moderate numbers of mobile health apps facing low health literacy problems which caused them to fail (Grundy et al. 2016). However, research studies have shown that some young users have problem of understanding common health information that provided by some mobile health apps because of its low health literacy (Kim ; Xie, 2015) which caused young users to stop using mobile health apps or resulted in incomplete data and that affected mobile health apps having difficulties to continue track young users’ progress (Dennison et al. 2013). Hence, mobile health apps developers should focus more on the contents’ cognitive accessibility areas and young user interfaces so that it can match with all young users’ reading levels averagely (Kamel, 2013).
184.108.40.206 Apps are not updated
Recently downloaded applications might affect mobile health apps as a mobile health app that operated in the smartphone would in fact need young user to update every once a week (Athinen et al. 2009). Because some mobile health app developers tend to produce their own versions of operating systems which caused them high prices, restrain users to update the app automatically and download foreign apps (Dennison et al. 2013). This has resulted in dissatisfying of young users as they either choose to allow a separate smartphone device specifically for using mobile health app purpose or forgo their personal time to continuously update mobile health apps manually. However, when mobile health apps are not updated consistently, health information that it provided might not be trustable as new health information constantly changing nowadays (Estrin, 2010).
220.127.116.11 Unreliable health information
Although mobile health apps provided health information but it does not provide sufficient backgrounds of those professionals (Gurupur & Wan, 2017) thus, this has resulted young users to be concerned with the reliability issues of its health information as young users are not professionals therefore, it is reasonable that they could not determine whether the information that they read are correct and trustable (Scher, 2015). Nevertheless, even though many young users search for health information that are mainly depends on the articles that posted by blogs, sites and also comments that can be found in the mobile health apps but the presented health information is frequently be questioned as they seldom provide information about the authors’ backgrounds (Becker et al. 2014). Thus young users would be relying more on the professionals analysis as they are more valuable but sometimes it does not mean that they are 100 percent correct because those professionals might can gain access to not trustable information sources that are delivered by the manufacturer or search for those experts’ opinion and hence combined both information that the professionals had found and sum up to a conclusion of the young users’ health condition (Free et al. 2013). According to Wolf et al.2013 has stated a scenario that a young user has affected with skin disease caused the young user to take picture of its own skin lesions and uploaded on to a mobile health app as to seek for medical advice instantly, but the uploaded image were unclear which caused the professionals to judge inaccurately of the young user’s disease and this has reduces the chances of the young user to be cured in time. This situation has showed that health advice that provided by professionals might not be accurate and reliable.
Chapter 3 : Methodology
3.1 Chapter Overview
In this study, this chapter has mainly focus on nine main sections which are research paradigms, research design, philosophical assumptions, role as a researcher, data collection procedures, sample, pilot test, data analysis procedures and assessment and validating findings.
In this chapter, research paradigms has four sub-sections which are ontology, epistemology, research methodology and phenomenology. Besides, data collection procedures has two main sub-sections which are sample and interview. Moreover, sample has consists of two sub-sections that are purposeful sampling method and snowball sampling method. Data analysis procedures contain of one sub-section which is thematic analysis in this chapter.
3.2 Research Paradigms
A research paradigm is basically a belief system which it guides the researcher to conduct the study or further determined a set of actions and this can extent the idea patterns to practices (Healy & Perry, 2000). There are many different paradigms that are to control disciplines which are positivism, realism, interpretivism and pragmatism. According to Guba (1990), research paradigms are being characterised into ontology, epistemology and methodology; ontology defines as a universal perception of how an individual perceives knowledge and how an individual perceive themselves that is related to knowledge; epistemology defines an individual perceived the knowledge and its relationship with the knowledge, thus this means that epistemology approach will be based on ontological view and the epistemological research approach will also directly influence methodology; methodology refers to what research methods that the researcher will use to search for knowledge and conducting the research (Polit & Hungler, 2004). These three different categories have its own characteristics which these will be mentioned in the following section.
However, in this chapter, it is important for the researcher to select an appropriate philosophical theory in the research paradigm as to guide the researcher for data collection method in this research. Nevertheless, studies have shown that in the research paradigm, positivism and interpretivism are the most commonly used by researchers (Collis & Hussey, 2014). Thus, the researcher must understand the differences between positivism and interpretivism in the research paradigm and to choose the appropriate philosophical theory for this research. According to Neuman (2003), has acknowledged that positivism views social sciences as a structured technique which it will combine a logic way of thinking and observations of one’s behaviour and sum up to a conclusion that others will behave in that way too. This means that positivism is more to objective manner and also can be applied to deductive research studies whereas interpretivism defined as “associated with the philosophical position of idealism, and is used to group together diverse approaches, including social constructivism, phenomenology and hermeneutics; approaches that reject the objectivist view that meaning resides within the world independently of consciousness” (Taylor, 2013). This means that interpretivism is more to subjective manner and it is applied to inductive research studies. Thus, this has resulted that positivism is the opposition of interpretivism as interpretivism is more to subjective manner whereas positivist paradigm is depends on the observations but carried along with philosophies’ perspectives and also the consideration of human health behaviours by researcher (Stephen, 2015). There are other significant differences between positivism and interpretivism that can be refer to the table below:
After understanding the differences between positivism and interpretivism, the researcher will be moving on to ontology study and mention about the decision of choosing positivism or interpretivism as to conduct this research.
Ontology has demonstrated four research philosophies which are pragmatism, positivism, realism and interpretivism and hence interpretivism will be the most appropriate to conduct this research because the researcher approach interpretivism philosophy to understand the interest of human being (Saunders, Lewis & Thornhill, 2012). Interpretivism defined “the association with the philosophical position of idealism as well as utilize to combine with diverse approaches, involving social constructivism, phenomenology and hermeneutics” (Saunders, Lewis & Thornhill 2012). Moreover, when researcher use interpretivism philosophy to obtain data, it will depends on naturalistic approach for example, interviews. However, in this research study, the researcher will utilize semi-structured interviews as it allows the researcher to comprehend participants’ experiences and perceptions regarding to the use of mobile health apps because interpretivists are certain that every person has its own opinion (Thanh ; Thanh, 2015).
According to Roberto (2010) stated that ontology is a term that refers to branches of philosophy that deals with nature of existence and the construct of the world. Ontological theory focus on the beliefs referring to the social world and what did an individual discovered from it (Roberto, 2010). The concern of ontology is the nature of existence of a specific occurrence that needs to be recognized (Edirisingha, 2012). Ontology is delineated as the science or study of an individual (Blackie, 2010) and it articulates with the nature of life. Ontology is an arrangement of ideas that translates by a person about what constitutes a reality and the theory of ontology placed interpretivist perspective to view the world as structured and experienced by an individual in their communication with one another and this philosophy highlights on qualitative analysis (Guba, 1994). Thus, interpretivism can be said that it views the world in a subjective manner as everyone have different thinking and opinion therefore one should not assume others’ perception or thoughts will be the same, therefore a researcher who obey interpretivism paradigm will need to use one’s experiences to structure and translate the researcher’s understanding from collected information (Thanh & Thanh, 2015).
Epistemology can be referred to the theory of knowledge, particularly regarding to its techniques, legitimacy, areas and the differentiation between reasonable belief and views (Cohen et al. 2007).The assumptions of epistemological are related to how knowledge is able to be generated and obtained which it can be said that “what does it understand to know” (Streubert & Carpenter, 2003). This means that epistemology defined the relationship between reality and research. Since in this research, interpretivism is being chosen as the appropriate one for the researcher to conduct this study thus, in this chapter, the researcher has to mention about the position of interpretivism that is related to ontology and epistemology. However, interpretivists consider that the existence is various and comparative (Hudson and Ozanne, 1988). Studies have justified that these numerous existences based on other systems for meanings and that causes it to be more harder in interpreting in terms of fixed existences (Neuman, 2000). The knowledge obtained in this discipline is socially constructed instead of objectively determined (Carson et al. 2001) and perceived (Hirschman, 1985, Berger and Luckman, 1967, Hudson & Ozanne, 1988).
Positivist studies will be prevented to use by interpretivists as interpretivists are more to implementing individual and flexible type of research arrangements (Carson et al., 2001) and also understand an individual’s perceptions, thoughts and opinions through communication (Black, 2006). Interpretivists trusted the researcher and the participants are interdependent and influencing each other (Hudson ; Ozanne, 1988). The interpretivist researcher enters a particular research context after having an in-depth understanding from the previous studies but this is inadequate to produce a permanent research design because of various unpredictable changes of existences and that is perceived as reality (Hudson ; Ozanne, 1988). However, the researcher should be in an open minded to accept new knowledge during the research such as accepting the information that is provided by the participants. According to Neuman (2000) stated that the purpose of this research that used interpretivism is to understand and able to translate exact meaning of their participants from the interview instead of generalize and expect everyone will perform the same behaviour. As a interpretivist researcher in this study, it is vital to understand the views, opinions, thoughts and ideas that are provided by the young participants after experiencing mobile health apps. (Hudson and Ozanne, 1988; Neuman, 2000).
3.2.3 Research Methodology
Methodology describes the plan of actions which lies behind the decision and utilization of specific techniques (Crotty, 1998)Therefore, methodology is particular about when, what, how and from where the information is gathered and investigated. Guba and Lincon (1994) has clarified that methodology examine a question which is “in what manner can the inquirer approach discovering whatever they trust can be known? According to Polit and Hungler (2004), methodology demonstrates techniques of obtaining, organizing and analysing data. Methodology is a theory of scientific decision which it shows to researcher of how a research should be conducted (Vosloo, 2014). Since interpretivism has been chosen to use in this study therefore the researcher will be using qualitative technique as it has been commonly used by interpretivist research. Thus, qualitative method will be depending more on interviews and also to understand their target segment because interpretivist believed that different people have different opinion and perception through their own experiences (Merriman, 1998). Therefore, the researcher will need to be prepared and open minded to receive new knowledge and interpret the understanding from participants and other researchers into written words. However, the purpose of using qualitative research methodology is also because it always give clear information about actions, attitudes and feelings which this is the thing that quantitative approach is lacking (Bernard, 2017). Therefore, qualitative approach is appropriate for researcher to understand young users’ experience of using mobile health apps in Malaysia.
Phenomenology concentrated on experiences, phenomenon and events with disrespect or least respect of the external and physical existence (Smith, 2013).Phenomenology, otherwise called non-positivism, is a variety of interpretivism as well as other alternatives , for example, hermeneutics, representative interactionism and more (Sokolowski, 2000). This branch of metaphysics “defines the philosophical approach that what is specifically seen and felt is viewed as more trustworthy than clarifications or understandings in communication” (Remeyni et al. 1998).
In phenomenology thoughts are created from large amounts of obtained information by the methods of stimulation and human interest. Thus, this research will concentrated more on the participants’ experiences and ideas of using mobile health apps. According to Jasper (1994) has stated that phenomenology describes the true value of phenomena which is to be explored through the experience of an individual (Van Manen,1990). Generally, phenomenology analyses the construct of different types of experiences such as views, ideas, memory, desire and feeling (Brentano, 1995) thus this phenomenology research is the most appropriate to the aim of this study which is to understand the experiences of young users using mobile health apps. However, in this phenomenology research, interview is the main data collection method in the research design as it also allows the researcher to understand participants’ experience using mobile health apps (Soderhamm, 2001).
3.3 Research Design
Research designs have various meanings which several authors defined research design as the option between quantitative and qualitative research technique. In other words, research design means a basic idea about how the researcher will answer according to the research questions (Saunders, 2012). Research design will be categorized into two different groups that are exploratory and conclusive (Dudovskiy, 2018). The purpose of exploratory research is explain particular research area but it would not give final answers according to research questions and hence it can be applied to qualitative research method for obtaining data and data analysis (Singh, 2007) which interview is one of the data collection method in the exploratory research design (Dudovskiy, 2018). Compared to conclusive research, the purpose of the study is to produce findings and sum up to a conclusion thus, conclusive research design can be applied to quantitative research technique for obtaining data and data analysis (Nargundkar, 2008). However, the main differences between exploratory and conclusive research design can refer to the table below :
In conclusion, the researcher will be using exploratory research design as it brings more advantage to this research study as it is flexible to modify and also productive in laying the fundamentals which would direct to other research in the future as well as exploratory research is able to reduce time and resources as it can decide the type of research that will use at the beginning of the study (Brown, 2006). However when the research design is exploratory and it is applied in qualitative research (Dudovskyi, 2018) thus according to Creswell (2009) has stated the procedures of qualitative research as movements from assumptions to interpretive frameworks and on to the methods including in learning social or human issues and then a framework will be presented for the methods such as grounded theory, case study and more. Therefore, the philosophical assumptions is rather important as it is the beginning of the flow for the procedures of qualitative research, and if the assumptions are incorrect, it will affect how researcher formulate the research problems and questions and how the researcher search for information to solve the questions (Creswell, 2011) hence philosophical assumptions will be further discussed in the following section.
3.4 Philosophical Assumptions
During the past twenty years, these philosophical assumptions have already been expressed in multiple qualitative studies (Denzin & Lincoln, 1994), however when ‘axiomatic’ problems arose by (Guba & Lincoln,1998) as a guidance philosophy lies behind qualitative research, paradigms are being called to represent these beliefs (Lincoln, Lynham, & Guba, 2011; Mertens, 2010); philosophical assumptions, epistemology and ontology; widely considered research methodology (Neuman, 2000); as well as other knowledge statements (Creswell, 2009). These beliefs are connecting with ontology which means the nature of existence, epistemology means how knowledge is able to be generated and obtained, axiology means the role of researcher’s values and methodology means the procedure of the study. However these philosophical assumptions with implications into actions can be refer to the below table :
However, in this qualitative research, will only focused on the ontological assumptions and epistemological assumptions. Thus ontology defined the nature of existence and its attributes (Roberto, 2010). For qualitative researcher, they are comprising the concept of various reality. However, distinct researchers comprised different reality thus this can also be applied in one being studied (Nikolaus, 2011). When investigating an individual, the researcher will perform a qualitative research with the purpose of describing these various realities. The facts of various realities involve the utilization of various forms of facts in themes utilizing the actual written words of distinct individuals as well as offering distinct perspectives, for instance, when an author compile phenomenology research, the author will describe how one involves in the research view their experiences in a different way (Moustakas, 1994).
As for the epistemological assumption, the researcher that perform qualitative research will attempt to move closer to the participants that are being investigated, thus individual perceptions will form a subjective facts. Hence, this has stated how knowledge is being claimed across the subjective experiences of individuals. Thus, it is important to understand the participants’ views, thoughts and ideas as they are the ones who provide information such as according to Wolcott (2008) extending the duration of staying at research place is a high quality of ethnography. This means that the researcher attempted to move closer to the participants that are being investigated (Guba & Lincoln, 1988).
3.5 Role as a Researcher
Axiology defined philosophical judgements of value (Saunders et al. 2012). In other words, axiology is to evaluate the role of the researcher’s his/herself value in this qualitative research on an overall research procedures (Li, 2016). Axiology fundamentally means the ‘purpose’ of this qualitative research (Carnaghan, 2013). It concentrates on the values that the researcher has found in the study as it will affects how the researcher will perform the study and what does the researcher valued in the data findings (Lee & Lings, 2008).
However, as a role of a researcher in this qualitative research, I have studied different journal articles that are relevant to my research topic as a qualitative researcher while conducting this research. I was asked to choose the topic that I am interested into and hence I have chosen mobile health apps as my research topic because I have always been enthused towards technology and also supports healthy lifestyle, therefore, I am keen on understanding young users’ experiences of using mobile health apps. When it is time to obtain data, I will play a role as an interviewer which I will listen to those participants’ opinions and their thoughts of mobile health apps and will tend to analysed their perceptions and opinions through their experiences. When I reach the finding stage, I will try to understand and analysed the answers that will be provided by those participants and search for ideas from different researchers’ about what motivates young users to use mobile health apps frequently and what types of issues that they faced while using it. At the last stage of this research, I will be an interpreter who will translate all spoken answers from the interview into written words and analyse those various opinions and translate them to words as well.
In the process of being a researcher, I plan to explore participants’ meaning using mobile health apps. I will cross-refer with the literature that I have been obtained and found out that many interesting information regarding to my research topic. However, understanding is one of the main factors that is very important to this qualitative research as I will need to understand all of the journal articles so that I am able to present the idea in this qualitative research, thus this will allow me to be more knowledgeable towards this research topic and also to improve my understanding skills. Hence, as a qualitative research in this study, I am honoured to have the opportunity to understand young users’ experiences using mobile health apps.
3.6 Data Collection Method
Generally, for researchers that conduct qualitative research can obtain data through several data collection methods such as observation, interview, focus group, visual study such as books (Stewart, Tresure, & Chadwick, 2008). But in this research study, the researcher will use interview as one of the data collection method to understand young users’ experiences using mobile health apps. However, before conducting an interview for this research, the researcher will first choose its sample size and then only decide to use the sample method which in this research, the researcher will be using purposeful sampling method as to obtain experienced young participants to conduct an interview which this allow the researcher to understand the experiences of young users’ using mobile health apps in Malaysia. Nevertheless, since larger sampling size will be used in this research study as to reduce the possibility of having random sampling error, thus the researcher will use snowball sampling as it allows the researcher to get enough participants to conduct an interview and also this research can be taken in place.
3.6.1 Sample Size
In this qualitative research, the researcher need to select an appropriate sample size as it can accurately justify the research question (Marshall et al. 2013). To make an accurate inferences about the target populations, a desirable number needed to be determined in this qualitative research for the sample size because it will affect the probability of having sample error. For example, if the researcher obtain large amounts of sample size, the probability of getting error in sampling will reduce. However, there are always been a general misconception that the numbers in the sampling size are not critical in establishing the competence of a sampling tactic (Sandelowski, 1995). A smaller sample size is commonly been used in qualitative research and hence it is recommended for the qualitative researcher to use larger sample size to receive comments for most perceptions. Accessing to most perceptions would lead to the accomplishment of theoretical or data saturation. Saturation means that when adding additional participants to the research are not helping with providing any extra information. Studies have suggested that the idea of data saturation is most suitable for accomplishing appropriate sample size in qualitative research (Glaser & Strauss, 1967). According to Mayring (2007) has stated that data saturation guides the research sample size and when saturation has achieved, the outcome must be generalized.
Creswell (1998) has been suggested that sample size should be in the range of 20 to 30 in grounded theory research. However, semi-structured interview will be used in this qualitative research therefore according to Evans (2018) has stated that semi-structured interview is a grounded theory which means that in this mobile health apps research study, the sample size will follow the recommendation that have been suggested by Creswell (1998) which are 25 to 30 participants to achieve saturation. After choosing the sample size, the researcher will need to decide the sample method as to target the right participants for interview sessions.
Sampling delineates as a method of choosing participants from a population of interest for the study. The purpose of qualitative sampling is to have a deeper understanding of a target group and in this qualitative research, the researcher will utilize purposeful sampling method and snowballing sampling method to obtain data.
18.104.22.168.1 Purposeful sampling
In qualitative research, purposeful sampling is a method that is broadly utilized for recognizing and choosing information-rich cases which this has includes in choosing an identified target group that have a lot of knowledge and experienced with the related research topic (Jamshed, 2014). Therefore, purposeful sampling methods allow researchers to validate as well as generalised from the studied sample (Creswell, 2012). Hence, in this research, the researcher will utilize purposeful sampling technique which involves in selecting a group of participants that are knowledgeable and experienced with mobile health apps and ask if they are willing to join an interview sessions. The main aim of using purposeful sampling method in this research study is to allow the researcher to understand a minor target group of young users’ experience using mobile health apps (Creswell, 2012).
Purposeful sampling method will conduct by the researcher such as interact with university students face-to-face at Sunway University in Kuala Lumpur and will ask them some simple and understandable questions which in turn achieving the objective of being honest and ethic as a role of a researcher. The designed questioned will be how long have you been using mobile health apps? how frequently do you use mobile health apps? Are you satisfied with using mobile health apps? These questions will act as the first topic to start the whole conversation with those potential participants. Later, the researcher will only further clarify the research study in detail and explain the objective of conducting this study and also display the consent form as to determine that the researcher is honest and ethical, and then the researcher will ask the potential participants whether they are willing to share their experiences and thoughts about mobile health apps during the interview sessions. This has resulted that purposeful sampling method will be the one of the most effective use in limited resources.
22.214.171.124.2 Snowball sampling
Snowball sampling refers to a non-probability sampling technique will be used when the attributes owned by samples are rare and hard to search for (Stephanie, 2014).However, this snowball sampling technique includes basic data origin designate another potential basic data origin to be utilize in the research which this means that snowball sampling is a sampling method which existing participants recruit potential participants within their acquaintances because some potential participants might know other people that has the same situation as themselves and this could be an advantage of this study (Larsen, 2010). Nevertheless, snowball sampling is divided into three patterns of snowball sampling that are linear snowball sampling, exponential non-discriminative snowball sampling and exponential discriminative snowball sampling (Devkota, 2018). Linear snowball sampling method refers to a participants give one referral only whereas exponential non-discriminative snowball sampling method refers to the first participant gives a few referrals and exponential discriminative snowball sampling refers to the participants provide some referrals but only one potential participant will be recruited (Dudovskiy, 2018). Therefore, in this qualitative research, the researcher will use exponential non-discriminative snowball sampling as to get enough participants for this research study to take place.
Furthermore, using snowball sampling method can benefits those research studies that are explorative, descriptive and qualitative which this means that this researcher can gain advantage from using informal method to gain access to target population. (Hendricks et al. 1992). However, in this qualitative research, before conducting snowball sampling method, the researcher will use purposeful sampling technique first and later only use snowball sampling method which is to ask potential participants to recruit their friends or family members that have the same situation as themselves for interview sessions. However, snowball sampling technique can also be utilized as formal methodology because some researchers have hard time of conducting household surveys thus, snowball sampling method can implies reasoning judgements about potential participants (Snijders, 1992; Faugier & Sergeant, 1997).
Interview is one of the data collection method that used in this research and it has originally been divided into three parts which are structured interview, semi-structured interview and in-depth interview (Bryman, 2011). In this qualitative research, the researcher will be conducting semi-structured interview on understanding young users’ experience using mobile health apps. However, semi-structured interview has the attributes of structured interviews and in-depth interviews which participants have to state their answers according to open and closed questions (Sandy, 2011).
Nevertheless, the interview schedule is briefer compared to questionnaire design, but researcher needs to concern the views of interviewer and translate the meaning into written words. Attentive qualitative researcher can develop a comprehensive interview schedule with good writing skills. However, interviewers can state their own ideas or review according to the research questions nor topics in this research study. When preparing the interview questions, interviewer is suggested to begin with the first research question (Durmay, 2011). Apart from that, researcher that select a specific type of interview method is mainly depends on the research questions and research method (Rowley, 2012).
Interviewers that conduct semi-structured interviews have to observe their participants’ behaviour when they are expressing their own opinions as to determine a good quality of interview which this will be utilized in this research study. Gillham (2000) has stated that semi-structured interview has defined as producing large amounts of complete data such as semi-structured interview typically designed open and close questions and have been organized in a logical sequence which can be determined as ready and well-arranged. However, if unpredictable questions that are asked during the interview sessions, participants are feel free to express their opinions, emotions, feedback at that point of time (Kutty, 2014).
Edwards (2013) has argued the considerable diversities in style which all qualitative research methods including semi-structure interview which has its own unique primary features and that involved the exchanging of opinions or thoughts on a specific problems between two or more participants in face-to-face setting. Semi-structured interview is suitable to use in the grounded theory and ethnography theory (Sandy, 2011). Hence, in this qualitative study, the researcher is appropriate to perform semi-structured interview because the aim of this research is to understand young users’ experience using mobile health apps.
Researcher will perform semi-structured interview in this approach which are, first, the researcher will go to Sunway University and ask students a few easy and clear questions such as “how long have you been using mobile health apps? how frequently do you use mobile health apps? Are you satisfied with using mobile health apps?” Researcher will then followed by clarifying the aim of performing this research study and display the consent form as to determine that the researcher is honest and ethical, and after that the researcher will ask whether the potential participants are ready to join an interview session and would be there and then tell the potential participants that the interview session will tend to last around 10 minutes for every person and also informing them that interview sessions will be conducted in an empty and available classroom in Sunway University, Kuala Lumpur because choosing a quiet environment will not disrupt the process of interviewing and if the potential participants are willing to join the interview sessions, researcher will then be conducting interviews with them. Lastly, interviewer will ask the participants the following interview questions but addition questions can be added during the interview and also unnecessary questions will be ignored if the duration of undergoing interview sessions is too long.
1. Do you use mobile health apps?
2. How frequently will you use mobile health apps?
3. What are the main factors that motivates you to use mobile health apps?
4. What challenges that you faced while using mobile health apps?
5. What do you think about the distinctions between mobile health apps and mobile website that can also search for health information?
6. How will you perceived mobile health apps?
3.7 Pilot Test
Generally, pilot test defined that discovering whether the interview questions are working effectively in the reality world by conducting a trial on several people first (Lavrakas, 2008). The pilot test has to run one to two sessions as to ensure the completed study goes well (Resnick, 2015). The aim of pilot test in this research is to ensure all participants understand the interview questions and also to make participants comfortable with the interview questions and hence the researcher needs to conduct pilot test due to the concern of the sensitivity levels of interview questions (Teijlingen & Hundley, 2001). Besides, conducting pilot test will allows the researcher to roughly know what is the duration of an interview sessions should be about. Pilot test will be conducted before conducting an interview sessions with potential participants so that to ensure high quality of interview questions will be developed (Lancaster et al. 2004). Besides, the researcher also needs to search for those people that can represent the target groups within the research’s intended sample to conduct pilot test accurately, therefore regarding to this research topic, young users who has experience of using mobile health apps are the target market and hence the researcher needs to search for those people who are young and also using mobile health apps at the same time to conduct pilot testing so that their perceptions can be confirmed by others.
However the researcher needs to know the steps of conducting the pilot test which are first, the interview sessions must be conducted in the same way as the actual interview sessions will be conducted and interviewer must record starting and ending time so that researcher can roughly estimate the duration of each interview sessions will last (Callitz, 200); Secondly, the researcher must pay attention onto the responses of participants when they are being asked questions so that the researcher would know whether the interview questions are hard to understand or are confusing (Wright, 2018); Third, after the participants have completed the interview sessions, the interviewer must ask whether they can understand every questions that are being asked and for those participants that confused with interview questions during interview sessions, the interviewer must asked whether which questions have confused them so that interviewer can improve the quality of the particular questions (Hassan et al. 2006); Fourth, the interviewer also must ask the participants whether that the interview questions have any sensitive questions that may affect their emotions and also the interviewer has to ask whether or not the arrangement of questions have encouraged their intentions to continue the interview sessions; Lastly, the interviewer has to ask for feedback regarding to the interview questions and also to ask the participants to say in words about what every questions that was enquiring and afterwards interviewer can ask the participants to suggest alternative questions that can be asked during the actual interview sessions (Schade, 2015).
3.8 Data Analysis Procedure
Qualitative data refers to the obtained information about qualities and information that could not be measured. In this qualitative research, interview is the data collection method and hence recordings during the interview sessions will be collected which in turn be interpreted into transcripts (Creswell, 2012). According to Glesne (1999), data analysis is the process of examining, filtering, converting and modelling data as to achieve the aim of determining helpful information, sum up to a conclusion as well as assisting decision-making.
In the research study, qualitative data analysis is a process that researcher has to analyse the collected qualitative data into the means of understanding and explanation (Taylor, 2010). According to Creswell (2012), to relate the data collection and translating the data, coding has develops the foundation for generating the analysis, thus it can be said that coding is analysis. Hence, in this qualitative research, the researcher must analysed the data that has been obtained, and translates the recordings into transcripts in a systematic way and hence researcher can understand and make inferences of this study.
3.8.1 Thematic Analysis
Thematic analysis defines the procedure for differentiating, analysis and describing models of the data which this will showed a comprehensive set of data (Carswell, 2013). According to Hasan (2012) has stated that it is the most appropriate analysis tool to be used in qualitative study because it examine qualitative data patterns successfully. Hence, thematic network model is a part of thematic analysis thus, it can be considered as a framework to relate the relationship between the themes (Hasan, 2012).
According to Braun and Clarke (2006) has illustrated the six stages of how to conduct a thematic analysis in a qualitative study which can refer to the figure below:
After the researcher has obtain the data from an interview session, the researcher will need to analyse the data. However, the technique of storing the data during an interview session is by using voice recorder, thus this method is not just for storing the data but also a prove and copy for the utilization of transcription (Annexure, 2012).
First and foremost, the researcher will need to familiar with the data that had been obtained by continuously listen to the voice recording.
Next, the researcher will move onto the transcription process which means that the researcher will need to interpret the verbal information into written words for the convenience aim of coding process. The transcript is one of the evidence that can prove to the participants that the researcher is honest and ethical as the researcher will translate the exact answers that provided by the participants and also will even write down the characteristics that obtained from the voice recorder such as timing, emotions, pace and more because these characteristics will determine the meaning of the answers that provided by participants such as participants will tend to emphasize on expressions like “hmm…erm….” and this shows that the participant is lacking of beliefs towards his or her own opinion. Besides, the transcription will be attach to the appendix after the researcher has translate the verbal information into written words (Bengstsson, 2016).
However, a long written words will be formed in the transcript and therefore this is when the researcher will begin to summarize the transcript words into a list of initial codes in the data analysis. The aim of producing a list of initial codes is to understand young users’ experience using mobile health apps (Boyatzis, 1998).
Then, the researcher will move on to the next level after obtaining a few codes in the analysis which is search for themes. This stage is for the researcher to analyse the list of codes and perceive them as concepts (Strauss & Carbin, 1990) which in turn will result the researcher to use frameworks like mind map to categorized these few codes into themes ((Braun & Clarke, 2006).
According to Braun and Clarke stated that there are issues that had been occurred in the previous studies which are two similar codes are not gathered into one theme and another issues was that after a group of themes had been arranged, one of the theme have insufficient data information to support it therefore in this research, the researcher needs to review the themes that had constructed in the previous stage as to check whether each of the themes are consistent in a clear structure. However, if the researcher has found any mistakes in the themes, the researcher is required to re-organize or re-do all of them as to make the themes more identifiable and distinctive (Patton, 1990).
Furthermore, the researcher will proceed to defining and naming the themes that have been arranged in the previous stage. For this stage, the researcher will first explore the attributes of all themes and then only can decide how to name each and every themes as different themes defines different attributes. After that, the researcher will need to justify the relationship between the main theme and its sub-theme that stated using mind map in this study so that the researcher can in-depth understand about the variations among themes. (Braun & Clarke, 2006)
After names and justifications of themes are stated in the previous step, the researcher will move on to the last step which is producing a report of thematic analysis that depends on the outcome of data findings. Hence, the analysis report is able to be written in a clear manner, logical, able to gain access to the relationship between the main theme and the sub-theme and others, and this will convince the readers and researchers in the future that this study is reliable and valid. Besides, the analysis report will allow the researcher to have sufficient evidence to support the justification of every theme in this research and also can prove that every theme has its own special attributes which future readers and future researchers can differentiate each and every theme. Furthermore, the analysis report needs to be able to relate back to the analysis of the research question and literature so that the researcher will have a better understanding towards young users’ experience using mobile health apps in this research (Braun & Clarke, 2006)
3.9 Reliability and Validity of the study
According to Creswell (2014), researchers need to measure the reliability and validity in qualitative research. Reliability can be defined as exact reliability of the procedures and the outcomes. However, such description of reliability is challenging and epistemologically objective truth in qualitative research. Thus, reliability of this research focus more consistency. Compared to validity, validity is defined as appropriateness of the instruments, procedures and information. Regardless of whether the exploration question is valid for the preferred outcome, the selection of methodology must be suitable for resolving the research question, the research design must be appropriate for the methodology and sampling method and data analysis procedures must also be valid which researchers can only sum up to a conclusion that the outcomes are valid. Hence, in this qualitative data analysis, honesty plays a vital role in researcher. Therefore, to make sure the qualitative data is accurate, reliable and valid, researcher will give the transcripts to the participants to check whether it is true and reliable as transcript is an evidence to prove the subject matter during the interview. Hence, the researcher is obligated to ensure the transcript does no error which this will increase the accuracy level of coding procedures.
Joppe (2000) defines reliability as :
Reliability defines as a concept that is utilized to evaluate quantitative research but it can also be utilized in qualitative research as well. If the researcher views the concept of testing as a way of information elicitation then the most important test of any qualitative research is its quality. A high quality of qualitative study allows the researcher to better understand a condition (Eisner, 1991). This has relevant to the idea of high quality research which reliability is used to assess quality in quantitative research by means of ‘aim of explaining’ whereas reliability that used in qualitative research defined the aim of ‘producing understanding’ (Stenbacka, 2001).
The concept of validity is portrayed by an extensive variety of terms in qualitative research. Even though several qualitative researchers have stated that validity is not able to apply in qualitative research, but in the meantime, researchers have discovered that they are required to qualify check or measure for their study such as, Creswell & Miller (2000) recommend that the researchers’ perception as well as the researchers’ option of research paradigm that has affected the term validity in the research. This has resulted that several researchers have generated their own ideas of validity and frequently used those terms that they perceive as appropriate, for example, quality as well as trustworthiness (Davies & Dodd, 2002).