Development and validation of the mHealth Apps Rating Inventory (mARI): A comprehensive tool for assessing the quality of mobile health applications.

Abstract

Despite various assessment frameworks for mobile health applications (MHAs), current tools often lack comprehensiveness to evaluate vital quality dimensions in chronic disease management apps, including usability, security, and specialized content. This study aimed to develop and psychometrically validate the mHealth Apps Rating Inventory (mARI), a comprehensive assessment tool for evaluating chronic disease management app quality. This methodological study, conducted in Iran in 2024, employed a rigorous two-phase approach guided by COSMIN standards. Phase 1 utilized Waltz's four-step method for tool development through integrative literature review and content analysis. Phase 2 involved comprehensive psychometrics evaluation including content validity by 10 multidisciplinary experts, face validity with 10 target users, and construct validity assessment through exploratory factor analysis (EFA) on 200 chronic disease apps. Convergent validity was examined using MARS on 50 apps. Reliability was assessed through internal consistency, inter-rater agreement (25 apps), and test-retest stability (30 apps). Data analysis employed SPSS with maximum likelihood estimation and varimax rotation. Starting with 88 items across six domains, content validity assessment eliminated 16 items (S-CVI = 0.97). EFA retained 37 items identifying four factors explaining 59.26 % of variance: Usability and Content Quality, Security and Technical Requirements, Design and User Experience, and Notification Management and User Guidance. The mARI demonstrated significant positive correlation with MARS (r = 0.832, p < 0.001). Floor and ceiling effects were minimal (0 % and 1 %). Excellent reliability was achieved: Cronbach's alpha (α = 0.971), McDonald's omega (Ω = 0.966), test-retest ICC = 0.995, and inter-rater ICC = 0.926. SEM was 3.655 with SDC = 5.300. The mARI demonstrates robust psychometrics properties as a comprehensive, validated tool for evaluating chronic disease management app quality, providing healthcare professionals and patients with reliable evidence-based guidance for selecting appropriate digital health interventions.