Development and validation of the Italian version of the Mobile Application Rating Scale and its generalisability to apps targeting primary prevention

Abstract

BackgroundA growing body of literature affirms the usefulness of mobile technologies, including mobile applications (apps), in the primary prevention field. The quality of health apps, which today number in the thousands, is a crucial parameter, as it may affect health-related decision-making and outcomes among app end-users. The mobile application rating scale (MARS) has recently been developed to evaluate the quality of such apps, and has shown good psychometric properties. Since there is no standardised tool for assessing the apps available in Italian app stores, the present study developed and validated an Italian version of MARS in apps targeting primary prevention.MethodsThe original 23-item version of the MARS assesses mobile app quality in four objective quality dimensions (engagement, functionality, aesthetics, information) and one subjective dimension. Validation of this tool involved several steps; the universalist approach to achieving equivalence was adopted. Following two backward translations, a reconciled Italian version of MARS was produced and compared with the original scale. On the basis of sample size estimation, 48 apps from three major app stores were downloaded; the first 5 were used for piloting, while the remaining 43 were used in the main study in order to assess the psychometric properties of the scale. The apps were assessed by two raters, each working independently. The psychometric properties of the final version of the scale was assessed including the inter-rater reliability, internal consistency, convergent, divergent and concurrent validities.ResultsThe intralingual equivalence of the Italian version of the MARS was confirmed by the authors of the original scale. A total of 43 apps targeting primary prevention were tested. The MARS displayed acceptable psychometric properties. The MARS total score showed an excellent level of both inter-rater agreement (intra-class correlation coefficient of .96) and internal consistency (Cronbach’s α of .90 and .91 for the two raters, respectively). Other types of validity, including convergent, divergent, discriminative, known-groups and scalability, were also established.ConclusionsThe Italian version of MARS is a valid and reliable tool for assessing the health-related primary prevention apps available in Italian app stores.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0323-2) contains supplementary material, which is available to authorized users.

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“…Second, despite the fact that the professional and user versions of MARS are very similar, only the professional Italian version of MARS has been validated. Considering that the two original English versions of MARS differ only slightly (although the user version does not require training), we supposed that the psychometric properties of the professional Italian version of MARS [36] would be similar to those of the user version. Third, as our sample of participants who filled in the MARS was not representative of the population of Italian adult Internet users, our estimates could differ from the average scores of the reference population.…”

“…The quality of the app was assessed by means of the Mobile Application Rating Scale (MARS) [22], the Italian version of which has recently been validated [36]. The scale consists of 23 Likert-type items on a 5-point range (from 1, “poor,” to 5, “excellent”) and assesses app quality in 4 objective dimensions (engagement, functionality, aesthetics, and information) and 1 subjective quality dimension.…”

“…The MARS total score is obtained by averaging the summary scores on the 4 objective quality dimensions. The Italian version of MARS has shown good psychometric properties; the MARS total score has been seen to have an intraclass correlation coefficient of .96, Cronbach alpha of .90, and acceptable levels of convergent, divergent, discriminative, known-groups validity, and scalability [36]. …”

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“…Missing value analysis was performed to estimate the frequency and level of missingness, and determine the best strategy to address the issue (e.g., multiple imputation, listwise deletion, etc.). Internal consistency (Cronbach's ) was interpreted as excellent (≥ 0.90), good (0.80-0.89), acceptable (0.70-0.79), α questionable (0.60-.69), poor (0.50-.59) and unacceptable (<0.50) [42].…”

“…The MARS scale is multi-dimensional as it encompasses the domains of 'engagement', 'functionality', 'aesthetics', 'information', which are used to estimate an "objective" app quality dimension (calculated as an average score of the aforementioned domains), based on objective features and characteristics of an app. The MARS tool, generalized to primary prevention apps [42], has been used in several expert reviews of apps for a variety of behaviors, such as drink-driving [43], food consumption [44], medication adherence [45], mental health and mindfulness [46], quality of life [47], rheumatoid arthritis [48], weight loss related to smoking cessation [49], and weight management [24]. The MARS tool is also available in a simplified version for end-users (i.e., 'uMARS') [50], which was originally tested on two harm minimization and affect management apps [50].…”