Configurations of Quality Dimensions Associated With Researcher and Patient Ratings of HIV/AIDS Mobile Health Apps in China: Fuzzy-Set Qualitative Comparative Analysis.

BACKGROUND: Mobile health (mHealth) apps have become important tools for HIV/AIDS management. Although the Mobile App Rating Scale and its user version are widely used, how different stakeholder groups combine quality dimensions into overall judgments remains unclear. Discrepancies between researcher and patient evaluations may affect app adoption and clinical effectiveness.

OBJECTIVE: This exploratory study aimed to compare configurational pathways associated with high subjective quality ratings of HIV/AIDS apps between researchers and patients using fuzzy-set qualitative comparative analysis.

METHODS: Twenty-one Chinese HIV/AIDS mobile apps from early 2023 were evaluated by 3 researchers using the original Mobile App Rating Scale and 2 HIV-positive patients using the user version of the Mobile App Rating Scale. Six conditions were examined: engagement, functionality, aesthetics, information quality, privacy protection, and developer type. Necessary and sufficient configurations were identified for both groups. Wilcoxon signed-rank tests compared raw ratings between groups. Sensitivity analyses covered 4 calibration anchor sets, 4 raw-consistency cutoffs, 4 proportional reduction in inconsistency cutoffs, and multivalue operationalization of privacy protection.

RESULTS: Researcher and patient ratings differed significantly for functionality (median difference 0.50, IQR 0.00 to 0.63; P=.003) and engagement (-0.20, IQR -0.40 to 0.10; P=.04), but not for aesthetics (P=.16), information (P=.07), or subjective quality (P=.06). Five sufficient configurations were identified for researchers (solution consistency=0.981, coverage=0.649) and 4 for patients (solution consistency=0.998, coverage=0.796). Configurations including privacy protection appeared only among researchers; its absence appeared in 3 patient configurations, reflecting the rarity of protection in the sample (5/21 apps) rather than lower patient ratings for protected apps. For patients, functionality (0.907) and information quality (0.915) exceeded the necessity threshold but were strongly correlated (r=0.816), so functionality was retained on substantive grounds rather than as an independent necessary condition. Illustrative cases were Wu Ai Fang Hua and Ai Yi Jian for the researcher-oriented pathway and Chabei for the patient-oriented pathway. Sensitivity analyses left the configurations unchanged across all anchor sets and raw-consistency cutoffs; 1 researcher configuration did not survive the stricter proportional reduction in inconsistency cutoffs, and the patient necessity result was anchor-dependent.

CONCLUSIONS: The 2 evaluator panels' assessments of HIV/AIDS mHealth apps appeared to follow different configurational logic in this sample, with several equifinal pathways to high subjective quality in each group. Because the patient panel comprised 2 evaluators, and 21 apps were analyzed with 6 conditions, the findings should be read as hypothesis-generating rather than representative of people living with HIV. The findings nonetheless suggest that both expert and end-user perspectives are needed during mHealth development, and that, because privacy protection was rare and not required for a favorable patient judgment, its provision in a population highly vulnerable to disclosure-related harm needs to be ensured by developers and regulators rather than left to user demand.