Checklist para o desenvolvimento de aplicativos móveis em saúde: uma proposição na perspectiva do letramento digital em saúde

Abstract

Introduction: Mobile health applications have become established as relevant tools for health promotion, prevention, and care follow-up, expanding access to information and fostering self-care. For these applications to be effective, they must be developed in an accessible manner and aligned with users’ needs. In this context, digital health literacy (DHL) is a determining factor for the adoption and continued use of these technologies, yet it remains insufficiently incorporated into their development. Nursing plays an increasing role in this scenario, acting in stages such as requirements definition, design, prototyping, and testing, thereby promoting the creation of patient-centered and evidence-based solutions. However, the literature lacks instruments that guide the development of applications from a DHL perspective, a gap that compromises digital inclusion and the care potential of these tools. Objective: To evaluate the evidence of content validity of a checklist of recommendations for the development of mobile health applications, grounded in the principles of digital health literacy. Method: A psychometric study conducted in two stages. In the first stage, checklist items were generated based on the identification of recommendations for the development of mobile health applications. To this end, a scoping review was carried out guided by the question: “Which strategies promote digital health literacy in the development of mobile health applications?”. Studies describing application development processes that included aspects of DHL were included. The search was conducted in eight databases, followed by independent screening by two reviewers using Rayyan. The extracted strategies underwent cross-mapping with documents addressing the development of digital technologies. In the second stage, evidence of content validity of the checklist items was assessed in terms of relevance and clarity using the Content Validity Ratio, considering a cutoff point >0.42. Experts in the areas of health literacy and human–computer interaction were invited to participate in this stage. Results: The scoping review included 47 studies, of which 17 explicitly mentioned digital health literacy. Fifty-one strategies were identified and grouped into six categories: incentive features (n=15), information architecture (n=10), design (n=9), accessible content (n=8), cultural inclusion (n=6), and evaluation/revision (n=3). The use of visual and auditory resources (n=24) and user involvement in development and testing (n=24) were the most frequent strategies. The extracted strategies were cross-mapped with documents addressing the development of digital health technologies, resulting in a preliminary checklist with 65 items. In the content evaluation, items related to readability, intuitive design, and cultural adaptation achieved the highest CVR values, whereas those related to incentive features had the lowest indices. All items in the “Evaluation and revision” dimension exceeded the critical value. The final version of the checklist comprised 39 items. Conclusion: The final checklist demonstrated evidence of content validity and constitutes a novel instrument to guide the development of health applications grounded in digital health literacy. Its use may promote the creation of more accessible, inclusive, and effective digital technologies, strengthening technology-mediated nursing care and health decision-making.