The findings of the study, which focused on the requirements of three reproductive healthcare mobile apps "MaGrossesse", "MyContraception", and "Mamma&Baby" are discussed in this section. The requirements were extracted, refined, and organized based on relevant studies in the three reproductive healthcare domains.
The SQ of the three apps was evaluated by assessing the impact of the specified requirements on eight quality characteristics and their related sub- characteristics, as defined in the ISO/IEC 25010 model and ISO/IEC 25023 standard. As presented above in section 3, three categories of requirements have been identified to define those related to each domain of the three reproductive healthcare: Prenatal, Contraception, and Postnatal. To determine the extent to which each requirement affects the external quality attributes, the analysis process outlined in section 4 has been applied to all requirements, which are categorized as SQ requirements, except the OS version (AA2) and cost (AA3). The data analysis and the generation of graphics have been based on the use of Statistical Package for the Social Sciences software version 22.2 (SPSS Statistics 22.0)
RQ1.What is the impact of pregnancy monitoring, newborn baby care, and contraception mobile apps requirements on the SPQ?
After completing the application of the impact analysis process, it was discovered that the blocks PD, PF, and POF significantly influenced the SQ characteristics. There has been a significant rise in the number of mobile apps related to health, offering advanced tools and services for decision support healthcare systems based on the user's situation, particularly in the medical domain. These apps operate using both implicit and explicit data collected from the user and their environment, and they store confidential information about the patient [27]. This implies the importance of implementing security ([28],[29]) and privacy as non-functional requirements and considering it during the development of the mobile app, as failure impacts negatively stakeholders and users alike.
In addition to data security and privacy, eHealth and m-health applications must adhere to strict regulations and standards, such as HIPAA (Health Insurance Portability and Accountability Act) in the United States, to ensure that patient data is handled appropriately and within legal boundaries. SQ is necessary to ensure that the mobile app meets these requirements and complies with the relevant regulations and standards [30], [31]. Therefore, it is essential to prioritize SQ characteristics such as security, privacy, and portability in the development of mobile health apps. By doing so, developers can ensure that their apps meet the highest standards of quality and that users can trust them with their sensitive information which enhances the popularity of the mobile app and increase the number of downloads and positive reviews [25].
RQ2. What are the requirements that have a significant impact on SPQ?
Regarding the specifications considered as app features, an integrated social network for moms to help each other, and share experiences, and problems (POF19) for the postnatal app is the bloc POF requirement that has the highest impact on SPQ (Fig. 7, Fig. 10, and Fig. 11). Research indicates that individuals who use social media benefit from health recommendation services for minor issues, particularly busy individuals who prefer it to in-person consultations which can lead to misdiagnoses ([32],[33]). A mobile discussion forum is one of the most interesting features, especially in pregnancy monitoring and childcare apps ([34],[35]). This in-app open discussion area is an opportunity for pregnant women and new mothers to ask questions, discuss their potential fears and concerns about their pregnancy or postnatal period, and share their experiences to receive real-time guidance in times of doubt.
Functional Suitability, the most impacted characteristic by the requirements, ensures that apps meet user requirements, provide expected results, and offer features such as ease of use and reliability. Numerous studies have been carried out to identify an effective approach for evaluating ISO/IEC 25010's critical characteristic of functional suitability and usability ([26],[36]). The findings of these studies have led to the development of a comprehensive evaluation methodology, procedure, and a set of tools that enable a thorough assessment of functional suitability ([37]–[39]).
During the design and development stages, Operability emerges as the second most affected characteristic by the requirements in the three apps, based on the observations made in Fig. 9. Its significance lies in its critical role in improving user engagement, satisfaction, health outcomes, and app adoption while reducing errors. The ease of use of health apps is crucial for users to achieve their goals, as pointed out by studies [38], [39], and [40]. Furthermore, Fig. 9 highlights the considerable influence of requirements on Performance Efficiency and Reliability, which are essential for ensuring a positive user experience, fostering trust, driving revenue, and maintaining competitiveness in the mobile app market. A study conducted on 115 organizations in Italy confirmed that during crisis conditions, IT performance is significantly influenced by usage reliability and support service reliability [41].
Efficient performance also has a significant as shown in Fig. 9, and 11, it helps minimizing battery usage, process sensitive data quickly and securely, and providing timely and accurate information to users. There are several factors that can contribute to the efficient performance of a mobile app, including optimizing code by respecting the best practices of programming ( comment the code, avoid duplications, using design patterns, etc) minimizing network requests, Efficient memory usage, Battery optimization, Testing and debugging[40]–[42]. Efficient performance of a mobile app is determined by its speed, responsiveness, and resource utilization, all of which are essential for a positive user experience.
RQ3. What are the other features that should be added to the three apps?
According to Figs. 6, 7, 8, and 9, transferability and compatibility are the characteristics that appear to be the least affected by requirements. Ensuring transferability and compatibility helps to ensure that the app is accessible, functional, and able to provide positive user experiences.
To ensure transferability for health apps, developers can use standard data formats that are compatible with multiple platforms, such as the Health Level Seven International (HL7) standard for electronic health records (EHRs)[43]–[46]. They can also use cloud-based storage solutions to allow users to access their data from any device with an internet connection[47]–[49].
To ensure compatibility, developers can use standard coding practices and programming languages that are compatible with multiple platforms like JavaScript, Dart, Xamarin, Kotlin and others [50]–[52]. They can also test the app on various devices and operating systems to ensure that it works properly on all of them[53]–[56].In addition, developers can use responsive design techniques to ensure that the app's user interface and features adapt to different screen sizes and resolutions.
This passage is referring to a reform of the authentication mechanism of a system. The authentication (UA4) was found to have significant security flaws, and the impact of these flaws on the system is significant (as shown in Figs. 7, 10, and 11). To address these flaws, Additional security steps are being suggested to offer enhanced security for user credentials. Some options include utilizing a secure question, smart card technology, or biometric verification. These alternatives provide various benefits and are aimed at increasing the protection of the user's information and reducing the possibility of unauthorized access, thereby safeguarding confidential data [57].
Apps should not only provide useful features, but also secure their users' data. A block-chain and Distributed Ledger-based Improved Biomedical Security system (BDL-IBS), has been suggested in study [58] as a way to increase privacy and security in healthcare. The research found that using block-chain technology offers fast, easy, and safe data exchange, improving privacy and security for patients.
RQ4. What are the common features among the three apps?
Keeping track of your medical history might be stressful. Keeping track of all your doctor's appointments, conversations, tests, lab results, and other treatments may sound like a lot of work, especially for people managing complicated or various health conditions ([59],[60]), which implies the importance of this feature in mobile apps ([61],[62]). In the three apps "Mamma&Baby", "MaGrossesse", and "Mycontraception" there is a common feature which is the capability of tracking your medical history (CF5) for the contraception app, (PF1) for the prenatal app, and (POF6) for the postnatal app, can be added as a crucial source of security shortcomings beside the authentication.
Reminders have a crucial function in mobile applications by assisting users in remembering vital tasks and events, avoiding forgetfulness, enhancing the user experience, boosting engagement, and improving the reliability of the application. The apps "Mycontraception" and "Mamma&Baby" share a common feature (CF3) and (POF5), which is the reminder feature that enables women to create alerts or notifications for essential tasks, such as taking medication, attending appointments, staying on track with their breastfeeding goals, or meeting deadlines. Reminders, including mobile phone-based interventions and patient-centered reminders, have been shown to be effective in improving medication adherence and follow-up care in postnatal contraception and prenatal care settings[63]–[65].