@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2020;12(4):223-233

Background
Coronavirus is the cause of a wide range of viral diseases and leads to simple colds to severe diseases threatening general health, such as respiratory distress syndrome [1, 2].
Previous Studies
... [3-12]. With the spread of COVID-19, information has become available to the public through social media, as well as the possibility of using services through the Internet and recording a person's clinical condition [13]. ... [14, 15]. Despite the development of health applications, very few have been shown to achieve their most important goal to improve the health condition of patients [15, 16]. For this purpose, applications can be evaluated in terms of quality, safety, and their potential value for patients and physicians [15]. ... [17]. The Mobile Application Rating Scale (MARS) is one of the most widely used tools for measuring the quality and content of applications in the field of health [15]. ... [18].
Aim(s)
The aim of this study was to objectively evaluate the strengths or weaknesses, quality, and content of the Persian-Iranian health-oriented systems/sites and applications of COVID-19.
Research type
The present research was a descriptive study.
Research society, place and time
In this study, the feedback and information of Iranian health-oriented applications and systems (screening, prevention, and treatment) related to COVID-19 with direct and indirect interaction with users were examined in December 2020.
Sampling method and number
Keywords of system, site, software, application, app, installation, SARS-CoV-2, COVID-19, Coronavirus, self-assessment, health, care, counseling, Screening, prevention, follow-up, infection, disease, diagnosis, treatment, emergency, guidelines, education, online, and testing were searched using the Google, Yahoo, Bing websites and the markets of Cafe Bazaar, Myket, Charkhoneh, Anardooni, SibApp, Sibcheh. Then, the software and systems were examined and the items related to COVID-19 were studied.
Used devices&materials
Applications were evaluated based on the MARS. … [15]. Scoring was done on a Likert scale from 1 to 5 (1 = insufficient, 2 = poor, 3 = acceptable, 4 = good, 5 = excellent) [15, 19]. Technical and software features of the applications and systems according to the essential user registration information, being private or governmental (personal or individual), cost of use, being active or inactive, manufacturer, ability to update and share the application, providing a list of medical centers (introduction of medical centers/hospitals/clinics to receive health services), user location registration (latitude and longitude - GIS) and recording the location of high-risk people on the map (distribution of the geographical location of patients), showing the number of users, the number of installations and scoring (in Iranian markets, scoring is small and between 1 and 5) until the end of December 2020 were assessed. In addition to Persian, the use of other languages for non-Persian speakers was examined. The content of the applications and systems related to COVID-19 were then evaluated. Demographic characteristics (age, sex, height, and weight), risk factors (heart disease, asthma, bronchitis, diabetes, dialysis, cancer, chemotherapy, corticosteroids, AIDS, immune disorders, kidney failure, pregnancy, and history of organ transplantation), clinical symptoms (fever, chills, sore throat, shortness of breath, dry cough, pain and lethargy, diarrhea and vomiting, decreased sense of smell and taste) and their history while using programs and sites were evaluated. In addition, the feedback provided to the user by the system/application was categorized. These included any response to the user by health services: screening, care, prevention, follow-up, need for referral, the presence of a clinical guide/training files with a valid source, and the possibility of online consultation with a physician. Of the 318 applications searched for health-related keywords, 86 were related to COVID-19. There were 60 applications that were games or just provided statistics on the number of patients. Out of 26 hotlines/systems/applications/questionnaires, those that met the inclusion criteria and interacted with the user by providing feedback to promote health in the areas of prevention, screening, and treatment were selected. Also, 6 were questionnaires and did not give feedback to the user, which were excluded from the study. Of the 4 online counselors evaluated, 2 were excluded from the study because they were only voice messages and not interactive.
Findings by Text
A total of 18 systems, applications, and hotlines were evaluated in this study. The highest frequency (8 items) was related to the applications and included 4030, Safiran Salamati, COVID-19 Testing and Knowledge (VADA), COVID-19 News and Testing, COVID-19 Diagnosis, Corona-check, Coronaplus, and ZeroOne. Four items were systems and applications (Darmankade, Mask, CORONA115, and ZeroOne), 4 items were only systems (COVID-19-screening, COVID-19 Self-assessment-Ministry of Health, COVID-19 Online Testing, COVID-19 -Isfahan-checklist), and 2 cases were hotlines (4030 and 190). The online consultants and systems with the application all interacted directly with the user and 8 cases that were only applications had indirect interaction with the user. Only COVID-19 Online Testing allowed the user to select language both Persian and English. It has been between 1 and 8 months since the last update of the applications offered in Iranian markets. The shortest updates were found in the COVID-19 news and testing (2 months), Darmankade and Mask (1 month), and Corona-check (6 months), and the longest time was related to Coronaplus, 4030, Safiran Salamati (7 months), and ZeroOne (8 months). Mask, COVID-19-screening, COVID-19 news and testing, ZeroOne applications could display the diagram of the distribution of the patients with COVID-19 on a map based on a person's geographic information. However, none of them had the possibility of registering the user's location (GIS) to provide a diagram of the distribution of patients around the user. All evaluated applications and systems were available to users free of charge, and 50% of the applications were produced with the support of the Ministry of Health and Medical Education. The total number of downloaded applications was 941173 times and Mask had the highest number of downloads (74.4%). Also, 13,621 comments/feedbacks were submitted by users and the highest rate of comments was related to the Mask (49%) and ZeroOne (48.7%) applications. The COVID-19 news and testing (4.5) and Mask (4.4) applications showed the highest scores and Corona-check was found with the lowest score (2.9). One-third of the applications provided no above-mentioned information (Tables 1 and 2). Comprehensive questions about demographic characteristics, history of possible exposure to a patient with COVID-19 or high-risk sites, underlying risk factors, and the presence of clinical signs of COVID-19 were asked in the applications. Open questions were provided by the 190 and 4030 hotlines and based on the user's complaint/question were targeted for screening and treatment. The COVID-19-Isfahan-checklistsystem had two options for screening adults and children. Feedback provided to the user by the system/application was categorized in the following areas: - Confirmation of the exposure or the presence of risk factors, screening (confirmation of possible clinical signs of COVID-19); - The need to follow-up again at the recommended time; - The need to refer to a medical center to evaluate COVID-19 or follow up other diseases not related to COVID-19; - The possibility of online consultation with a doctor; - Care guideline if you need care at home; - Providing prevention guidance in cases of quarantine-isolation needs; - Providing a valid source for the provided guides and instructions. Information on demographic characteristics, underlying factors (risk), clinical signs, screening, and the need to refer to a physician or clinic was received and stored by all applications and systems; however, the information about the history of exposure was evaluated in 6 systems. The CORONA115 application, by guiding the individual in measuring the number of breaths per minute, identified the possibility of determining pulmonary involvement and the need for immediate referral to health centers. Providing feedback to users was provided in three forms of orally using telephone, SMS, or on the system page (Table 3). In addition to clinical care and prevention guidelines (quarantine and isolation), pamphlets, articles, audio-visual interviews, and videos and training videos of the COVID-19 were also provided. Of the cases evaluated, only the CORONA115 and COVID-19 Online Testing provided a reliable source for their training packages, guides, and instructions (Table 3). According to the MARS, the 4030 applications had the highest score with an average of 3.6, followed by Darmankade, Mask, and CORONA115. COVID-19 Testing and Knowledge (VADA)and Corona-check scored the lowest (Table 4).
Main comparison to the similar studies
... [20-23]. The popularity and use of these systems are at a very low level compared with other countries, such as Canada [24]. … [25-30]. According to the MARS, the scores were between 1.9 and 3.6 with an average of 2.6 out of 5. .... [18]. Only for two subscales of the information of the CORONA115 application and the performance of Darmankade, scores above 4 were obtained. The Darmankade application was used by users to consult with general practitioners and specialists before the COVID-19 outbreak and did not merely evaluate the COVID-19 and its advantage is related to the longer provision of paid health services. According to the MARS, the scores obtained in these applications were lower compared with similar English applications. In the United States and Europe, with the outbreak of COVID-19, families were provided with facilities using online telephone counseling for mild and moderate patients to use online electronic tools to reduce the visits to medical centers without paying and insurance, or with the minimum cost [31]. ... [32-39].
Suggestions
The effectiveness of COVID-19 applications on people's behavior and health was not investigated in this study and should be considered in future studies.
Limitations
One of the limitations of this study is that the programs are constantly updated and changed; thus, the programs reviewed may be updated to newer versions.
Conclusions
In this study, 12 applications were designed in the Persian language, but the acceptance and use of systems and applications related to COVID-19 were at a very low level.
Acknowledgments
The authors express their gratitude and appreciation for the help of the software and marketing experts of Asr Danesh Afzar Company, Mr. Amir Hossein Khodayari, Mohammad Javad Najmi, Abbas Davoodi Mehr, Sorena Pishdad, Mohammad Hossein Ghodsi Khameneh, and Ali Pasha Montaseri.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
This research was designed and implemented with the support of Janbazan Medical and Engineering Research Center, Tehran, Iran.

TABLES and CHARTS

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