Bridging Language Gaps in Digital Health: Adapting MARS for French-Speaking Regions

Researchers adapted and validated the Mobile Application Rating Scale (MARS) into French, creating MARS-F, to ensure reliable assessment of mHealth apps in French-speaking regions, showing high alignment and scalability with the original scale. This tool supports better evaluation and selection of health-promoting apps, enhancing digital health interventions globally.

In recent decades, the proliferation of mobile health (mHealth) apps has skyrocketed, paralleling the rise in smartphone users globally. Despite this surge, the validation process for these health-promoting apps remains inadequate, posing a public health concern. Researchers from the Health, Systemic, Process, Research Unit 4129 at the University Claude Bernard Lyon 1, University of Lyon, and the Laboratory Anthropology, Health Law, and Medical Ethics at Aix-Marseille University have focused on addressing this issue. The Mobile Application Rating Scale (MARS), a widely recognized tool, is used to assess the quality of mHealth apps. However, MARS is not tailored to French culture or language. This study aimed to translate, adapt, and validate a French version of MARS, known as MARS-F.

Translating MARS: A Rigorous Process

The original MARS was translated into French by two bilingual scientists and back-translated into English by two native speakers to ensure accuracy. The comprehensibility of the French version was evaluated by six individuals, leading to the creation of the final MARS-F. Two bilingual raters then assessed 63 apps using both MARS and MARS-F, with their reliability evaluated through intraclass correlation coefficients. The internal consistency and validity of both scales were also examined using Mokken scale analysis. The translation process was meticulous, involving multiple stages to ensure the French version maintained the integrity and effectiveness of the original MARS. First, the translation from English to French was carried out by two independent bilingual scientists. Their translations were then reviewed, discussed, and merged into a single version. This version was blind back-translated into English by two native English speakers, each from different educational backgrounds. This rigorous process ensured that the final French version, MARS-F, was as close as possible to the original in terms of meaning and comprehensibility. The final version was then evaluated for comprehensibility by a diverse group of individuals, including both researchers and non-academic professionals.

Evaluating Apps: Consistency and Reliability

In the evaluation phase, two bilingual raters independently rated 63 health-related apps using both MARS and MARS-F. The apps were selected based on specific criteria from the French Apple Store and Google Play Store. The raters underwent training to ensure consistency in their evaluations, including downloading and testing apps to familiarize themselves with the rating process. The reliability of their ratings was measured using intraclass correlation coefficients, which indicated high alignment between the two scales. The internal consistency of the scales was also tested, with both MARS and MARS-F showing good to acceptable results across various dimensions, including engagement, functionality, aesthetics, and information quality. The overall internal consistency of the scales was found to be strong.

Mokken Scale Analysis: Assessing Validity

To further assess the validity and scalability of the scales, Mokken scale analysis was employed. This analysis revealed strong scalability for both MARS and MARS-F, indicating that the scales reliably measure the quality of mHealth apps. The results showed high correlation coefficients between the corresponding dimensions of MARS and MARS-F, ranging from 0.97 to 0.99. These findings suggest that MARS-F retains the robustness and reliability of the original MARS, making it a valuable tool for evaluating mHealth apps in French-speaking regions. The study underscores the importance of culturally adapting and validating assessment tools to ensure their effectiveness in different contexts. MARS-F addresses a significant gap by providing a reliable tool for French-speaking health professionals to assess the quality of mHealth apps. This adaptation is particularly crucial given the increasing reliance on digital health solutions for health promotion and disease prevention. The use of validated tools like MARS-F can help health professionals, researchers, and public health authorities make informed decisions about the quality and effectiveness of mHealth apps, ultimately benefiting end users.

Enhancing Digital Health Interventions

In conclusion, the development and validation of MARS-F represent a significant step forward in the evaluation of mHealth apps. By providing a reliable and culturally adapted tool, MARS-F enables better assessment and selection of health-promoting apps in French-speaking countries. This, in turn, can enhance the overall quality of digital health interventions, supporting better health outcomes through the use of validated and reliable mHealth apps. As the use of digital health tools continues to grow, the importance of such validated assessment scales cannot be overstated. They ensure that health apps meet high standards of quality, functionality, and user engagement, providing end users with effective and trustworthy health solutions. The success of MARS-F also highlights the potential for similar adaptations in other languages and cultural contexts, paving the way for more inclusive and comprehensive health app evaluations worldwide.

Future Adaptations: A Global Perspective

The potential for future adaptations of MARS-F into other languages and cultural contexts is immense. As digital health tools continue to expand globally, the need for reliable, validated assessment tools becomes increasingly critical. The success of MARS-F paves the way for similar efforts in other regions, ensuring that health apps worldwide can be evaluated for quality and effectiveness. This global perspective highlights the importance of cultural adaptation in health app assessment, ensuring that tools like MARS-F can be effectively used in diverse linguistic and cultural settings.