International Journal of Human–Computer Interaction

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Mobile Technologies and Healthy Ageing: A

Bibliometric Analysis on Publication Trends and
Knowledge Structure of mHealth Research for
Older Adults

Farzana Parveen Tajudeen, Nurhidayah Bahar, Tan Maw Pin & Nor Izzati
Saedon

To cite this article: Farzana Parveen Tajudeen, Nurhidayah Bahar, Tan Maw Pin & Nor Izzati
Saedon (2022) Mobile Technologies and Healthy Ageing: A Bibliometric Analysis on Publication
Trends and Knowledge Structure of mHealth Research for Older Adults, International Journal of
Human–Computer Interaction, 38:2, 118-130, DOI: 10.1080/10447318.2021.1926115

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Published online: 26 May 2021.

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INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION
2022, VOL. 38, NO. 2, 118–130
https://doi.org/10.1080/10447318.2021.1926115

Mobile Technologies and Healthy Ageing: A Bibliometric Analysis on Publication

Trends and Knowledge Structure of mHealth Research for Older Adults
a
Farzana Parveen Tajudeen *, Nurhidayah Bahara, Tan Maw Pinb, and Nor Izzati Saedonb
a
Department of Operations and Management Information Systems, University of Malaya, Kuala Lumpur, Malaysia; bDepartment of Medicine,
University of Malaya, Kuala Lumpur, Malaysia

ABSTRACT
The use of mHealth technologies can help to improve older adults’ quality of life, and this has generated
more interest among the academic community. Publications in mHealth research have grown dramatically
from 2011 to 2020, and this has prompted the current study to conduct a bibliometric analysis of the articles
published in mHealth- and older-adult-related research. Data were extracted from 290 scientific articles
identified from the Web of Science (WOS) database. Significant journals, authors, citations, countries, and
research areas were then tabulated, and four important clusters of mHealth research were identified, namely,
self-management and quality of life; physical activities and risk; behavior, adherence, and barriers; followed
by adoption and acceptance of mHealth technologies. The outcome derived from this article serves as
a suitable reference for future researchers in locating any research gaps in mHealth, and in detecting relevant
articles needed for additional information. The analysis of this article highlighted older adults’ behavior, their
needs, and the barriers faced in using mHealth technologies. This information would, therefore, be of benefit
to technology designers in developing and promoting mobile applications and tools that are suitable for
older adult usage.

1. Introduction
According to the World Health Organization (WHO), the average
person tends to live longer than 70 years in today’s current state of
affairs, such that by year 2020, the total number of older adults
living in the world would be more than the number of young
children below five years of age. By 2050, the older adult popula­
tion would make up 22% of the overall world population (World
Health Organization, 2015), with 80% of them belonging to the
lower- and middle-income countries. High-income countries
would also be experiencing a similar phenomenon, for example,
30% of Japan’s population would comprise older adults by the
same year (World Health Organization, 2018). Comparatively,
today’s older adults are enjoying a longer life span since they
have been provided with better health-care services than the
times of their parents. The development of information and
communication technology is also contributory to the better
health care higher living standards, and wealth experienced by
older adults today. This is evidenced by today’s mobile healthcare
service delivery that had led to the emergence of mobile health
(mHealth), a technology that offers healthcare support via mobile
communication technologies (De La Vega & Miró, 2014; Shen et
al., 2018).
The last decade has seen an explosive surge of mHealth
innovations (Gutierrez et al., 2017). The rapid growth of the
mHealth market has been forecasted to reach USD 310.37 billion
by the year 2027, at a global growth rate of 28.8% (Reports and
Data, 2020). Results drawn from the 3rd global survey on eHealth
(World Health Organization, 2016) reported that about 87% of
countries that participated in the survey have at least one
mHealth government sponsored program in their country.
However, the survey results varied distinctively between low-
income and high-income countries. About 91% of the high-
income countries as compared to 80% of the low-income coun­
tries reported having at least one mHealth program. This per­
centage is, in fact, a high uptake in terms of mHealth for low-
income countries when contrasted with previous years. This is
also reminiscent of smartphone ownerships that can facilitate
mHealth, where the majority of older adults aged 50 years and
above and living in advanced countries own smartphones. In
contrast, less than 35% of older adults in emerging economies
own smartphones (Silver, 2019).
In today’s era, the smartphone is especially useful for health-
related matters, particularly to older adults. Smartphones and
mobile devices act as a medium for the older users in managing
their well-being (Vo et al., 2019). These applications enable
people to save their medical records, drug information, etc.,
into their smartphones. mHealth devices such as wearables
through their self-tracking features can collect and analyze per­
sonal health data and provide feedback to support healthy life­
style (Rieder et al., 2021). This advantage of the smartphones and
mHealth devices encourages older adults to be more accountable
for their own health management.

CONTACT Farzana Parveen Tajudeen farzanatajudeen@um.edu.my Department of Operations and Management Information Systems, Jln Profesor Diraja
Ungku Aziz, 50603 Kuala Lumpur, Malaysia
*These authors contributed equally to this work.
© 2021 Taylor & Francis Group, LLC
 INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 119

By taking into account the growing importance of mHealth 3. Methods

technologies which can support older adults in today’s mobile
As a bibliometric analysis, data were retrieved from the Web of
era, the current article aims to present a bibliometric analysis
Science (WOS) database with a time horizon of 10 years (2011–­
of various studies that had been conducted in the past to
2020). The extracted articles were indexed in the Science Citation
demonstrate the extent of mHealth- and older-adults-related
Index Expanded, the Social Science Citation Index, the Emerging
research performed thus far. The results derived from this
Sources Citation Index, and the Arts and Humanities Citation
bibliometric analysis could provide some knowledge on the
Index. The WOS database was selected because it confers high-
existing mHealth- and older-adults-related studies and offer
quality, reliable, and a wide range of integrated and multidisci­
some guidance to future researchers who are interested in this
plinary research from multiple sources (Dong & Chen, 2015;
research area. This review article also has other significant
Odriozola-Fernández et al., 2019; Shen & Naeim, 2017). The
practical implications. For instance, information on older
PubMed database was excluded, and this may be viewed as
adults’ mHealth adoption behavior, the need for elder-
a limitation. PubMed covers articles related to biomedical disci­
friendly mHealth applications, and the barriers that hindered
plines. In contrast, mHealth is a multidisciplinary field which
the older adults from adopting these technologies could pro­
comprises some aspects of technology, health, and other related
vide some insights for the mHealth technology developers.
areas. Therefore, by using a multidisciplinary database such as
This information could be used to design and develop more
WOS, better results could be yielded. The extracted articles were
suitable applications for older adults. The results derived from
reviewed from various perspectives, including growth of the pub­
the analysis can also assist health-care professionals and care­
lications, main research topic and area, most productive country,
takers to understand the status of current technologies which
most productive and prominent author, articles with the highest
are used to track the activities of older adults, thereby helping
citation, most productive journal, author keyword analysis, and
them to provide adequate care, service and advice for the
content analysis.
target group. The review would also shed light on the existing
For the purpose of this article, several keywords such as
mHealth technologies for older adults such that they would be
“mobile health” or mHealth; “mobile app*”; and “senior citi­
motivated to use these applications or tools for self-
zen*” or “older adult*” or “elder*” were utilized. The symbol *
management of their daily activities in their pursuit of active
allows for the inclusion of the plural, and quotations were
and healthy aging.
used to search for an exact phrase. Since mobile health,
mHealth and mobile apps were used interchangeably as
2. mHealth and its benefits terms to represent mobile technologies, all these options
were also considered for the bibliometric analysis. Likewise,
The Global Observatory of eHealth survey (GOe) has defined
keywords like senior citizens, older adults, and elders were
mobile health, also known as mHealth, as the health practice
also used interchangeably to represent older people. Based on
of the medical profession and the public. It utilizes appropri­
keyword search, a total of 412 articles were retrieved. For the
ate digital technologies and mobile devices, including personal
document types, “Article” was used to extract a total of 328
digital assistants, mobile phones, monitoring devices, and any
records, excluding book chapters, books, or other documents.
other wireless devices (World Health Organization, 2016).
This article only used articles written in the English language
The evaluation and implementation of mHealth may poten­
which resulted in 316 records. The abstracts of the articles
tially help the public, such as older adults, to be more self-
were reviewed prior to the full text. As a result of this, a total
sufficient and independent in managing their health.
of 14 articles on mHealth or mobile apps with no focus on
Nonetheless, despite the increase in technology ownership
older adults were discarded. Twelve articles which examined
and usage, the usability and engagement of mHealth has
Internet and communication technologies that supported
remained at the average level (Quinn et al., 2019). A review
elderly users but not especially on mobile health technologies
of 36 articles focusing on mHealth technology for older adults
were also excluded. Figure 1 shows the selection process.
was conducted by Kruse et al. (2017). They found that
mHealth technology functions as a health-care assistive tool, This study uses the VOS viewer software which has been widely used
rather than its original function as a communication tool. The for bibliometric data analysis (Van Eck & Waltman, 2010).
Functions such as citation analysis, bibliographic coupling (when
study also identified three facilitators of mHealth adoption
two works cite the same third document), frequency of keywork
among older adults. They include feeling of independence occurrence, and co-occurrence of keywords (identifies the keywords
among older adults in managing their health, understanding that appear in the same work) (Odriozola-Fernández et al., 2019)
of mHealth application, and visibility of mHealth applica­ were also applied.
tions. They also noted three barriers of mHealth adoption
which encompassed complexity, limited usage, and ineffective
4. Results
practice. This means that the adoption of mHealth application
was solely dependent on the individual’s interest. Kruse et al. The analysis of the results is presented accordingly, based on
(2017) thus proposed that future researchers focus on the the following:
complexity of technology barriers, and on improving existing
health literacy of older adults in mHealth adoption. The
4.1. Year of publication
current study aims to contribute to future research by provid­
ing more details about the existing knowledge in this field of The number of publications focusing on mHealth in older adults
research. is graphically represented in Figure 2. The figure showed that the
120 F. P. TAJUDEEN ET AL.
Figure 1. Article selection process from WOS database.
number of publications has been growing at a steady pace, moving
from just one publication in 2011 to 73 publications in 2019. Data
for this article were collected from those published in 2011 until
the first quarter of 2020, thereby witnessing a total of 19 publica­
tions for 2020.
4.2. Research topics
Analysis of the 10-year period showed that research topics
had evolved from basic mHealth technologies to more
advanced ones. Articles published in the year 2011 to 2015
focused on the review of mobile functionalities that benefitted
older adults (Plaza et al., 2011), the design and development
of mobile devices for tracking the physical activities of older
adults and for promoting active lifestyles (Martín et al., 2013;
Weiss et al., 2013), the development of SOS phones (Paredes
et al., 2014), and mobile applications for health management
(Ellis et al., 2015; Grindrod et al., 2014; Kee et al., 2014;
Knight et al., 2014; Sannino et al., 2015; Zorluoglu et al.,
2015). In the same period of time, topics related to mHealth
adoption, willingness to use, and factors hindering the adop­
tion of mHealth technologies were also examined (Guo et al.,
2013; Nielsen & Mengiste, 2014; Parker et al., 2013; Shahrokni
et al., 2015).
Further analysis had shown that articles published in 2016 and
2017 focused on usability-related issues, such as assessing the
performance of mHealth applications (Ehrler et al., 2016). In the
same period of time, topics such as augmented reality (AR) in
mobile application development (Bormans et al., 2016), and adop­
tion of mHealth technologies (Abelson et al., 2017) were also
examined. A closer analysis of articles published from 2018 to
2020 showed that topics incorporating advanced technologies in
mHealth, such as game centered mobile applications (Shake et al.,
 INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 121

Growth in "mhealth and older adults" research

publica!ons
80 73
70
60
60
48
50 42
40
30 23
18 19
20
10 6
1
0
2011 2013 2014 2015 2016 2017 2018 2019 2020 (1st
Q)

Figure 2. Publications from 2011 to 2020.

2018), google glasses (Haesner et al., 2018), machine learning Table 2. Top 10 countries in mHealth and older adult research.
techniques (BalBalli et al., 2019; Tsinganos & Skodras, 2018), No. Country No. of Publications
robots (Zhou et al., 2018), neural networks (Galán-Mercant 1 USA 115
et al., 2019), IOT technologies (Addante et al., 2019; 2 Spain 22
3 Canada 19
Durán-Vega et al., 2019), WeChat (Li et al., 2019), real-time 4 People’s Republic of China 19
geolocation tracking (Gala et al., 2020), multimodal mid-air ges­ 5 England 16
6 Australia 13
ture, and speech-based interactions (Mich et al., 2020) had been 7 Germany 13
examined. Apart from these, some studies (Li & Luximon, 2020; 8 Netherlands 12
Morey et al., 2019) had also focused on the usability features of 9 Switzerland 12
10 Italy 11
existing apps, challenges faced by older adults, and guidelines to
improve the usability of mobile applications.

4.3. Research areas
The WOS database had categorized the 290 articles generated
from the search into 42 research areas. Most of the publica­
tions were categorized under health-care services (30% of
articles), and medical informatics (26% of articles) which
addressed various health-related issues. This is followed by
computer science (20%) which looked at the development of
technologies including mHealth tools that support older
adults. Other articles were categorized under Engineering,
Geriatrics Gerontology, Telecommunications, and others.
Table 1 lists the top 10 research areas.
4.4. Countries
In the analysis, it was found that authors of the 290
published articles were from 51 countries, with the USA
Table 1. Top 10 research area.
No. Research Area No. of Articles
1 Health Care Sciences Services
2 Medical Informatics
3 Computer Science
4 Engineering
5 Geriatrics Gerontology
6 Telecommunications
7 Instruments Instrumentation
8 Nursing
9 Public Environmental Occupational Health
10 Chemistry
ranking first, with 115 articles which contributed to 40%
of the total publications. Followed by Spain which pub­
lished 22 articles, and then Canada and the People’s
Republic of China, with 19 articles each. England,
Germany, and Australia produced 13 articles, respectively,
while the Netherlands and Switzerland produced 12 arti­
cles, and Italy contributed a total of 11 articles. Table 2
shows the 10 countries that were productive in publishing
articles related to mHealth and older adults.
Further analysis was carried out to examine the biblio­
graphic coupling of the countries. Bibliographic coupling
occurs when two or more countries cite the same third docu­
ment. Figure 3 shows the bibliographic coupling of the coun­
tries. The results showed that these countries could be
classified into four clusters. Countries in the red cluster
(USA, Canada, Spain, Portugal, People’s republic of China,
South Korea, Taiwan, Ireland, and Sweden) tend to have
higher bibliographic coupling in terms of citing other coun­
tries within their own cluster than countries in other clusters.
% of 290 The shorter the distance between the nodes, the stronger the
88 30
74 26
relation between them. For instance, the distance between the
57 20 USA and Canada is shorter; this shows the strong relation
32 11 between the two countries in terms of bibliographic coupling.
30 10
15 5 In addition, the size of the country’s icons represented the
13 4 number of articles published in the country. Figure 3 shows
13 4
13 4 that the USA icon was larger; hence, it produced more articles
11 4 in mHealth and older adult research.
122 F. P. TAJUDEEN ET AL.
Figure 3. Bibliographic coupling of countries.
4.5. Most productive journals in mHealth- and
older-adults-related research
Analysis further showed that mHealth- and older-adults-related
research had been published in 170 journals between 2011 and
2020. shows the top 20 journals which were ranked accordingly,
and then evaluated based on the number of citations. It appears
that Journal of Medical Internet Research (JMIR) mHealth and
uHealth journal was the most productive, with 39 publications,
and garnering a total of 416 citations. The second most productive
was the JMIR, with 11 articles and 373 citations. It was interesting
to note that some journals with only one publication were also able
to get high citations. For instance, the journal Neurorehabilitation
and Neural Repair had published only one article in 2013, but the
article had garnered 112 citations. Likewise, the Journal of Systems
and Software had also published one article, and the article had
accumulated a total of 108 citations.
These results highlighting the most productive journals in
mHealth field would be more beneficial if further investigations
were conducted on their impact factor. According to the Clarivate
analytics, impact factor is commonly used to evaluate the relative
importance of a journal (Gann, 2019) within its field, and to
measure the frequency with which the “average article” in
a journal has been cited in a particular time period (Sharma
et al., 2014). In the current study, the impact factor of the most
productive journals was retrieved from the Journal Citation
Reports, listed on the WOS official website. The analysis of results
showed that the IEEE Internet of Things journal had the highest
impact factor of 9.515 for 2018, and a five-year impact factor of
11.216. Next in line was the JMIR, which had an impact factor of
4.945 for 2018, and a five-year impact factor of 6.204. The third in
line was the JMIR mHealth and uHealth journal, which had an
impact factor of 4.301 for 2018, and a five-year impact factor of
5.150. This analysis showed that articles on mHealth- and older-
adults-related research were published in quality journals that also
carried high impact factor Table 4. The high citations of these
articles showed the relative importance of the topic, as illustrated
in Table 3.
4.6. Articles with high citations
The 10 most cited articles were also examined, as presented in
Table 5. It appears that the article produced by Lyons et al.
(2014) and published in the JMIR had obtained the highest of
191 citations. This article reviewed the behavior change tech­
niques that were available in the activity monitoring devices,
as offered in the market. Comparisons were then made of the
activities of these monitors which were noted to support the
users, especially older adults.
The next article by Weiss et al. (2013) which was published in
the Neurorehabilitation and Neural Repair journal had gathered
a total of 112 citations. The study had used the accelerometer to
examine fall risks among older adults in a home setting.
Following this is the article by Plaza et al. (2011), published in
the Journal of Systems and Software, which had received 108
 INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 123

Table 3. Most productive journals on mHealth and older-adult-related research.

No. Journals *Total Publications *Total Citations Impact Factor (2018) 5 Years Impact Factor (2013–2018)
1 JMIR mHealth and uHealth 39 416 4.301 5.150
2 Journal of Medical Internet Research 11 373 4.945 6.204
3 Sensors 11 137 3.031 3.302
4 Neurorehabilitation and Neural Repair 1 112 3.757 4.366
5 Journal of Systems and Software 1 108 2.559 2.774
6 International Journal of Medical Informatics 5 107 2.731 3.146
7 Personal and Ubiquitous Computing 1 85 1.735 2.061
8 BMC Geriatrics 4 77 2.818 3.458
9 PLOS ONE 3 56 2.776 3.337
10 Journal of Telemedicine and Telecare 3 53 2.229 2.443
11 Mobile Networks & Applications 1 53 2.390 2.881
12 Electronic Markets 1 48 3.553 3.487
13 Telemedicine and e-Health 6 46 1.996 2.339
14 The American Journal of Geriatric Psychiatry 3 39 3.488 3.886
15 British Journal of Clinical Pharmacology 1 39 3.867 4.205
16 Applied Ergonomics 1 37 2.610 2.597
17 EEE Internet of Things Journal 1 35 9.515 11.216
18 Neurocomputing 1 30 4.072 3.824
19 European Archives of Oto-Rhino-Laryngology 1 29 1.750 1.683
20 IEEE Transactions on Parallel and Distributed System 1 28 3.402 4.366
*Total Publication refers to the total number of returned mHealth- and older-adult-related articles that are published in the particular journal (based on the search
results of WOS database)
*Total Citations refers to the total citations obtained by the returned mHealth- and older-adult-related articles that are published in the particular journal (based on
the search results of WOS database)
*Impact factor refers to the journals’ overall impact factor.

citations. This article was also a review article that had described
the strengths and weaknesses of mobile applications that could
be used by older adults. The outcome of the article provided
information on the trends and areas of research that could be
conducted in the future.
Following the above were eight more articles that had accumu­
lated a total of 50 citations. These articles which were authored by
Martín et al. (2013), Mercer et al. (2016), and Lane et al. (2014) had
analyzed the activity of recognition, and the design of the activity
trackers in wearables or mobile devices. Two articles produced by
Hoque and Sorwar (2017) and Parker et al. (2013) had investigated
the adoption of mHealth and mobile applications, while the article
by Grindrod et al. (2014) examined user perception of the usability
features of mobile applications. The article by (Gee et al., 2015)
reviewed e-health tools that supported the chronic self-
management system which led to the recommendation for
a revised e-health chronic care model (eccm), and finally, the
article by Mira et al. (2014) examined the design and implementa­
tion of medication and self-management apps. Table 4 presents
the outcomes accordingly.

Table 4. Top 10 articles with high citations.

R Authors Article Title Journal Y TC ACPY
1. Lyons, Elizabeth J.; Lewis, Zakkoyya H.; Mayrsohn, Brian G.; Behavior Change Techniques Implemented in Journal of Medical 2014 191 27.29
Rowland, Jennifer L. Electronic Lifestyle Activity Monitors: A Systematic Internet Research
Content Analysis
2. Weiss, Aner; Brozgol, Marina; Dorfman, Moran; Herman, Does the Evaluation of Gait Quality During Daily Life Neurorehabilitation 2013 112 14
Talia; Shema, Shirley; Giladi, Nir; Hausdorff, Jeffrey M. Provide Insight Into Fall Risk? A Novel Approach and Neural Repair
Using 3-Day Accelerometer Recordings
3. Plaza, Inmaculada; Martin, Lourdes; Martin, Sergio; Medrano, Mobile applications in an aging society: Status andJournal of Systems 2011 108 10.8
Carlos trends and Software
4. Martin, Henar; Bernardos, Ana M.; Iglesias, Josue; Casar, Jose R. Activity logging using lightweight classification
Personal and 2013 85 10.63
techniques in mobile devices Ubiquitous
Computing
5. Hoque, Rakibul; Sorwar, Golam Understanding factors influencing the adoption of International 2017 74 18.5
mHealth by the elderly: An extension of the UTAUT Journal of Medical
model Informatics
6. Parker, Samantha J.; Jessel, Sonal; Richardson, Joshua E.; Older adults are mobile too! Identifying the barriers BMC Geriatrics 2013 74 9.25
Reid, M. Cary and facilitators to older adults’ use of mHealth for
pain management
7. Gee, Perry M.; Greenwood, Deborah A.; Paterniti, Debora A.; The eHealth Enhanced Chronic Care Model: A Theory Journal Of Medical 2015 65 10.83
Ward, Deborah; Miller, Lisa M. Soederberg Derivation Approach Internet Research
8. Mercer, Kathryn; Li, Melissa; Giangregorio, Lora; Burns, Behavior Change Techniques Present in Wearable JMIR mHealth and 2016 62 12.4
Catherine; Grindrod, Kelly Activity Trackers: A Critical Analysis uHealth
9. Grindrod, Kelly Anne; Li, Melissa; Gates, Allison Evaluating User Perceptions of Mobile Medication JMIR mHealth and 2014 58 8.29
Management Applications With Older Adults: uHealth
A Usability Study
10. Lane, Nicholas D.; Lin, Mu; Mohammod, Mashfiqui; Yang, BeWell: Sensing Sleep, Physical Activities and Social Mobile Networks & 2014 53 7.57
Xiaochao; Lu, Hong; Cardone, Giuseppe; Ali, Shahid; Doryab, Interactions to Promote Wellbeing Applications
Afsaneh; Berke, Ethan; Campbell, Andrew T.; Choudhury,
Tanzeem
*R is Ranking, TC is total citations, Y is year, and ACPY is average citations per year. The ranking is given based on number of citations, if there is a tie then ACPY is used.
124 F. P. TAJUDEEN ET AL.

4.7. Most productive authors most frequently used keyword in 79 occurrences. The next
keyword was “older adults”, with a total of 46 occurrences,
In looking at the most productive authors, the current analysis
while the keyword “mobile health” occurred 29 times. This is
uncovered a total of 1477 authors who had conjointly pub­
followed by “physical activity” which occurred 27 times, and
lished a sum of 290 articles. A detailed examination showed
finally, “elderly” which occurred 20 times.
that Bartels, S. ranked top, with a total of sevenarticles and 35
Among the clusters, it appears that the red cluster carried
citations. The low citations, in this case, could be due to the
a greater number of keywords which comprised “mobile applica­
fact that most of the articles authored by Bartels, S. were
tion”, “mobile phone”, “mobile devices”, “wearables”, “mHealth”,
recently published, from 2018 onwards. Ranking second was
“health behavior”, “aged”, “heart failure”, and “adherence”. These
Grindrod, K. who published five articles with 133 citations.
keywords also co-occurred in the respective articles. For instance,
The next author(s) in line were Lohman, M, Fortuna,
studies investigating mHealth, mobile phones, or mobile applica­
K and Naslund, J.A., including Bartels, S., who had conjointly
tions were similarly noted to contain keywords like “medication
published four articles. It is interesting to note that the articles
adherence”, “heart failure”, and “health behavior of aged people”.
by Lewis, Z.H. and Lyons, E.H. had received a total of 222
All these outcomes are highlighted in Figure 4.
citations, the highest, for a mere sum of two articles, of which,
one had reviewed the behavior change techniques in activity
monitoring devices. This article had garnered a total of 191 4.9. KeyWords Plus analysis
citations, and it was also listed as the number one article, with
To understand the knowledge structure of the field, the
the highest citation, with the most influential article heading
KeyWords Plus analysis was performed. KeyWords Plus are
(as noted earlier). Table 5 further illustrates.
the words generated through computer algorithms; they refer
to frequently used words or phrases noted in the titles of
4.8. Analysis of keywords articles (J. Zhang et al., 2016). KeyWords Plus analysis enables
the article contents to be captured with great depth and in
To understand the key contents of the articles, an analysis on variety (Garfield & Sher, 1993). In the case of the current study,
author keywords was performed. The number of occurrences of KeyWords Plus terms noted in the 290 articles were analyzed
author keyword represents the frequency of a keyword, whereas to identify the knowledge structure of mHealth- and older-
co-occurrence is defined as the pair of keywords occurring adults-related research. A total of 770 keywords were discerned
simultaneously (J. Zhang et al., 2016). The analysis revealed from the KeyWords Plus featured in the VOS viewer. Upon
a total of 946 keywords generated from 290 articles. After limit­ limiting them to a minimum of 10 occurrences, only 30 key­
ing this activity to a minimum number of five occurrences of the words with four clusters were revealed. The most frequently
keyword, a total of 37 frequently used keywords were detected. occurred keywords include “older adults” (65 counts), “health”
These keywords were then placed under six different clusters, (48 counts), “technology” (39 counts), “management” (36
based on their links. These six clusters were indicated with counts), and “care” (25 counts).
different colors, as shown in Figure 4. The distance between Figure 5 shows the four clusters with keywords and links
the nodes indicates the strength of the relation. For instance, which help to explain some of the main streams of research
the strong relation between mHealth and mobile health is noted conducted under mHealth and older adults. The red cluster
in its proximity to each other. Likewise, the strong relation indicates the maximum number of keywords (nine keywords).
between older adults and aging is also indicated in the short It highlights research related to self-management and quality
distance between the two words. of life. The green cluster (eight keywords) points to research
The weight of the keyword is determined by the node size. related to physical activities, exercises, and risks. The blue
As expected, “mhealth” node appeared to be bigger; it was the cluster (seven keywords) shows research related to behavior,
adherence, and barriers, and finally, the yellow cluster (five
Table 5. Productive authors. keywords) showcases research related to adoption, acceptance
No. Name No. of Articles No. of Citations of mHealth, and technologies.
1 Bartels, Stephen J. 7 35
2 Grindrod, Kelly 5 133
3 Lohman, Matthew C. 4 32 4.10. Content analysis of articles
4 Fortuna, Karen l. 4 20
5 Naslund, John A. 4 8 Past studies have consistently proven that mHealth technologies
6 Guo, Xitong 3 56 and mobile applications positively impact our daily lives and
7 Mertens, Alexander 3 38
8 Dadema, Tessa 3 10 health care, besides being useful for treating diseases (Y. Zhang
9 Engelbert, Raoul H. H. 3 10 et al., 2019). The development of mHealth applications is useful
10 Krose, Ben J. A. 3 10
11 Mehra, Sumit 3 10 for supporting older adults and their well-being, This is espe­
12 Van Den Helder, Jantine 3 10 cially so for those with critical conditions like hypertension,
13 Visser, Bart 3 10 diabetes, Alzheimer's disease, and other physical or cognitive
14 Weijs, Peter J. M. 3 10
15 Batsis, John A. 3 3 impairments. Undeniably, mHealth applications have the poten­
16 Lewis, Zakkoyya H. 2 222 tial to encourage older adults to self-manage their health activ­
17 Lyons, Elizabeth J. 2 222
18 Li, Melissa 2 120 ities, thereby easing the burden of care-takers.
19 Giangregorio, Lora 2 66 In conducting the bibliometric analysis, this article had
20 Mercer, Kathryn 2 66
detected that topics related to self-management were an

Figure 4. Author keyword analysis.
important research area. The results indicate that the studies in
this cluster were related to the designs and the implementation
of mobile applications and technologies, which were aimed at
improving older adults’ quality of life. In this regard, researchers
like Chhabra et al. (2018); Ellis et al. (2015), and Wali et al.
(2019) had developed mobile applications which could support
older adults suffering from aging-related issues, such as
Parkinson’s disease, chronic back pain, heart-related issues,
and others. Their studies had mainly projected the importance
of self-care among older adults. Thus, it can be seen that the
development of more useful and convenient mHealth applica­
tions would facilitate self-management among older adults.
The second cluster of articles was observed to be related to
physical activities and risks associated with older adults. Aging
may cause older adults to lose their physical and mental abilities,
thereby increasing the risk of illness and death, in some serious
circumstances. An unexpected fall, for example, can be very risky
for older adults. Previous researchers such as Kronbauer et al.
(2018), Lane et al. (2014), and Martín et al. (2013) had developed
mHealth applications which could track the physical activities,
such as walking, running, sitting, standing, sleeping, and falling,
of older adults. Based on the recognized activities detected by the
applications, appropriate feedback would be given to the older
adults. Some mHealth applications also provide notifications to
caretakers during emergency situations, such as when encoun­
tering a fall. Past studies (Bisio et al., 2017) had also incorporated
INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 125
more current technologies like the Internet of Things (IOT) and
advanced sensors which can enhance the accuracy in recogniz­
ing the activities and movements of older adults. The informa­
tion harvested from these applications could be useful for
physical rehabilitation purposes. This suggests that having
a device that could track the physical activities of older adults
is crucial, as has been evidenced by past studies which were
conducted to develop more suitable activity trackers.
Subsequently, these trackers can be used to monitor older adults’
movement, thereby mitigating risks associated with aging.
Analysis further showed that the third cluster of studies
had focused on older adult behavioral changes, their adher­
ence to medication, and the barriers related to older adults’
usage of mHealth technology. It appears that aging issues,
such as deteriorating physical strength, and weaker memory
could lead older adults to have inactive lifestyle behaviors.
Likewise, non-medication adherence could affect older adults’
wellbeing. Findings of past studies had shown that existing
electronic activity monitors contained a wide range of beha­
vior change techniques. When used properly, these can pro­
vide feedback about older adults’ behavior. This information
can then be used for improving older adults’ movements and
their health activities (Lyons et al., 2014; Mercer et al., 2016).
Similarly, medication adherence-related features in mHealth
apps could be used to remind older adults on taking the right
dosage of medication at the right time. This can be useful for
126 F. P. TAJUDEEN ET AL.
Figure 5. KeyWords Plus analysis.
preventing any mishaps caused by medication nonadherence
among older adults (Conway et al., 2018). Despite their use­
fulness, current mHealth tools also seemed to suffer from
some constraints. For instance, they lack practical functions
like planning or providing instructions to older adults; they
are costly, they lack user-friendly features for older adults,
they contain some usability problems, and they also incur
issues related to privacy and confidentiality (Parker et al.,
2013; Pywell et al., 2020; Wildenbos et al., 2019). Based on
this cluster of articles, some design guidelines for developing
mHealth applications were captured. It is recommended that
mHealth applications incorporate more behavior change tech­
nique features such as planning features or giving instruction
features which can help older adults to plan their activities
and to be better informed. In this regard, it is vital that proper
instructions and guidelines that support medication adher­
ence and other health-related activities can be incorporated
into mHealth applications. Further, mHealth applications also
need to be more affordable for older adults. They should also
be secure and contain user-friendly features which are suitable
for older adults.
The final cluster of the articles (Alsswey & Al-Samarraie,
2020; Hoque & Sorwar, 2017; Ma et al., 2016; Yang & Lin,
2019; etc.) had investigated the adoption and acceptance of
mHealth technologies among older adults. These articles were
able to detect the usefulness, ease of use, the cost of the
mHealth applications, social influence, facilitating conditions,
resistance to change, and the attitude of the users, as some of
the factors affecting older adults’ intention to use mHealth
technologies. All these factors need to be considered in the
design, development and implementation of mHealth tech­
nologies for older adults.
5. Discussion
The findings derived from the current bibliometric analysis
indicate that the number of mHealth studies had increased,
from only one published article in 2011 to 73 articles in 2019,
and a total of 19 articles published in the first quarter of 2020.
The increasing trend of this research area demonstrates the
increasing interest in the topic as well as its importance. First
of all, this research area is a good opportunity for future
researchers to pursue as their research interest. Second, it was
evident that the research trend had developed from the advance­
ment of simple mHealth applications in the early years (2011 to
2015) to the inclusion of advanced technologies like IOT,
machine learning techniques, neural networks, and game-
based applications in the latter years (2016 to 2020).
Throughout the 10-year period, related research had covered
topics linked to adoption, usability, and acceptance of mHealth
technologies. This indicates that older adults’ adoption of
mHealth technologies had always been problematic; hence, it
had been extensively researched until today. Third, it was noted
that the top research areas related to mHealth studies ranged
from health-care services, medical informatics to computer
science, all of which accounted for 20–30% of the publications.
Since mHealth is a multidisciplinary field which combines the

health, medical, and technological aspects, most of the studies
also tended to focus on these areas of research.
In looking at the top three countries from which mHealth
articles had been published, countries like the USA, Spain, and
Canada came top in the list, suggesting that most research on
mHealth and older adults originated from developed and high-
income countries. A comparison of the current bibliometric
analysis was made with the (World Bank, 2019), and the out­
come showed that of the 51 countries that had published articles
in mHealth- and older-adults-related research, 44 were high-
income and upper-middle-income countries. In contrast, lower-
middle-income and low-income countries had published only
a total of seven (7) articles. Moreover, most of the countries that
were noted to be productive in mHealth- and older-adults-
related research tended to be developed nations. This distinction
highlights the gap in mHealth- and older-adults-related research
being conducted in developing countries. In that regard, more
research needs to be conducted in developing countries to
explore the use and impact of mHealth services for older adults.
Furthermore, the bibliometric analysis indicated that 90% of the
top 10 countries that published articles in this area comprised
European and North American countries. This shows that such
countries have a longer tradition of publishing articles in older-
adults-related and mHealth-related fields. It is also possible that
the high rate of publications contributed by these countries was
due to their high percentage of aged population who may have
required the mHealth services. This possibility has been
endorsed by the United Nations’ World Population Prospects
which reported that Europe and North America have the highest
number of aged populations in 2019, with 18% of them being
65 years old and above (United Nations, 2019)
In terms of productive journals, the JMIR mHealth and
uHealth journals was observed to have the highest number
of publications, followed by the JMIR. In terms of journal
impact factor, the IEEE Internet of Things had the highest
impact factor followed by the JMIR, and the JMIR
mHealth and uHealth journal. The findings in the journals
which had published articles involving mHealth and older
adults are important because the outcome would be able
to indicate new directions for future researchers, such as
which journal to focus on for reviewing the literature. This
exercise also highlights those top journals that prioritized
articles related to mHealth- and older-adults-related
research. In that regard, the outcome would be beneficial
to researchers aiming to submit their articles for future
publications.
In terms of author articles with high citations, the one
by Lyons et al. (2014) had received the highest number of
citations, followed by the article by Weiss et al. (2013).
Article citations are dependent on the year in which articles
were published, and in this regard, it was observed that
some articles published in 2018, 2019 and 2020 had not
been receiving high citations yet, due to the recent years of
publication. In this regard, analysis showing the important
articles with high citations in this field of research can serve
as a reference for future researchers. By reviewing these
articles, they can also identify some important topics that
may require further exploration.
INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 127
In terms of productive authors, without considering the
position of author (first, second, or subsequent author),
Bartels, S. was identified to be the most productive author
followed by Grindrod, K. The studies by Bartels focused
mainly on understanding obesity issues, and peer supported
medical self-management interventions for older adults,
whereas the studies by Grindrod focused on evaluating
the design of wearable activity trackers, testing usability
features for user authentications, and medication manage­
ment in mobile applications. One particular study by
Grindrod also looked at developing an interdisciplinary
research agenda to serve as a guide for future mHealth
research. Based on what was found, it can be said that
these findings on prominent authors would benefit future
researchers. They may refer to these authors’ work as the
pathway to identify more worthy research paths, thereby
contributing to their research ideas.
The analysis on keywords had also provided some inter­
esting results. Four research clusters were detected, and the
content analysis of these articles also highlighted some com­
prehensive details on mHealth- and older-adults-related
research. Several articles had investigated the design and
development of mHealth applications which could be used
to facilitate self-management (Chhabra et al., 2018; Ellis et al.,
2015; Wali et al., 2019) while others tracked the physical
activities of older adults to minimize risks associated with
aging (Bisio et al., 2017; Kronbauer et al., 2018; Lane et al.,
2014; Martín et al., 2013). Despite this, it was noted that most
of the existing applications were lacking in accuracy when
used for detecting older adults’ physical activities; hence, the
feedback provided was not very specific. In this regard, future
researchers and system developers may need to develop more
efficient mHealth applications by incorporating advanced
technologies such as IOT, machine learning, augmented, and
virtual reality which can help to track the physical activities of
older adults more accurately, thereby providing customized
feedback. With such applications, caretakers and health-care
workers, such as doctors, can be notified of an emergency
situation in real-time. Through this, they are able to respond
more quickly, and so prevent the situation from worsening.
Several researchers have also investigated barriers that pre­
vented older adults from using mHealth applications (Parker
et al., 2013; Wildenbos et al., 2019), and the factors affecting
their intention to use mHealth technologies (Alsswey & Al-
Samarraie, 2020; Hoque & Sorwar, 2017; Ma et al., 2016). By
understanding these constraints, it can be foreseen that sys­
tem designers and developers have the opportunity to further
improve the mHealth applications for older adult usage. It
would appear that before developing any mHealth applica­
tions, a study on user requirement needs to be conducted.
This could offer a more exact idea on older adult needs, such
as usability features, functions, user interface, colors, fonts
and others. Senior friendly and fun based features can be
included in mHealth applications. For instance, mHealth
applications may incorporate the exergame features which
combine the physical activity with simple game mechanics
which might encourage the older adults to use the applica­
tions and improve their health and wellness (Kappen et al.,
128 F. P. TAJUDEEN ET AL.
2019). Cost is also an important factor for older adults when
deciding to use mHealth applications; therefore, these
mHealth applications need to be affordable. Awareness and
training, without doubt, need to be extended to older adult
users too to get them familiarized. Likewise, their cultural,
geographical and language backgrounds also need to be con­
sidered when developing such mHealth applications. By tak­
ing into account all these factors, older adults may be
encouraged to adopt the use of mHealth applications.
Although the current review and analysis had provided
valuable information about mHealth technologies as noted
through the relevant studies, this study is also constrained
in some aspects. Firstly, the articles were retrieved from the
WOS database only. This implies that some important
articles that were accessible in other worthwhile databases
like PubMed and Scopus may have been inadvertently
omitted. Undeniably, PubMed offers a huge collection of
journals in life sciences and biomedical disciplines while
Scopus has been noted to offer the largest collection of
journals that also encompass scientific disciplines.
Therefore, future studies may consider using these data­
bases to conduct a more comprehensive review.
Secondly, there was a slight degree of bias in analyzing the
authors information. It is possible that the authors’ names in the
citations may have been used or written differently, for instance,
in some articles, initials of authors were used, whereas in other
articles, authors’ middle names were given in full. Some journals
had also cited the authors’ names differently due to a change in
name after marriage (Chang & Ho, 2010; Le et al., 2019). To
minimize such possibilities, the current study manually checked
the author names that had some differences, and then verified
them prior to analyzing the results. For instance, one author’s
(Grindrod, K.A.) name was written differently in different articles.
Some articles used the middle name initial while other articles
omitted the middle name initial (Grindrod, K.). This was identi­
fied during analysis and considered as the same author after
verification was done with the authors’ personal homepage, and
the university website in which the authors were affiliated with.
6. Conclusion
This article offers a critical review of many scholarly works
done in the field of mHealth and older adults. The findings
showed that research on mHealth and older adults is rising
rapidly, and it is expected to grow even more in the future.
Collaborations between countries to do comparative studies in
terms of mHealth technology development, and usage among
older adults, their behavior, acceptance, and barriers in using
mHealth technologies from different countries stance would
add an interesting perspective to this research area. Among
the contributions of this article are the detailed insights it
offers into mHealth- and older-adults-related studies which
could be useful for future researchers to gain knowledge on
the important topics, prominent authors, top articles in the
field, and citations. The outcome derived from the current
article may help the future researchers to identify the appro­
priate research gaps to improve future research ideas. This
article had offered an in-depth analysis of top journals which
had published mHealth-related research, and so future
researchers have an idea on where they may make their future
article submission. The outcome of this article is also of
significance to practitioners. For instance, one cluster of arti­
cles had highlighted the issues faced by older adults when
using existing mHealth technologies. Current mHealth tech­
nology developers should take this feedback as a point to
understand older adult needs to enhance the future design
of applications and tools. This review article also benefits
health-care professionals in terms of understanding what the
current mHealth technologies are offering as a tool to monitor
older patient, thereby providing better geriatric care. This
review article also offers new insights into older adults in
better understanding current mHealth technologies, and the
benefits to be gained. This could motivate them to use the
mHealth applications or tools for self-management of their
health activities, thereby promoting active and healthy aging.
Funding
This research was funded by University Malaya’s Impact-Oriented
Interdisciplinary Research Grant Programme (IIRG); grant number
(IIRG030A-2019).
ORCID
Farzana Parveen Tajudeen http://orcid.org/0000-0001-9903-7898
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About the Authors
Farzana Parveen Tajudeen is a Senior Lecturer in the Department
of Operations and MIS, University of Malaya. Her research
interests include technology adoption, social media impact, mHealth
applications, and artificial intelligence in business. She has published
articles in journals such as Information & Management, Management
Decisions, Telematics and Informatics, etc.
Nurhidayah Bahar is a Senior Lecturer at University of Malaya. She
received her master’s degree in Information Technology from University
Technology MARA and her PhD from University of Malaya. Her areas of
expertise are in the field of knowledge management, IT/IS, database, and
e-commerce.
Tan Maw Pin is a Professor of Geriatric Medicine at the University of Malaya.
She is currently the Principal Investigator for Life After Falls (LiAF) study
funded by University of Malaya IIRG grant and the Obesity, Sarcopenia and
Falls in Older Persons (OSFOP) study funded by Ministry of Education, FRGS
grant.
Nor Izzati Saedon is a medical lecturer at the Faculty of Medicine,
University of Malaya. Her areas of expertise are in the field of Geriatric
Medicine which includes Fall, Syncope, Arrhythmia, Blood Pressure,
Cognitive Impairment, Dementia, and Frailty.