Translation and validation of the traditional Chinese Mobile App Rating Scale (MARS-TW) for evaluating mHealth apps.

Abstract

Background: Mobile health (mHealth) applications are widely used in Taiwan, yet their quality remains unregulated. The Mobile App Rating Scale (MARS) is a validated tool for assessing mHealth app quality, but a Traditional Chinese version has not been developed and validated. This study aimed to translate and validate the traditional Chinese version of MARS (MARS-TW) and assess its reliability and validity using a cross-cultural adaptation framework.

Methods: A three-phase cross-sectional study was conducted: (I) conceptual and item equivalence were evaluated by three experts; (II) semantic equivalence was assessed through forward and backward translation; (III) operational, measurement, and functional equivalence were tested on 44 mHealth apps related to cancer care (CC) and hypertension self-management (HTM), rated independently by two reviewers.

Results: The expert review confirmed conceptual and item equivalence. Semantic equivalence was achieved through iterative refinements. Reliability testing demonstrated good internal consistency (Cronbach's α ≥0.80) and inter-rater reliability [intraclass correlation coefficient (ICC) ≥0.76]. Convergent validity was supported by strong correlations within subscales [item-subscale (I-S) correlation >0.3, item-total (I-T) correlation >0.2], while divergent validity was acceptable (subscale correlations <0.70, P<0.05).

Conclusions: MARS-TW is a reliable and valid tool for evaluating Traditional Chinese mHealth apps. Future research should explore its applicability across broader health-related app categories.