To validate the final Italian uMARS scale, we roughly followed the original methodology, as described by Stoyanov et al. (2016). We aimed to test the internal consistency and test-retest reliability of the scale.

To validate the questionnaire, we set a target of 100 individuals, a sample size in line with the original uMARS validation study [15]. Potential participants were selected from the University of Florence, Faculty of Medicine. Subjects who, on the day of enrollment, were able to navigate in the study target app from their devices were potentially eligible. Participants had to be sufficiently fluent in Italian.

The app chosen for uMARS validation was Facebook. There were several strong arguments for this choice: this app is free, popular and does not require participants to spend the time they would normally need to familiarize themselves with a new app, and Facebook contains all of the components covered by the four uMARS domains; therefore, all items could be confidently validated. The choice of Facebook was also related to the cost of downloading some health apps and the unavailability of some health apps on various mobile operating systems. Moreover, the use of certain health apps would have excluded some subjects from participating in the study.

Eligible subjects were instructed to navigate all the app functions for at least 10 min and then to rate the app by using the uMARS. In order to ascertain intra-rater reproducibility, this procedure was carried out twice: on enrollment (t1) and approximately two weeks later (t2); this time-lag was deemed an appropriate waiting period by the research team.

The study was conducted in accordance with the Declaration of Helsinki. Participation in this research was voluntary and all relevant Italian and international biomedical and privacy-related guidelines were followed. As the nature of the study was neither interventional nor biomedical, participants were not exposed to any risks. Therefore, formal ethical approval for this study was deemed unnecessary. Furthermore, all participants were enrolled on a voluntary basis, and our research group guaranteed their privacy.

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