A Social Network Analysis of the Financial Links Backing Health and Fitness Apps.

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To identify the major stakeholders in mobile health app development and to describe their financial relationships using social network analysis. We conducted a structured content analysis of a purposive sample of prominent health and fitness apps available in November 2015 in the United States, Canada, and Australia. We conducted a social network analysis of apps' developers, investors, other funding sources, and content advisors to describe the financial relationships underpinning health app development. Prominent health and fitness apps are largely developed by private companies based in North America, with an average of 4.7 (SD = 5.5) financial relations, including founders, external investors, acquiring companies, and commercial partnerships. Network analysis revealed a core of 41 sampled apps connected to 415 other entities by 466 financial relations. This core largely comprised apps published by major technology, pharmaceutical, and fashion corporations. About one third of apps named advisors, many of whom had commercial affiliations. Public health needs to extend its scrutiny and advocacy beyond the health messages contained within apps to understanding commercial influences on health and, when necessary, challenging them.