Features, Design, and Adherence to Evidence-Based Behavioral Parenting Principles in Commercial mHealth Parenting Apps: Systematic Review.

Abstract

There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of "parent" apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT). This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components. A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53% (30/57) proceeded to the final evaluation of level of adherence to BPT principles. In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44% (25/57) were available on both the Google Play and Apple App Stores and 68% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74%, SD 11%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development. Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development.