App Quality Score Research Articles

Design overview and usability of the codesigned My Surgical Pathway E-health tool for supporting patient self-managed surgical preparation and recovery

IntroductionSurgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers. MethodsThis mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements. ResultsThe mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature. ConclusionsThe study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study.

The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three- and bottom three-rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app's perceived impact. The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app.

Design, Development and Evaluation of an Application based on Clinical Decision Support Systems (CDSS) for Over-The-Counter (OTC) Therapy: An Educational Interventions in Community Pharmacists.

Mobile health (mHealth) technology-based applications provide strong medical health-care support. Applications have an important impact as tools to improve the knowledge and support the health-care team practice. In this study, an over-the-counter (OTC) therapy application was developed based on Clinical Decision Support Systems (CDSS). CDSS is a key to improve health-related decisions and healthcare delivery. Furthermore, the quality and effectiveness of this application were evaluated among community pharmacists. The application was designed and developed for 10 topics of OTC therapy. After the approval of the expert panel, 40 pharmacists affiliated with Tehran University of Medical Science (TUMS) participated in this before and after quasi-experimental study. The related scenarios and checklists were designed for the ten topics. The participants had to manage the scenarios first by their knowledge and then with the application. The knowledge and pharmaceutical skills in OTC therapy were evaluated based on the obtained scores and the time recorded. The quality of the application was evaluated by pharmacists using user version of mobile application rating scale (uMARS) questionnaire. To compare before/after measurements of parametric and non-parametric data, we used the paired t-test and Wilcoxon matched-pairs test, respectively. Besides, the variables was compared using Mann-Whitney test. The statistical significance was considered at P<0.05. The analyses were performed using the statistical software Stata (ver. 13). All scores after using the application increased, and the P-value was not significant. Also, the recorded time was increased after the use of the application, and the P-value was not significant. The minimum mean scores of the six uMARS questionnaire sections were 3. It means that acceptable scores were obtained in all sections of the questionnaire. The "App quality score" section of the application was reported 3.45±0.94. No relationship was found between gender and the median score of each section of the uMARS questionnaire. The OTC therapy application developed in this study will help Persian-speaking pharmacists to increase their knowledge and pharmaceutical skills.

What Makes a Quality Health App? Developing a Global Research-based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: A Delphi Study.

The lack of an international standard for assessing and communicating health app quality and even of consensus about what makes a high-quality health app negatively affects uptake of such apps. At the request of the European Commission, international Standard Development Organizations (SDOs) CEN-CENELEC, ISO, and IEC have joined forces to develop a Technical Specification (TS) for assessing the quality and reliability of health and wellness apps. This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality. A two-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42) or both (n=41) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the at most 100 requirement questions for uptake of health apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries spanning 6 continents who participated in the SDO technical committees, were invited to comment on 4 working drafts and afterwards vote on the TS. The final quality assessment framework includes 81 questions, 67 of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as 'Healthy and safe', 'Easy to use', 'Secure data', and 'Robust build'. The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2 to 4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software - Part 2: Health and wellness apps - Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs from 6 continents. These included 6 of the 10 most populous countries worldwide (China, India, the US, Pakistan, Brazil, and Russian Federation). A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers to enhance and efficiently demonstrate the quality of health apps, consumers and healthcare professionals to make informed decisions on health apps, and insurers to make reimbursement decisions on health apps.

Smartphone applications for sleep tracking: rating and perceptions about behavioral change among users.

IntroductionThis study aims to assess existing sleep apps for mobile phones to determine the perceived effect of these applications on user’s attitudes, knowledge, willingness to change, and its likelihood to change behavior from a user’s perspective.Material and MethodsA systematic search was conducted through Google play store and iTunes Apple store using terms related to sleep tracking. Apps were evaluated using Mobile Application Rating Scale (MARS) tool for assessing and classifying mobile health applications quality. Additionally, a convenience sample of subjects were asked to evaluate the included apps for perceived sleep behavior changes.ResultsThe average MARS app quality score on a 5-point scale was 3.3. Between 30-50% of participants believed that sleep tracker apps are likely to increase awareness about sleep patterns and sleep hygiene, infuence sleep hygiene habits, and are likely to encourage help seeking for sleep hygiene when required.ConclusionApps available for sleep self-management and tracking may be valuable tools for self-management of sleep disorder and/or improving sleep quality, yet they require improvement in terms of quality and content, highlighting the need for further validity studies.

Parents' Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study.

BackgroundHuman papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation.ObjectiveWe aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback.MethodsStudy data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement.ResultsThe 98 parents were mainly female (n=94, 96%), 41 (5.67) years of age, college educated (n=55, 56%), and White and non-Hispanic (n=55, 56%) and had private health insurance for their children (n=75, 77%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88%), knowledge (84/95, 88%), and HPV vaccination intentions (64/95, 67%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73%-94%]). Parents also agreed that HPVCF is clear (86/95, 91%), accurate (86/95, 91%), and more helpful than other HPV vaccine information they had received (89/95, 94%) and that they would recommend it to others (81/95, 85%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality.ConclusionsHPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education.

A Preliminary Evaluation of Mobile Phone Apps to Curb Alcohol Consumption.

Mobile apps have become increasingly prevalent in modern society, and persuasive technology has a broader market than ever. Mobile-based alcohol cessation apps can promote positive behaviour change in users and improve the overall health of our society. This research aimed to understand the various features users respond to and make design recommendations for alcohol cessation apps. This paper reports on three sources of feedback (user ratings, user reviews, MARS App Quality score) provided on 20 alcohol cessation apps in the Google Play Store. Our findings suggest that self-control type apps received much greater positive user reviews than motivational apps. In addition, this trend was not observed through numeric user ratings. We also speculate on design recommendations for apps that are meant to inhibit alcohol intake.

Mobile health technologies for the monitoring of menstrual cycle: A systematic review of online stores in Brazil.

To perform a systematic review of available mHealth apps for menstrual cycle monitoring in Brazil. A search for menstrual cycle mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on October 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Our review identified 2400 potentially relevant mHealth apps, of which 56 were eligible for inclusion. The majority of the apps offered tools to track menstruation symptoms (63%) and educational content for users (32%). The mean ( ±SD) MARS app quality score for the 28 evaluated apps in Android was 3.5 ± 0.6 on a 0-5 scale. For the 28 evaluated apps in iOS, the mean app quality score was 3.8 ± 0.4. Most of the included apps, for both systems, scored average for credibility, user interface, and engagement. The majority of available tools in Brazil are of moderate quality and limited functionality for menstrual cycle monitoring. This study highlights the top three mHealth apps available on each online store for individuals seeking menstrual cycle monitoring options.

User-centered development of a smartphone application (Fit2Thrive) to promote physical activity in breast cancer survivors.

Increased moderate and vigorous physical activity (MVPA) is associated with better health outcomes in breast cancer survivors; yet, most are insufficiently active. Smartphone applications (apps) to promote MVPA have high scalability potential, but few evidence-based apps exist. The purpose is to describe the testing and usability of Fit2Thrive, a MVPA promotion app for breast cancer survivors. A user-centered, iterative design process was utilized on three independent groups of participants. Two groups of breast cancer survivors (group 1 n = 8; group 2: n = 14) performed app usability field testing by interacting with the app for ≥3 days in a free-living environment. App refinements occurred following each field test. The Post-Study System Usability Questionnaire (PSSUQ) and the User Version Mobile Application Rating Scale (uMARS) assessed app usability and quality on a 7- and 5-point scale, respectively, and women provided qualitative written feedback. A third group (n = 15) rated potential app notification content. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using a directed content analysis. The PSSUQ app usability score (M1= 3.8; SD = 1.4 vs. M2= 3.2; SD = 1.1; lower scores are better) and uMARS app quality score (M1 = 3.4; SD = 1.3 vs. M2= 3.4; SD = 0.6; higher scores are better) appeared to improve in Field Test 2. Group 1 participants identified app "clunkiness," whereas group 2 participants identified issues with error messaging/functionality. Group 3 "liked" 53% of the self-monitoring, 71% of the entry reminder, 60% of the motivational, and 70% of the goal accomplishment notifications. Breast cancer survivors indicated that the Fit2Thrive app was acceptable and participants were able to use the app. Future work will test the efficacy of this app to increase MVPA.

A Content Analysis of Free, Popular Low FODMAPs Diet mHealth Apps

ObjectivesCanada has one of the highest Irritable Bowel Syndrome rates (IBS) globally (18% vs. 11%). There is growing interest in the low FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols) diet as nutrition therapy for IBS. However, recognizing IBS symptoms and identifying low FODMAPs foods has been challenging for users. Mobile technology may be a convenient and cost-effective tool in helping users adhere to the low FODMAPs diet. The objective was to assess free, popular mobile Health (mHealth) Apps supporting a low FODMAPs diet. MethodsApple iTunes and GooglePlay App stores were searched on December 22, 2020, using pre-selected search terms. The top 100 returns were screened for eligibility. Free and popular (≥3 out of 5 ratings; ≥100 total reviews) mHealth Apps available in English and primarily marketed to help follow FODMAPs diets were included. Apps were downloaded and assessed by 3 nutrition professionals using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) tool. ResultsOf the 1304 screened Apps, n = 9 (mean ratings ± SEM = 4.4 ± 0.1) met the eligibility criteria for assessment, comprising 5 FODMAPs identifiers and 4 tracking/monitoring symptoms Apps. Apps targeted the general population, and 70% focused on nutrition education and food shopping. The Apps used education (9), skills training (5), and/or goal setting (5) as a behavior change tool. 3 Apps provided a cognitive behavioral therapy component. The MARS (rated out of 5) revealed a high overall App quality score (3.6 ± 0.2), credibility (3.1 ± 0.5) and subjective quality scores (2.9 ± 0.3). The AQEL (rated out of 10) revealed high scores in App function (6.2 ± 0.7) and purpose (7.4 ± 0.8), but low scores in behavioral change potential (5.2 ± 0.7), knowledge acquisition (5.4 ± 0.7) and skills development (2.4 ± 1.2). ConclusionsA small number of free FODMAPs diet Apps are available, with limited information on the nutritional adequacy and users’ compliance in following a low FODMAPs diet. Considering the need for careful assessment and management of IBS symptoms with the highly restrictive low FODMAPs diet, Apps should be evidence-based and designed with Behavioral Change Techniques and easy access to healthcare professionals that support Canadians in acquiring knowledge about the diet and in self-monitoring IBS. Funding SourcesNone.

A Content Analysis of Free, Popular Plant-Based Mobile Health Apps

ObjectivesThere has been an increased emphasis on plant-based foods and diets in numerous dietary guidelines worldwide. Although mobile technology has the potential to be a convenient and cost-effective tool to aid adherence to dietary guidelines, little is known about the content and the quality of available mobile Apps on plant-based diets. Therefore, the objective of the study was to assess free, popular mobile health (mHealth) Apps supporting plant-based diets for Canadians. MethodsUsing pre-defined search terms, Apple iTunes and GooglePlay App stores were searched on December 22, 2020; the top 100 returns for each search term were screened for eligibility. Free and popular (≥3 out of 5 ratings; ≥100 total reviews) mHealth Apps available in English, primarily marketed to help users follow plant-based diets were included. Included Apps were downloaded and assessed for quality by three research assistants/dietitians using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) tool. ResultsOf the 998 Apps screened, 16 Apps (mean ratings ± SEM = 4.5 ± 0.08) met the eligibility criteria for assessment, comprising 10 recipe manager and meal planners, 2 food scanners, 2 vegan community builders, 1 restaurant identifier, and 1 sustainability-focused App. All included Apps targeted the general population and focused on changing behaviours using education (14 Apps), skills training (14 Apps), and/or goal setting (5 Apps). Vegan, vegetarian or other plant-based (e.g., pescatarian, flexitarian) settings were available in 13 Apps, while 3 Apps offered no plant-based diet settings. The MARS (rated out of 5) revealed a high overall App quality score (3.84 ± 0.66) and subjective quality score (3.63 ± 0.62), but low credibility score (2.09 ± 0.36). The AQEL (rated out of 10) revealed high scores in App function (8.29 ± 0.47), purpose (8.11 ± 0.39), and behavioral change potential (8.35 ± 0.45), but a low score in support of knowledge acquisition (4.82 ± 0.43). ConclusionsAlthough a variety of free plant-based Apps with different focuses and behavioural change techniques are available to help Canadians follow plant-based diets, our findings suggest a need for credible Apps and other resources to complement the low support of knowledge acquisition in plant-based Apps. Funding SourcesBanting & Best Diabetes Centre.

Mobile Phone Apps in Australia for Improving Pregnancy Outcomes: Systematic Search on App Stores.

BackgroundWomen are increasingly turning to mobile health platforms to receive health information and support in pregnancy, yet the content of these platforms vary. Although there is great potential to influence health behaviors, little research has assessed the quality of these platforms or their ability to change behavior. In recent years, validated tools to assess app quality have become available.ObjectiveTo identify and assess the quality and ongoing popularity of the top 10 freely available pregnancy apps in Australia using validated tools.MethodsA systematic search on app stores to identify apps was performed. A Google Play search used subject terms pregnancy, parenting, and childbirth; the iTunes search used alternative categories medical and health and fitness. The top 250 apps from each store were cross-referenced, and the top 100 found in both Google Play and iTunes were screened for eligibility. Apps that provided health information or advice for pregnancy were included. Excluded apps focused on nonhealth information (eg, baby names). The top 10 pregnancy apps were assessed using the Mobile App Rating Scale (MARS). A comparative analysis was conducted at 2 time points over 2 years to assess the ongoing popularity of the apps. The MARS score was compared to the download and star rating data collected from iTunes and Google Play in 2017 and 2019. Health behaviors including breastfeeding, healthy pregnancy weight, and maternal awareness of fetal movements were reviewed for apparent impact on the user’s knowledge, attitudes, and behavior change intentions using the MARS perceived impact section and the Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy.ResultsA total of 2052 free apps were screened for eligibility, 1397 were excluded, and 655 were reviewed and scored. The top 10 apps were selected using download numbers and star ratings. All 10 apps were suboptimal in quality, practicality, and functionality. It was not possible to identify a primary purpose for all apps, and there was overlap in purpose for many. The mean overall MARS app quality score across all 10 apps was 3.01 (range 1.97-4.40) in 2017 and 3.40 (range 2.27-4.44) in 2019. A minority of apps scored well for perceived impact on health behavior using the MARS tool. Using the CALO-RE 40 item taxonomy, the number of behavior change techniques used was low. The mean number of behavior change techniques for breastfeeding was 5 (range 2-11), for pregnancy weight was 4 (range 2-12), and for maternal awareness of fetal movements was 5 (range 2-8).ConclusionsThis review provides valuable information to clinicians and consumers about the quality of apps currently available for pregnancy in Australia. Consideration is needed regarding the regulation of information and the potential opportunity to incorporate behavior change techniques to improve maternal and fetal outcomes.

A Critical Appraisal of Fertility and Menstrual Tracking Apps for the iPhone

This study sought to review and appraise Apple App Store applications (apps) designed for menstrual cycle tracking, ovulation prediction, and other topics related to fertility or the management of infertility. The Apple App Store was systematically searched using the keywords "period tracker," "menstrual tracker," "fertility," "ovulation," "IVF," and "in vitro fertilization." Apps were downloaded after being screened against pre-defined inclusion criteria. Included apps were independently reviewed by two authors. Data were extracted, and an app quality score (AQS) was calculated according to a premade rubric. Apps were assessed on the basis of their general features, menstrual cycle tracking and prediction features, infertility-related features, and usability. A total of 140 apps were included in the final analysis, of which 90 (64.3%) were free. The average AQS was 32.5%. There was no significant difference in AQS between free and paid apps (31.5% vs. 34.2%; P = 0.491). A total of 62 (44.3%) apps made dynamic cycle predictions on the basis of cumulatively input data. Thirty-one apps (22.1%) contained serious inaccuracies in content, tools, or both. Only 25 apps (17.9%) contained information or functions specifically related to infertility or its management. Some high-quality menstrual cycle tracking apps are available; however, many more are of low quality, and users should be wary of relying on their predictions to avoid pregnancy or to maximize chances of conception. Few apps specifically address the needs of patients struggling with infertility.

Patient focused oral hygiene apps: an assessment of quality (using MARS) and knowledge content.

Introduction Smartphone apps can be a valuable means for education and prevention to improve the health of children, adolescents and adults. A recent review of apps has revealed that there are over 1,000 patient-focused oral hygiene apps available on the Apple App Store and Google Play (Android) store.Objective The purpose of this research is to objectively assess the quality of 20 commercially available, patient-focused oral hygiene apps using the Mobile App Rating Scale (MARS). Furthermore, the accuracy of oral hygiene-related information contained within the apps will be assessed.Methods Apps meeting inclusion criteria were evaluated for: 1) quality using the MARS tool; and 2) information accuracy using an eight-item, evidence-based checklist relating to important aspects in the prevention of caries and periodontal disease.Results The mean app quality score was 3.4/5 (2.3-4.9). On average, of the four MARS subscales assessed, 'functionality' had the highest mean score (4) and 'information' had the lowest (2.9). With regard to the accuracy of information contained within these apps, only two were found to contain accurate information for all eight items of the checklist. The majority (60%) of the apps (n = 13) did not contain information relating to at least 50% or more of the items present.Conclusions Currently available apps appear to be functional, however, there is a need to improve engagement, aesthetics and most importantly information content of apps.

Patients' Experiences of Using a Consumer mHealth App for Self-Management of Heart Failure: Mixed-Methods Study.

BackgroundTo support the self-management of heart failure, a team of hospital clinicians, patients, and family caregivers have co-designed the consumer mobile health app, Care4myHeart.ObjectiveThis research aimed to determine patient experiences of using the app to self-manage heart failure.MethodsPatients with heart failure used the app for 14 days on their own smart device in a home setting, following which a mixed-methods evaluation was performed. Eight patients were recruited, of whom six completed the Mobile Application Rating Scale and attended an interview.ResultsThe overall app quality score was “acceptable” with 3.53 of 5 points, with the aesthetics (3.83/5) and information (3.78/5) subscales scoring the highest. The lowest mean score was in the app-specific subscale representing the perceived impact on health behavior change (2.53/5). Frequently used features were weight and fluid restriction tracking, with graphical representation of data particularly beneficial for improved self-awareness and ongoing learning. The use of technology for self-management will fundamentally differ from current practices and require a change in daily routines. However, app use was correlated with potential utility for daily management of illness with benefits of accurate recording and review of personal health data and as a communication tool for doctors to assist with care planning, as all medical information is available in one place. Technical considerations included participants’ attitudes toward technology, functionality and data entry issues, and relatively minor suggested changes.ConclusionsThe findings from this usability study suggest that a significant barrier to adoption is the lack of integration of technology into everyday life in the context of already established disease self-management routines. Future studies should explore the barriers to adoption and sustainability of consumer mobile health interventions for chronic conditions, particularly whether introducing such apps is more beneficial at the commencement of a self-management regimen.

Smartphone apps for total hip replacement and total knee replacement surgery patients: a systematic review

Purpose: The aim of this study was to critically examine the content of smartphone apps produced for patients undergoing total hip replacement and total knee replacement surgery.Materials and methods: A systematic search was conducted across the five most popular smartphone app stores: iTunes; Google Play; Windows Mobile; Blackberry App World; and Nokia Ovi. Apps were identified for screening if they: targeted total hip replacement or total knee replacement patients; were free of charge; and were in English. App quality assessment was conducted independently by three reviewers using the Mobile App Rating Scale.Results: 15 apps met the inclusion criteria. On the 5-point Mobile App Rating Scale, the mean overall app quality score was 3.1. Within the Mobile App Rating Scale, the “Aesthetics” subscale had the most inconsistency across all apps, generating the highest and lowest mean scores (4.7 and 1, respectively). The “functionality” subscale had the highest mean score (3.8) among the four subscales, and the “information” subscale had the lowest mean score (2.7).Conclusion: This study highlights that despite a wide range of apps currently available to total hip replacement and total knee replacement patients, there is significant variability in their quality. Future efforts should be made to develop apps in partnership with patients, to improve the content, interactivity and relevance of apps.Implications for RehabilitationClinicians and rehabilitation professionals should consider that patients are using Smartphone apps to supplement their rehabilitation and be aware of currently available apps.Although some apps show promise, at present there is no one openly available app which is clinically recommended for rehabilitation use following total hip replacement and total knee replacement.Rehabilitation professionals tailor recovery programmes to individual patient needs following total hip replacement and total knee replacement, and future apps should also consider personal needs.We recommend that patients are involved in all stages of designing and testing future total hip replacement and total knee replacement rehabilitation apps.

An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign.

BackgroundThe recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines.ObjectiveThe objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality.MethodsAt 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users.ResultsOver 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project’s Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ≤.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562% (95% CI 456%-4870%) for the app and 620% (95% CI 176%-1777%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9% (95% CI 0.0%-1.8%) for the app and 1.4% (95% CI 0.7%-2.1%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5% (397/500).ConclusionsDespite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted.

Is There an App for That? Assessing the Quality and Content of Apps for Asthma Management Available In Canada

Abstract BACKGROUND: Asthma is the most common chronic respiratory disease in Canada, with highest prevalence in children 5-17 years of age. The use of effective apps for asthma management for children and adolescents may decrease the significant morbidity of this disease. A wide range of apps designed to assist in the home management of asthma are available online. However, there are no published data assessing the quality and content of asthma apps for children and families in Canada. OBJECTIVES: To evaluate apps targeted at children or parents for the active management of asthma based on quality, accuracy of content and presence of advertising. DESIGN/METHODS: The iOS and Google Play stores were searched using the key terms “asthma”, “reactive airways”, “puffer”, and “wheeze”. Apps that were available in English or French, were interactive, were targeted at children or their families, and addressed the medical management of asthma were included. Apps were examined using a detailed data collection tool to assess usability and content. Quality criteria was based on a published, validated tool. Content was evaluated based on the Canadian Thoracic Society asthma guidelines. RESULTS: A total of 95 apps were screened, and 11 met the inclusion criteria. Average app quality score was 3.65 (range 2.63 – 4.38) out of 5. One app used 7 out of 7 CTS criteria in assessing asthma control, one used 6, six used 5, and three used 4. 10 out of 11 apps had the capacity to track symptoms, which was linked to level of asthma control based on CTS/CPS criteria. 8 out of 11 apps had the capacity to record medication doses in a journal format and provided daily medication reminders. 6 apps had the capacity to create and save a personalized asthma action plan. All apps used medications available in Canada. The most functional app based on these criteria was asthmamd, followed by AsthmaSense. One app was funded but a pharmaceutical company and had industry logo, but no significant brand bias. No other apps had specific industry advertising. None were specifically designed for use by children or adolescents. CONCLUSION: 11 relatively high-quality apps are available for asthma management for Canadian families. Of these apps, the ones that best match quality, adherence to CTS guidelines, and lack of marketing/branding are asthmamd and AsthmaSense. There exists a gap to create apps that are specifically targeted at children and adolescents with high functionality for managing asthma.