Health-related Apps Research Articles

Popularity of Mental Health Chatbots Grows

Popularity of Mental Health Chatbots Grows

Codesign and Feasibility Testing of a Tool to Evaluate Overweight and Obesity Apps.

Background: Digital health interventions and mobile technologies can help to reduce the rates of obesity and overweight conditions. Although weight management apps are widely used, they usually lack professional content and evaluation, so the quality of these apps cannot be guaranteed. The EVALAPPS project aims to design and validate a tool to assess the safety and effectiveness of health-related apps whose main goal is to manage and prevent obesity and overweight conditions. Objective: The aim of this paper is two-fold: (a) to co-create and codesign the EVALAPPS assessment tool and (b) to pilot its feasibility among overweight and obese individuals that use weight control apps. Methods: A mixed-methods approach was used. A multidisciplinary team (n = 12) participated in a co-creation workshop to provide proposals and inputs about the look and feel of the content, usability aspects, appearance, sections, and main features of the EVALAPPS tool. The tool was tested for its feasibility among 31 overweight and obese individuals, attending the CP Endocrinologia i Nutrició SL Clinic for the first time. Participants were asked to use a specific weight control app [Yazio (YAZIO GmbH, Erfurt, Germany), My FitnessPal (MyFitnessPal, Austin, TX, USA) or MyPlate (MyPlate, Santa Monica, CA, USA)] for two weeks and then evaluate them by using the EVALAPPS (EVALAPPS, David Ganyan, Barcelona, Spain) (June 2020, David Ganyan, Barcelona, Spain) tool. Seven participants were phone interviewed to gain more insight into the use of the EVALAPPS tool. Results: The co-creation workshop allowed conceptualizing the EVALAPPS tool. The feasibility study showed that all criteria from the Usability and Functionality dimensions had valid answers, while Reliability, Security, Privacy, and Health indicators were the dimensions with less valid answers. In all three apps, the dimension with the highest score was Usability/functionality, followed by app purpose. Clinical effectiveness and Development were the dimensions with the lowest scores in all three tested weight control apps. Conclusions: The participation of the multidisciplinary team and end-users in the conceptualization and testing of a tool to assess health apps was feasible and relevant for the usability of the tool.

A Novel Method for Evaluating Mobile Apps (App Rating Inventory): Development Study.

BackgroundSelecting and integrating health-related apps into patient care is impeded by the absence of objective guidelines for identifying high-quality apps from the many thousands now available.ObjectiveThis study aimed to evaluate the App Rating Inventory, which was developed by the Defense Health Agency’s Connected Health branch, to support clinical decisions regarding app selection and evaluate medical and behavioral apps.MethodsTo enhance the tool’s performance, eliminate item redundancy, reduce scoring system subjectivity, and ensure a broad application of App Rating Inventory–derived results, inventory development included 3 rounds of validation testing and 2 trial periods conducted over a 6-month interval. The development focused on content validity testing, dimensionality (ie, whether the tool’s criteria performed as operationalized), factor and commonality analysis, and interrater reliability (reliability scores improved from 0.62 to 0.95 over the course of development).ResultsThe development phase culminated in a review of 248 apps for a total of 6944 data points and a final 28-item, 3-category app rating system. The App Rating Inventory produces scores for the following three categories: evidence (6 items), content (11 items), and customizability (11 items). The final (fourth) metric is the total score, which constitutes the sum of the 3 categories. All 28 items are weighted equally; no item is considered more (or less) important than any other item. As the scoring system is binary (either the app contains the feature or it does not), the ratings’ results are not dependent on a rater’s nuanced assessments.ConclusionsUsing predetermined search criteria, app ratings begin with an environmental scan of the App Store and Google Play. This first step in market research funnels hundreds of apps in a given disease category down to a manageable top 10 apps that are, thereafter, rated using the App Rating Inventory. The category and final scores derived from the rating system inform the clinician about whether an app is evidence informed and easy to use. Although a rating allows a clinician to make focused decisions about app selection in a context where thousands of apps are available, clinicians must weigh the following factors before integrating apps into a treatment plan: clinical presentation, patient engagement and preferences, available resources, and technology expertise.

Expectations of a Health-Related Mobile Self-Management App Intervention Among Individuals With Spinal Cord Injury.

Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users' expectations and needs. The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis. Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants' expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app's potential, identified participants' interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants' desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community. By exploring end-users' expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review.

BackgroundSelf-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app–based self-care in PD is insufficient.ObjectiveThis study aimed to explore the features and characteristics of mobile apps for self-care in people with PD.MethodsThis study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including ”Parkinson disease” and ”mobile.”ResultsA total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management.ConclusionsMobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267374.

Impact of COVID-19 on the 937 Telephone Medical Consultation Service in Saudi Arabia.

The impact of COVID-19 on healthcare services has been profound. One major impact has been underutilization of traditional healthcare services by patients. In 2020, the Saudi Ministry of Health (MoH) started offering general COVID-19 enquiries, education, and medical and psychological consultations around the clock via their 937-Call Center. Given this major change, there was a need to understand the impact of the COVID-19 pandemic on Call Center services, specifically medical consultations, to suggest future recommendations for patient care optimization. This descriptive study analyzed routinely collected data on the 937-Call Center service between March 2020 and September 2020. Data were reviewed, coded, verified, and analyzed using SPSS v22. There was a 296% increase in the number of calls received by the 937-Call Center in 2020 compared to the same period in 2019. The majority of calls received in 2020 were general medical enquiries (98.41%), but about three million COVID-19-specific enquiries were also received in 2020. The increased number of calls was managed by accepting volunteers to handle calls: an average of 236 volunteers per month, handling about 20% of the total call volume. The majority of volunteers were physicians but with the presence of pharmacists, psychologists, and specialized healthcare workers such as nutritionists. Utilization of the 937-Call Center increased during the COVID-19 pandemic, suggesting that it has been an effective strategy for combatting the COVID-19 pandemic in Saudi Arabia. Further research is recommended to investigate the impact of COVID-19 on public awareness of the 937-Call Center and other health-related mobile apps.

The Impression of ICT in Medical Education throughout COVID-19 Pandemic: A Survey among Medical Graduates of Bangladesh

In COVID-19 pandemic, the importance of ICT in Medical education is amplified. The purpose of the study was to assess and estimate the role and impact of ICT in relation to learning on medical education and changing behavior of the students in the period of pandemic. A questionnaire survey approach was applied amid of the Bangladeshi medical undergraduates during the period of August, 2020 to November, 2020. A Google linked structured questionnaire was used and distributed to the study population via email, messenger and WhatsApp. The questionnaire was completed by 201 medical students, with 65% were female and 35% were male students. Almost all respondents (98%) owned an android smartphone and used it to access the internet. Two-thirds (69%) of respondents have medical and health related apps in their device, with Medscape being the most widely utilized app. Respondents (49%) encountered bandwidth trouble during online class. For collaborative learning with classmates, 76% respondents favored messenger and whatsApp group. ICT knowledge should be included in the curriculum, according to 57% respondents. Over one-third participants, 37.3%, were neither satisfied nor dissatisfied. 30.8% respondents were satisfied while 19.4% were dissatisfied. The long-term benefits and problems of reforming the medical education system and utilizing ICT technologies should be considered. In this pandemic circumstance, digitalization of learning can give essential foundations for future medical education, aided by ICT tools. Our study may be used as a foundation for future research into developing digital teaching models in medical education. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 58-68

A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study.

BackgroundSmoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic.ObjectiveThis study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app.MethodsIn all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app.ResultsThe results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement.ConclusionsFindings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary.

Clinical wisdom in the age of computer apps: a systematic review of four functions that may complement clinical treatment

Abstract Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps. Key learning aims (1) To understand what apps are currently available to treat clinical-level psychiatric problems. (2) To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations. (3) To understand how mental health services can be complemented by utilizing computer processing power within apps.

Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study.

BackgroundPoor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring.ObjectiveThe aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults.MethodsA total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively.ResultsThe relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments.ConclusionsHome-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results.Trial RegistrationChinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229

Proof-of-Vax: Studying User Preferences and Perception of Covid Vaccination Certificates

Abstract Digital tools play an important role in fighting the current global COVID-19 pandemic. We conducted a representative online study in Germany on a sample of 599 participants to evaluate the user perception of vaccination certificates. We investigated five different variants of vaccination certificates based on deployed and planned designs in a between-group design, including paper-based and app-based variants. Our main results show that the willingness to use and adopt vaccination certificates is generally high. Overall, paper-based vaccination certificates were favored over app-based solutions. The willingness to use digital apps decreased significantly by a higher disposition to privacy and increased by higher worries about the pandemic and acceptance of the coronavirus vaccination. Vaccination certificates resemble an interesting use case for studying privacy perceptions for health-related data. We hope that our work will educate the currently ongoing design of vaccination certificates, give us deeper insights into the privacy of health-related data and apps, and prepare us for future potential applications of vaccination certificates and health apps in general.

Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment.

BackgroundThe incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public.ObjectiveWe explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes.MethodsThis qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis.ResultsThe collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle.ConclusionsParticipants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior.

Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features.

BackgroundMany pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women’s health–related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women’s satisfaction with their prenatal care.ObjectiveOur objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system.MethodsA list of pregnancy apps was identified in the first 20 Google search results using the search term “pregnancy app.” After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features.ResultsA list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature.ConclusionsOur search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps.

The use of wearables and health apps and the willingness to share self-collected data among older adults

ObjectivesThe aim of this study was to examine the extent to which older adults utilize mobile health tracking tools in everyday life and their willingness to share the collected health-related data with doctors, health insurance companies, or research institutions. MethodsThis study used a survey to assess mobile device use (smartphone, tablet, fitness tracker, and smartwatch), health app use (e.g., health insurance apps, fitness apps), and willingness to share health-related data in 1,149 Swiss adults aged ≥ 65 years. Results75.0% of the participants used at least one mobile device; 22.9% used health-related apps. Younger individuals and those with a strong interest in new technology had a higher likelihood of using health apps. Participants were more often willing to share their data with doctors than with health insurance companies or researchers; this willingness was also influenced by an affinity for technology. DiscussionThese results support the promotion of mHealth adoption among older adults by developers and policymakers.

P100 Stakeholders’ Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Underserved Hispanic Mothers

<h3>Background</h3> Dietary behaviors, which impact chronic disease risk, are established early, making infant- and toddler-feeding education (ITE) critical to health. Using mobile applications (apps) for ITE shows promise: most Hispanics own smartphones (79%) and health-related apps are accepted among mothers. However, the viability of ITE apps for low-income Hispanic mothers remains unclear. Health professionals, who have insight into Hispanic mothers' needs, can help clarify ITE apps' potential. <h3>Objective</h3> To characterizing health professionals' views on low-income Hispanic mothers' capability, motivation, and barriers to using ITE apps. <h3>Study Design, Settings, Participants</h3> New York City-based health professionals with >3 years' experience and >1 encounter/week with low-income Hispanic mothers of infants and toddlers (6-24 months) completed a demographic survey and an in-depth, semi-structured virtual interview. Capability, Opportunity, Motivation, and Behavior (COM-B), a well-accepted Dissemination and Implementation framework, informed the interview guide. <h3>Measurable Outcome/Analysis</h3> A directed content analysis approach was used to identify themes using COM-B theoretical codes and subcodes. Transcripts were coded independently by 2 researchers using NVivo 12. Survey data were analyzed using descriptive statistics. <h3>Results</h3> Participants included pediatricians, dietitians, WIC practitioners, and Cooperative Extension educators (n = 13); 100% owned a smartphone and 85% used popular apps "several times a week" or more often. The following themes were identified: 1) Mothers are tech-savvy (ie, high capability and use of smartphones and apps); 2) Potential limits to using apps exist (eg, home Internet access, literacy barriers, and multiple Spanish dialects); and 3) Easily accessible information motivates app use but capturing and maintaining interest is challenging (eg, abundance of app options overwhelming; apps are potentially burdensome). <h3>Conclusion</h3> ITE apps are a viable option as skills and use appear high among low-income Hispanic mothers. Important considerations for app development include availability of features with limited Internet access; strategies for low literacy and multiple dialects (eg, more visuals, less text); targeted app promotion; and careful consideration of user engagement.

Goldilocks and the Three Bears: A Just-Right Hybrid Model to Synthesize the Growing Landscape of Publicly Available Health-Related Mobile Apps.

Mobile health (mHealth) technologies have provided an innovative platform for the deployment of health care diagnostics, symptom monitoring, and prevention and intervention programs. Such health-related smartphone apps are universally accepted by patients and providers with over 50 million users worldwide. Despite the rise in popularity and accessibility among consumers, the evidence base in support of health-related apps has fallen well behind the rapid pace of industry development. To bridge this evidence gap, researchers are beginning to consider how to best apply evidence-based research standards to the systematic synthesis of the mHealth consumer market. In this viewpoint, we argue for the adoption of a “hybrid model” that combines a traditional systematic review with a systematic search of mobile app download platforms for health sciences researchers interested in synthesizing the state of the science of consumer apps. This approach, which we have successfully executed in a recent review, maximizes the benefits of traditional and novel approaches to address the essential question of whether popular consumer mHealth apps work.

Medical Care in the Digital Era.

Electronic health records (EHRs), virtual office visits, and health-related apps are priming the path toward a future vision of medical care in the digital age. That future includes streamlining patient-provider interactions, making good use of the wealth of collected data, and ultimately improving all levels of care from prevention to diagnosis, treatment, and outcomes.

Assessing the Quality of Mobile Health-Related Apps: Interrater Reliability Study of Two Guides.

BackgroundThere is a huge number of health-related apps available, and the numbers are growing fast. However, many of them have been developed without any kind of quality control. In an attempt to contribute to the development of high-quality apps and enable existing apps to be assessed, several guides have been developed.ObjectiveThe main aim of this study was to study the interrater reliability of a new guide — the Mobile App Development and Assessment Guide (MAG) — and compare it with one of the most used guides in the field, the Mobile App Rating Scale (MARS). Moreover, we also focused on whether the interrater reliability of the measures is consistent across multiple types of apps and stakeholders.MethodsIn order to study the interrater reliability of the MAG and MARS, we evaluated the 4 most downloaded health apps for chronic health conditions in the medical category of IOS and Android devices (ie, App Store and Google Play). A group of 8 reviewers, representative of individuals that would be most knowledgeable and interested in the use and development of health-related apps and including different types of stakeholders such as clinical researchers, engineers, health care professionals, and end users as potential patients, independently evaluated the quality of the apps using the MAG and MARS. We calculated the Krippendorff alpha for every category in the 2 guides, for each type of reviewer and every app, separately and combined, to study the interrater reliability.ResultsOnly a few categories of the MAG and MARS demonstrated a high interrater reliability. Although the MAG was found to be superior, there was considerable variation in the scores between the different types of reviewers. The categories with the highest interrater reliability in MAG were “Security” (α=0.78) and “Privacy” (α=0.73). In addition, 2 other categories, “Usability” and “Safety,” were very close to compliance (health care professionals: α=0.62 and 0.61, respectively). The total interrater reliability of the MAG (ie, for all categories) was 0.45, whereas the total interrater reliability of the MARS was 0.29.ConclusionsThis study shows that some categories of MAG have significant interrater reliability. Importantly, the data show that the MAG scores are better than the ones provided by the MARS, which is the most commonly used guide in the area. However, there is great variability in the responses, which seems to be associated with subjective interpretation by the reviewers.

Evaluating the quality and safety of health-related apps and e-tools: Adapting the Mobile App Rating Scale and developing a quality assurance protocol

BackgroundWhilst apps and e-tools have tremendous potential as low-cost, scalable mental health intervention and prevention tools, it is essential that consumers and health professionals have a means by which to evaluate their quality and safety. ObjectiveThis study aimed to: 1) adapt the original Mobile App Rating Scale (MARS) in order to be appropriate for the evaluation of both mobile phone applications as well as e-tools; 2) test the reliability of the revised scale; and 3) develop a quality assurance protocol for identifying and rating new apps and e-tools to determine appropriateness for use in clinical practice. MethodsThe MARS was adapted to include items specific to health-related apps and e-tools, such as the availability of resources, strategies for self-management, and quality information. The 41 apps and e-tools in the standard youth configuration of the InnoWell Platform, a digital tool designed to support or enhance mental health service delivery, were independently rated by two expert raters using the A-MARS. Cronbach's alpha was used to calculate the internal consistency and interclass correlation coefficients were used to calculate interrater reliability. ResultsThe A-MARS was shown to be a reliable scale with acceptable to excellent internal consistency and moderate to excellent interrater reliability across the subscales. Given the ever-increasing number of health information technologies on the market, a protocol to identify and rate new apps and e-tools for potential clinical use is presented. ConclusionsWhilst the A-MARS is a useful tool to guide health professionals as they explore available apps and e-tools for potential clinical use, the training, time, and skill required to use it effectively may be prohibitive. As such, health professionals and services are likely to benefit from including a digital navigator as part of the care team to assist in selecting and rating apps and e-tools, increasing the usability of the data, and technology troubleshooting. When selecting, evaluating and/or recommending apps and e-tools to consumers, it is important to consider: 1) the availability of explicit strategies to set, monitor and review SMART goals; 2) the accessibility of credible, user friendly information and resources from reputable sources; 3) evidence of effectiveness; and 4) interoperability with other health information technologies.

Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study.

BackgroundNovel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care.ObjectiveWe conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits.MethodsSelf-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log.ResultsAll subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future.ConclusionsWe have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely.Trial RegistrationClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888.