Health-related Smartphone Apps Research Articles

Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review.

The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more-mainly related to ethical, legal, and social aspects-resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064.

Smartphone app engagement and clinical outcomes in a hybrid clinic

Despite the growing prevalence of mental health-related smartphone apps, low real-world engagement has prevented these apps from transforming the mental health landscape. Integrating mental health apps into more traditional therapeutic models appears to support better clinical outcomes, but also raises questions about the relationship between app engagement, the app itself, and the coach or clinician. This study explores patient app engagement patterns and the associated clinical outcomes gathered from piloting a digital clinic. Patients with anxiety or depression completed eight clinical visits and coach visits over a median of 83 days with a standard deviation of 17.25 days. Between clinical visits, patients completed therapeutic activities on the mindLAMP app. Mean PHQ-9 and GAD-7 scores decreased from the intake visit to both visit 4 and visit 8. Patients had high app engagement, but engagement did not correlate with outcomes. From intake visit to visit 4, the interaction effects indicate significant differences in the change of both PHQ-9 and GAD-7 depending on participants’ average app satisfaction and clinician/coach satisfaction (as measured by WAI-SR) with engagement. Overall, results support the feasibility of incorporating an app into a hybrid clinic.

Effects of a smartphone app-augmented treatment for children with oppositional defiant disorder / conduct disorder and peer-related aggressive behavior – a pilot study

BackgroundSocial competence training interventions, especially child-focused ones, have proven to be effective in the treatment of children with conduct disorder. Therapy homework assignments implemented between the therapy sessions are essential for practicing strategies developed during treatment sessions and transferring them to everyday life. However, clinical experience shows that patients’ adherence regarding these assignments is often low, thus diminishing the treatment success. One obstacle in this regard is a lack of motivation. The use of smartphone apps in the context of child and adolescent psychotherapy is relatively new, and may provide novel ways to improve the transfer of coping strategies to daily life between treatment sessions. However, only a small number of high-quality studies have analyzed the systematic use of smartphone apps in therapy. The present study will therefore evaluate patients’ homework assignment adherence when using a smartphone app as compared to a paper-and-pencil method.MethodThe study will be conducted as a randomized controlled trial to evaluate the impact of a smartphone app on the adherence to therapy homework assignments (n = 35) in the treatment of children with aggressive behavior aged 6–12 years compared to paper-and-pencil homework assignments (n = 35).DiscussionThis trial is intended as a pilot study and aims to provide a basis for a subsequent multicenter trial. However, the results may already lead to recommendations for the development and use of mental health-related smartphone apps for children and adolescents with aggressive behavior problems.Trial registrationTrial registration AUTHARK: German Clinical Trials Register (DRKS) DRKS00015625. Registered on 15th October 2019.

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.

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.

Trust Concerns Regarding Health-Related Smartphone Apps in Collecting Personally Identifiable Information Throughout COVID-19-like Zoonosis

Coronavirus disease 2019 or COVID-19 is a zoonosis, which means a disease that contaminates from the animals to the humans. Since it is very highly epizootic, it has forced the public health experts to implement smartphone-based applications to trace its swift transmission trajectory as well as the affected individuals. For this, the individuals’ personally identifiable information is utilized. Nonetheless, these information may hamper privacy and cyber security, especially the trust concerns, if not handled properly. If the issues are not resolved at this very moment, the consequences will induce the mass level population to use the health-related applications in their smartphones inadequately. Therefore, a catastrophe will be imminent for another COVID-19-like zoonosis to come. So, to mitigate, an extensive study was required to address this severe issue, namely, trust concern. This paper has studied the needed by discussing the recently designed and developed health-related applications region by region across the world. Moreover, it has analyzed the benefits and drawbacks. The trust defiance is recognized and inspected from the perspective of an end-user. Some recommendations are advised in the later part of this paper to leverage and collaborate the awareness campaign between the Government, the App Developers and the common individuals.

Ethical and Safety Concerns Regarding the Use of Mental Health-Related Apps in Counseling: Considerations for Counselors.

Mental health–related smartphone apps (MHapps) have the potential to greatly enhance and enrich the counseling relationship, and dramatically improve the lives of clients. However, a large portion of MHapps have not been empirically researched and found to be effective. An average of 2 million apps are available in the Apple and Android stores, and users average more than 80 apps on their phones. Many of the apps lack disclaimers about the collection of user information, and there is no governing body to oversee and regulate app development and availability. This is particularly problematic with mental health–related smartphone apps, because many developers are not affiliated with mental health professionals, and many apps do not provide emergency information should a mental health emergency occur while using the app. Moreover, users are left to haphazardly make decisions about health-related apps usage without assistance. Counselors who supplement counseling with mental health–related smartphone apps could unknowingly violate their Code of Ethics by integrating apps that may jeopardize their clients’ safety. The authors review literature related to mental health–related app efficacy, safety, and ethics and provide a compilation of items to consider that can be used before supplementing counseling with mental health–related apps.

Smartphone Apps Meet Evidence-Based Medicine: The Future of Medicine May (Or May Not) Be in Your Smartphone.

"The future of medicine is in your smartphone," proclaimed an eminent medical researcher in a 2015 Wall Street Journal essay. In a sense, that future has already arrived, judging from the proliferation of apps and medical devices now connected to smartphones. One 2015 industry study identified more than 165,000 health-related smartphone apps available from the Google Play Store and Apple iTunes. But to what extent does this technology lead to improved patient outcomes? That question is one for evidence-based medicine, to be answered by clinical trials and systematic reviews by medical experts.

Results of the Clinician Apps Survey, How Do RDNs Use Health-related Smartphone Apps in Patient Care Settings?

Results of the Clinician Apps Survey, How Do RDNs Use Health-related Smartphone Apps in Patient Care Settings?

Evaluation of a smartphone application for self-care performance of patients with chronic hepatitis B: A randomized controlled trial

AimTo verify the usefulness of a smartphone application (App) for facilitating self-care in patients with chronic hepatitis B (CHB). BackgroundCHB is a global health problem, and patients with CHB need to routinely perform self-care. Health-related smartphone apps could help users self-manage their disease. MethodsFifty-three CHB patients were assessed in this randomized controlled before-and-after experimental study. The patients were randomly and equally assigned to groups that did (n=26) or did not (n=27) use the smartphone app for 12weeks. The experimental and control groups were analyzed for differences in disease knowledge, self-efficacy, and self-care before and after use of the smartphone app. ResultsAfter intervention, patients who used the app displayed significantly increased disease knowledge compared with the control group (p=.015). Self-efficacy and self-care also significantly increased in the experimental group (p=0.006 and 0.001, respectively). ConclusionThe smartphone app can be useful for increasing self-care in CHB patients.Abbreviations: App: application, CHB: chronic hepatitis B, CVI: content validity

Guidelines for a cancer prevention smartphone application: A mixed-methods study

ObjectivesThis study sought to explore the views and experiences of healthy young adults concerning the fundamental features of a cancer prevention smartphone app that seeks behaviour change. MethodsThree focus groups were conducted with 16 healthy young adults that explored prior experiences, points of view and opinions about currently available health-related smartphone apps. Then, an online questionnaire was designed and applied to a larger sample of healthy young adults. Focus group and online questionnaire data were analysed and confronted. ResultsStudy results identified behaviour tracking, goal setting, tailored information and use of reminders as the most desired features in a cancer prevention app. Participants highlighted the importance of privacy and were reluctant to share personal health information with other users. The results also point out important dimensions to be considered for long-term use of health promotion apps related with usability and perceived usefulness. Participants didn’t consider gamification features as important dimensions for long-term use of apps. ConclusionsThis study allowed the definition of a guideline set for the development of a cancer prevention app.

Download Alert: Understanding Gastroenterology Patients' Perspectives on Health-Related Smartphone Apps.

Objectives:The aims of this study were to understand patients' willingness to use different types of health-related smartphone apps and to explore their attitudes on the overall value, usability, feasibility, credibility, intrusiveness, and obtrusiveness of these apps.Methods:Questionnaires were distributed to adult patients presenting to gastroenterology clinics at an academic medical center. The 25-question survey consisted of 5-point Likert-type scale statements, multiple-choice questions, and open-ended questions.Results:Participants were mainly White (N=94, 78%) and smartphone owners (N=125, 93%). The mean age was 40.8 years (N=121, s.d.=13.2). Participants were willing to use most types of apps unless it monitored their location or social networking activity. Half were less willing to use an app if it required a visible accessory. Most participants were willing to use a health-related app up to 5 min a day indefinitely but unwilling to pay out-of-pocket for it. Participants generally disagreed that an app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. Overall, participants felt that health-related apps could help them and their doctors better manage their medical problems, but were neutral in trusting their quality. Most worried that personal information used for an app would fall into the wrong hands.Conclusion:Gastroenterology patients were willing to use and valued most types of health-related apps. They perceived this technology as feasible, usable, and relatively unobtrusive unless a visible accessory was required. However, many were concerned about their privacy.

Health-related Smartphone Apps: Status Update for Hem-Onc Practitioners

Health-related Smartphone Apps: Status Update for Hem-Onc Practitioners

A Systematic Review of Quality Assessment Methods for Smartphone Health Apps

There are large numbers of health-related applications (apps) available in various app stores for many smartphone devices. Consequently, increasing numbers of articles are attempting to evaluate the content and the quality of health-related smartphone apps for specific health conditions. The aim of this article is to describe and summarize the methodologies used to determine the quality of health-related apps targeting health consumers and to propose a set of criteria for evaluating the quality of smartphone health-related apps. In 2013, literature searches were performed using Medline and CINAHL, and we included all articles that had the aim of assessing the quality of health-related smartphone apps. The assessment method used in these studies was summarized and scored using a set of quality criteria developed for this study. From 606 articles generated by the search, only 10 met the inclusion criteria. Based on our quality criteria, the mean score was 5.05 out of 8 (range, 2-7). Eighty percent of the studies did not identify the app store country in which the apps were found. Forty percent of the studies did not clearly mention whether they only had assessed the app description or had downloaded the app content for evaluation. Sixty percent of the studies did not provide a list of the apps they had evaluated. Overall, we identified six evaluation methodologies used to assess the quality of health-related apps described in RESULTS. This article provides a summary of currently used methods for assessing the quality of smartphone health-related apps and proposes a set of criteria to enable future studies to consistently review health-related app quality in a standardized manner.

Download Alert: What Do Gastroenterology Patients Really Think of Health-Related Smartphone Apps?

Introduction: The aims of this study were to understand patients’ willingness to use different types of health-related smartphone apps and to explore their views on the overall value, usability, feasibility, credibility, obtrusiveness, and safety of these apps. Methods: Questionnaires were distributed to adult patients presenting to a gastroenterology clinic at an academic medical center. Our customized survey contained 20 statements and subjects were asked to indicate their agreement using a 5-point Likert scale. Results: The majority of the participants were female (n=73, 60%) and the mean age was 40.8 years (SD=13.2). The vast majority (n=125, 93%) of our subjects owned a smartphone and 63% (n=85) reported a history of using a health-related app. Subjects were most willing to use health-related apps for health reminders (78%; n=104), learning medical information (74%; n=99), tracking their bowel (54%; n=72) and lifestyle habits (56%; n=74), monitoring their vital signs continuously (55%; n=73), and receiving therapies (48%; n=64). Subjects were however less willing to use apps that could monitor their location (53%; n=71) or social networking activity (55%; n=73). Over half of the subjects were also less willing to use an app if it required them to wear a visible accessory. Most subjects strongly disagreed that a healthrelated app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. The majority of subjects were willing to use an app they perceived as valuable for their health problems up to 5 minutes a day indefinitely but unwilling to pay out-of-pocket for it. Although most subjects felt that health-related apps could help them and their doctors better manage their medical problems, they were neutral in trusting the quality of these apps. Subjects were more likely to use a smartphone app however if it was recommended by their doctor. Most did not worry that a health-related app would reduce their face-to-face provider time but did worry that their personal information used for an app would fall into the wrong hands. Conclusion: Gastroenterology patients are willing to use and value most types of health-related apps. They perceive this technology as feasible, usable and relatively unobtrusive unless a visible accessory is required. Although the perceived credibility of such apps increases if recommended by a doctor, patients mostly distrust the current quality of health-related apps and are concerned about their privacy.

Smartphone interventions for long-term health management of chronic diseases: an integrative review.

Long-term health management is challenging for the rapidly growing number of patients with chronic diseases. Smartphone interventions offer promising solutions. This article presents features of smartphone interventions for long-term chronic condition management, illustrating how these applications benefit patients with chronic diseases. Systematic searches for smartphone health interventions were conducted in five publication databases. Articles were included only if (1) the smartphone application (app) was exclusively developed for patients with chronic diseases and (2) the article incorporated a defined outcome measurement to evaluate the effects of the implemented intervention. Sixteen articles were included in the final review, including studies in diabetes, mental health problems, overweight, cancer, and chronic obstructive pulmonary disease. These studies found that the smartphone intervention was a completely or at least partially effective tool to assist in managing some chronic diseases. With the help of health-related smartphone apps, patients with chronic conditions (1) felt secure in the knowledge that their illnesses were closely monitored, (2) participated in their own health management more effectively, and (3) felt that they had not been forgotten by their doctors and were taken good care of even outside the hospital/clinic. However, there are limited smartphone apps for the long-term health management of chronic diseases. More smartphone apps need to be developed to help people manage chronic diseases.

Design, Development, and Formative Evaluation of a Smartphone Application for Recording and Monitoring Physical Activity Levels

Limited research exists addressing the development of health-related smartphone apps, a new and potentially effective health promotion delivery strategy. This article describes the development and formative evaluation of a smartphone app associated with a physical activity promotion website. A combination of qualitative and quantitative techniques (performance measures, direct observation, and subjective participant preferences) were implemented during two usability testing sessions (pre- and postmodification) while participants were completing tasks using the app. Design improvements to the app resulted in a reduction in the problems experienced and a decrease in the time taken to complete tasks. Four usability themes emerged from the data: design, feedback, navigation, and terminology. This study demonstrates the relevance of usability testing to the design and modification of a smartphone app related to a health promotion website. This study resulted in an app with much higher usability, which might increase usage and maintenance of health behavior change in the long term. This study demonstrates the need for formative evaluation in health-related smartphone apps. Attention should be given to basic design principles as well as feedback, navigation, and terminology in order to ensure utility and ease of use of future smartphone app designs.