Mobile App Rating Scale Research Articles

User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews.

BackgroundUser experience and engagement are critical elements of mental health apps’ abilities to support users. However, work examining the relationships among user experience, engagement, and popularity has been limited. Understanding how user experience relates to engagement with and popularity of mental health apps can demonstrate the relationship between subjective and objective measures of app use. In turn, this may inform efforts to develop more effective and appealing mental health apps and ensure that they reach wide audiences.ObjectiveWe aimed to examine the relationship among subjective measures of user experience, objective measures of popularity, and engagement in mental health apps.MethodsWe conducted a preregistered secondary data analysis in a sample of 56 mental health apps. To measure user experience, we used expert ratings on the Mobile App Rating Scale (MARS) and consumer ratings from the Apple App Store and Google Play. To measure engagement, we acquired estimates of monthly active users (MAU) and user retention. To measure app popularity, we used download count, total app revenue, and MAU again.ResultsMARS total score was moderately positively correlated with app-level revenue (Kendall rank [T]=0.30, P=.002), MAU (T=0.39, P<.001), and downloads (T=0.41, P<.001). However, the MARS total score and each of its subscales (Engagement, Functionality, Aesthetics, and Information) showed extremely small correlations with user retention 1, 7, and 30 days after downloading. Furthermore, the total MARS score only correlated with app store rating at T=0.12, which, at P=.20, did not meet our threshold for significance.ConclusionsMore popular mental health apps receive better ratings of user experience than less popular ones. However, user experience does not predict sustained engagement with mental health apps. Thus, mental health app developers and evaluators need to better understand user experience and engagement, as well as to define sustained engagement, what leads to it, and how to create products that achieve it. This understanding might be supported by better collaboration between industry and academic teams to advance a science of engagement.

Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality.

BackgroundCardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption.ObjectiveThe aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors.MethodsThe knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion.ResultsThis app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits.ConclusionsThe app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies.

Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation.

BackgroundPersonalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated.ObjectiveThis study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia.MethodsA systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS).ResultsWe identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing.ConclusionsRussian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458

Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation.

BackgroundMental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness.ObjectiveThis study aims to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores.MethodsA systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using the Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated.ResultsA total of 40 apps were analyzed, of which 35 (87.5%) were developed by companies and 33 (82.5%) provided links to access the privacy policy; 21 (52.5%) apps did not mention the involvement of relevant professionals or the guidance of a scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 82.5%). The overall quality average MARS score of the 40 apps was 3.54 (SD 0.39), and the total score was between 2.96 and 4.30. The total MARS score was significantly positively correlated with the scores of each subscale (r=0.62-0.88, P<.001). However, the user score of the app market was not significantly correlated with the total MARS score (r=0.17, P=.33).ConclusionsThe quality of multipurpose mental health apps in China’s main app market is generally good. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps.

Validation of a Korean version of mobile app rating scale (MARS) for apps targeting disease management.

The mobile app rating scale (MARS) is a widely used instrument for evaluating smartphone app quality. We aimed to examine the reliability and validity of the Korean version of MARS (MARS-K). Two independent raters performed the assessment using the translated 23-item questionnaire. We applied intraclass correlation coefficient analysis (ICC) to examine inter-rater reliability, Omega, and item-total correlation for internal consistency, and Pearson's r for test-retest reliability and correlation between subscales and the total score of MARS-K. Most items showed moderate to good ICC (0.447-1.000). The MARS-K showed excellent internal consistency and all subscales exceeded the acceptable level of omega. Results indicated MARS-K to be a valid and reliable instrument for evaluating disease management apps offered in the Korean app store. However, upgrades are recommended to further improve MARS-K's rating accuracy and reliability.

Digitized thought records: a practitioner-focused review of cognitive restructuring apps

Abstract Mental health (MH) apps can be used as adjunctive tools in traditional face-to-face therapy to help implement components of evidence-based treatments. However, practitioners interested in using MH apps face a variety of challenges, including knowing which apps would be appropriate to use. Although some resources are available to help practitioners identify apps, granular analyses of how faithfully specific clinical skills are represented in apps are lacking. This study aimed to conduct a review and analysis of MH apps containing a core component of cognitive behaviour therapy (CBT) – cognitive restructuring (CR). A keyword search for apps providing CR functionality on the Apple App and Android Google Play stores yielded 246 apps after removal of duplicates, which was further reduced to 15 apps following verification of a CR component and application of other inclusionary/exclusionary criteria. Apps were coded based on their inclusion of core elements of CR, and general app features including app content, interoperability/data sharing, professional involvement, ethics, and data safeguards. They were also rated on user experience as assessed by the Mobile App Rating Scale (MARS). Whereas a majority of the CR apps include most core CR elements, they vary considerably with respect to more granular sub-elements of CR (e.g. rating the intensity of emotions), other general app features, and user experience (average MARS = 3.53, range from 2.30 to 4.58). Specific apps that fared best with respect to CR fidelity and user experience dimensions are highlighted, and implications of findings for clinicians, researchers and app developers are discussed. Key learning aims (1) To identify no-cost mobile health apps that practitioners can adopt to facilitate cognitive restructuring. (2) To review how well the core elements of cognitive restructuring are represented in these apps. (3) To characterize these apps with respect to their user experience and additional features. (4) To provide examples of high-quality apps that represent cognitive restructuring with fidelity and facilitate its clinical implementation.

ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic.

Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.

The "Healthy Meals" web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation.

ObjectiveThe development and the evaluation of the Healthy Meals web app designed for professionals from different disciplines related to food, aimed to assess the nutritional and food allergen content of restaurant meals, was described.MethodsApp evaluation concerned: (1) usability, scored on a 7-point scale by 6 restaurateurs and 10 nutritionists through the Computer System Usability Questionnaire; (2) quality, scored on a 5-point scale by 10 nutritionists through the Mobile App Rating Scale; (3) validation, by two nutritionists through differences in entered nutrient contents. Ratings reliability was assessed by the interclass correlation coefficient.ResultsUsers agreed with the web app usability (mean 5.6/7 points, SD 0.9), with moderate reliability among ratings (interclass correlation coefficient = 0.57; 95% CI, 0.18 to 0.82). The web app showed good objective quality (mean 4.0/5 points, SD 0.4), with excellent reliability among nutritionists (interclass correlation coefficient = 0.91; 95% CI, 0.85 to 0.96). For web app validation, no significant differences were observed between the two nutritionists’ data, with excellent reliability (interclass correlation coefficient = 0.98; 95% CI, 0.97 to 0.99). App data entry was identified as a point to improve.ConclusionsThe Healthy Meals web app designed for professionals related to food, such as restaurateurs, demonstrated to be usable, of good quality and valid for dishes nutritional assessment and food allergen identification. Points to improve were identified, while app effectiveness should be tested in trials.

A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study.

BackgroundChronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD.ObjectiveThe objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD.MethodsOur stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data.ResultsPatients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms.ConclusionsPatients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence.

A systematic review of dialectical behavior therapy mobile apps for content and usability

BackgroundThe gap between treatment need and treatment availability is particularly wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT. This review examines DBT based apps, with a specific focus on content quality and usability.MethodsAll apps referring to DBT were identified in Google Play and iOS app stores and were systematically reviewed for app content and quality. The Mobile App Rating Scale (MARS) was used to evaluate app usability and engagement.ResultsA total of 21 free to download apps were identified. The majority of apps (71%) included a component of skills training, five apps included a diary card feature. Most (76.19%) apps were designed to function without help from a therapist. The average user “star” rating was 4.39 out of 5. The mean overall MARS score was 3.41, with a range of 2.15 to 4.59, and 71.43% were considered minimally ‘acceptable,’ as defined by a score of 3 or higher. The average star rating was correlated with the total MARS score (r = .51, p = .02). Estimates of app usage differed substantially between popular and unpopular apps, with the three most popular apps accounting for 89.3% of monthly active users.ConclusionsWhile the present study identified many usable and engaging apps in app stores designed based on DBT, there are limited apps for clinicians. DBT based mobile apps should be carefully developed and clinically evaluated.

Tools for Evaluating the Content, Efficacy, and Usability of Mobile Health Apps According to the Consensus-Based Standards for the Selection of Health Measurement Instruments: Systematic Review.

BackgroundThere are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties.ObjectiveThis study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps.MethodsFrom February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed.ResultsThe initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ≥5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version.ConclusionsThe Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps.

Usability and Perceived Usefulness of the AFib 2gether Mobile App in a Clinical Setting: Single-Arm Intervention Study.

BackgroundAlthough the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation (AF) or atrial flutter to make informed decisions about using anticoagulation (AC), the best method for facilitating shared decision-making remains uncertain.ObjectiveThe aim of this study is to assess the AFib 2gether mobile app for usability, perceived usefulness, and the extent and nature of shared decision-making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used.MethodsWe identified patients visiting a cardiology provider between October 2019 and May 2020. We measured usability from patients and providers using the Mobile App Rating Scale. From the 8 items of the Mobile App Rating Scale, we reported the average score (out of 5) for domains of functionality, esthetics, and overall quality. We administered a 3-item questionnaire to patients relating to their perceived usefulness of the app and a separate 3-item questionnaire to providers to measure their perceived usefulness of the app. We performed a chart review to track the occurrence of AC within 6 months of the index visit. We also audio recorded a subset of the encounters to identify evidence of shared decision-making.ResultsWe facilitated shared decision-making visits for 37 patients visiting 13 providers. In terms of usability, patients’ average ratings of functionality, esthetics, and overall quality were 4.51 (SD 0.61), 4.26 (SD 0.51), and 4.24 (SD 0.89), respectively. In terms of usefulness, 41% (15/37) of patients agreed that the app improved their knowledge regarding AC, and 62% (23/37) agreed that the app helped clarify to their provider their preferences regarding AC. Among providers, 79% (27/34) agreed that the app helped clarify their patients’ preferences, 82% (28/34) agreed that the app saved them time, and 59% (20/34) agreed that the app helped their patients make decisions about AC. In addition, 32% (12/37) of patients started AC after their shared decision-making visits. We audio recorded 25 encounters. Of these, 84% (21/25) included the mention of AC for AF, 44% (11/25) included the discussion of multiple options for AC, 72% (18/25) included a provider recommendation for AC, and 48% (12/25) included the evidence of patient involvement in the discussion.ConclusionsPatients and providers rated the app with high usability and perceived usefulness. Moreover, one-third of the patients began AC, and approximately 50% (12/25) of the encounters showed evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app on a larger sample and with a controlled study design.Trial RegistrationClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270International Registered Report Identifier (IRRID)RR2-21986

A systematic evaluation of primary headache management apps leveraging behavior change techniques.

Mobile health apps have the potential to promote adherence to headache management through the use of evidence-based behavior change techniques (e.g., self-monitoring). While many headache management apps exist, the extent to which these apps include behavior change techniques remains unknown. Thus, the present study systematically evaluated the content and quality of commercially available headache management apps. Headache apps were identified using a systematic search in the Apple App and Google Play stores. A total of 55 apps were evaluated using the taxonomy of behavior change techniques and app quality using the Mobile App Rating Scale. Headache management apps included 0-14 behavior change techniques (Mean [M] = 5.89) and 0-8 headache management behavior change techniques (M = 4.29). App quality ranged from 2.84-4.67 (M = 3.73) out of 5.00. Three apps, Migraine Trainer, Easeday: Headache & Migraine, and PainScale, included the highest number of overall and headache management behavior change techniques along with good quality scores. While randomized controlled trials are necessary to determine the efficacy of individual headache apps, most existing apps include evidence-based headache management behavior change techniques. Headache apps often focus on either self-monitoring or stress management via relaxation training, suggesting that patients' needs should be used to inform app selection.

Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study.

BackgroundManaging the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored.ObjectiveThe aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale.MethodsA systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score.ResultsGoogle Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps.ConclusionsThe quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.

96 The pediatric health app landscape: Results of an environmental scan

Abstract Primary Subject area Technology Background Providing resources that aid in detection and identification of serious childhood illness helps parents feel better equipped to assess their child’s health and significantly changes parental health-seeking behaviours. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access health information about their child. Mobile health (mHealth) apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. Objectives To systematically identify all Canadian and US child health apps for parents. Design/Methods We used an environmental scan approach – a review designed to summarize information for decision makers. The Android and Apple app marketplaces were used as search platforms. We built a list of search terms and used these platforms to search for apps targeted at parents, related to pediatric illnesses in US and Canada. Then once we determined that the app met the inclusion criteria, each included app was assessed using the Mobile App Rating Scale (MARS), a validated tool for assessing health apps. The MARS examines apps on five domains: engagement, functionality, aesthetics, information quality, and subjective quality. Results 650 unique apps were screened and 53 apps were included. On a scale of 1-5, the 53 apps assessed had an average Engagement score of 2.82/5 (θ = 0.86), Functionality of 3.98/5 (θ = 0.72), Aesthetics of 3.09/5 (θ = 0.87), Information quality of 2.73/5 (θ = 1.32), and Subjective quality of 2.2 (θ = 0.79). App scores ranged from 2.2/5 to 4.5/5 (µ= 3.2, θ =0.6).The top three apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top three apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces. In addition, published evidence of the included apps’ impact was poor: only 5/53 apps had an evidence base showing the app had been trialed. Conclusion There is a need for evidence-based apps of Canadian origin related to childhood illnesses. The results of this scan created a picture of the health app landscape by examining trends in apps related to pediatric health that are readily available to parents, and by identifying gaps in app design that can be addressed.

APLIKASI MHEALTH COVID-19 DI INDONESIA: ANALISIS KONTEN MENGGUNAKAN MOBILE APLICATION RATING SCALE (MARS)

It has been a year since the first COVID-19 cases in Indonesia and the development of COVID-19 health applications has grown significantly during that time. However, there has not been found research to analyze such an application in Indonesia. This study aims to evaluate the mHealth COVID-19 application in Indonesia application store, which will eventually become a reference for all researchers related to the mhealth application development in Indonesia. The researchers used COVID-19-related keywords to identify apps on iOS and Android devices. There were 17 applications selected for this research, and the applications' quality were assessed by two coders using the Mobile App Rating Scale (MARS). The search results totaled 842 applications, 19 of which met the researcher's criteria, and 17 applications were found to be assessed. This research was using the Krippendorff coefficient alpha (α) to calculate the reliability value of the agreement between coders. The result showed that PeduliLindungi applications had the highest (4.2/5) of the average MARS score, and the MARS scores of 14 applications were unacceptable (&lt;3.0), which explained that most of the COVID-19 related apps in Indonesia are of low quality. Also, this research implies that the information-related features should be the next focus for overall quality improvement of the Indonesian mHealth application in the future.

Assessment of mHealth Solutions Applied to Fall Detection for the Elderly.

Mobile Health has been increasingly present in healthcare due to the wide availability of applications for smartphones, however, robust assessment methods must be considered, seeking to provide evidence for clinical practice and mHealth solutions. This research presents the assessment of applications aimed at detecting and preventing falls for the elderly, available for Android and IOS, through the Mobile App Rating Scale. Based on the results presented, it can be concluded that the fall detection and prevention applications for the elderly available for Android and IOS showed good quality after rigorous evaluation.

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.

Quality evaluation of stress, anxiety and depression apps for COVID-19.

BackgroundCOVID-19 has caused increased stress, anxiety and depression with increased barriers to treatment. Mobile apps offer a potential solution, but there is no information on the quality of such apps recommended for COVID-19. This study aims to evaluate the quality of stress, anxiety and depression apps recommended for COVID-19.MethodsA search was conducted to identify relevant apps on the iOS and Android platforms. 44 apps were evaluated using the Mobile App Rating Scale (MARS), and the American Psychiatric Association's app evaluation model for data privacy and security.ResultsOverall quality scores of iOS and Android apps were 3.69 ± 0.43 and 3.66 ± 0.47. Thirty percent had good/excellent overall scores. In general, the iOS and Android versions of the apps scored best for functionality (4.21 ± 0.48, 4.12 ± 0.53), followed by aesthetics (3.84 ± 0.50, 3.78 ± 0.56), information (3.39 ± 0.54, 3.40 ± 0.60), and engagement (3.31 ± 0.81, 3.34 ± 0.84). Over half (59%) shared personal information with third parties and 14% were compliant with data protection standards.LimitationsOnly free apps available in Singapore were evaluated. Our results are time sensitive due to addition, removal, and update of apps in the app stores, thus our results should be extrapolated with caution to apps from other countries and paid apps.ConclusionApps that addressed all three conditions had the highest overall quality scores. The top ranked apps (Sanvello, Woebot, Happify, Youper, Bloom) were of good quality, but majority were of acceptable quality and had room for improvement. App developers are encouraged to use our findings to improve and develop better quality apps.

Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan.

BackgroundProviding parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. ObjectiveThe aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved.MethodsWe conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores.ResultsOverall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy.ConclusionsThere is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design.