Mobile Application Rating Scale Score Research Articles

Development and usability testing of a cognitive-behavioral therapy-guided self-help mobile app and social media group for the post-acute treatment of anorexia nervosa

ObjectiveAnorexia nervosa (AN) is often treated in the acute setting, but relapse after treatment is common. Cognitive-behavioral therapy (CBT) is useful in the post-acute period, but access to trained providers is limited. Social support is also critical during this period. This study utilized a user-centered design approach to develop and evaluate the usability of a CBT-based mobile app and social networking component for post-acute AN support. MethodParticipants (N = 19) were recently discharged from acute treatment for AN. Usability testing of the intervention was conducted over three cycles; assessments included the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), the Mobile Application Rating Scale (MARS), a social media questionnaire, and a semi-structured interview. ResultsInterview feedback detailed aspects of the app that participants enjoyed and those needing improvement. Feedback converged on three themes: Logistical App Feedback, boosting recovery, and Real-World App/Social Media Use. USE and MARS scores were above average and SUS scores were “good” to “excellent” across cycles. ConclusionThis study provides evidence of feasibility and acceptability of an app and social networking feature for post-acute care of AN. The intervention has potential for offering scalable support for individuals with AN in the high-risk period following discharge from acute care.

A content-based review of mobile health applications for breast cancer prevention and education: Characteristics, quality and functionality analysis.

Mobile Health apps could be a feasible and effective tool to raise awareness for breast cancer prevention and to support women to change their behaviour to a healthier lifestyle. The aim of this study was to analyse the characteristics and quality of apps designed for breast cancer prevention and education. We conducted a systematic search for apps covering breast cancer prevention topics in the Google Play and Apple App Store accessible from Germany using search terms either in German or in English. Only apps with a last update after June 2020 were included. The apps identified were downloaded and evaluated by two independent researchers. App quality was analysed using the Mobile Application Rating Scale (MARS). Associations of app characteristics and MARS rating were analysed. We identified 19 apps available in the Google Play Store and seven apps available in the Apple App Store that met all inclusion criteria. The mean MARS score was 3.07 and 3.50, respectively. Functionality was the highest-scoring domain. Operating system, developer (healthcare), download rates and time since the last update were significantly associated with overall MARS score. In addition, the presence of the following app functions significantly influenced MARS rating: breast self-examination tutorial, reminder for self-examination, documentation feature and education about breast cancer risk factors. Although most of the apps offer important features for breast cancer prevention, none of the analysed apps combined all functions. The absence of healthcare professionals' expertise in developing apps negatively affects the overall quality.

Three cycles of mobile app design to improve HIV self-management: A development and evaluation study.

Employing three cycles of Design Science Research (DSR) to develop a mobile app 'ESSC (Excellent Self Supervised HIV Care)' to improve self-management among people living with HIV (PLWH). This study is based on the DSR framework comprising three iterative cycles. In the Relevance cycle, PLWH participated in a survey of mobile health (mHealth) experiences and needs. In the Rigor cycle, the information-motivation-behavioural skills (IMB) model was applied to foundations of the app, and HIV specialists verified the contents. Experts evaluated the heuristic system and the app quality with the Mobile Application Rating Scale (MARS). In the Design cycle, ESSC was built on the findings of the other two cycles, and end-users tested the usability using uMARS. The contents of the app were developed based on user requirements. The IMB model led ESSC to supplement motivational components for self-management, which built five functions: information contents; health life records including mental and sexual health; interactive counselling with healthcare providers; setting health goals after watching videos; and my page for self-reflection. To reduce social stigma and promote acceptance of the information-driven app, we created animated characters with neutral and bright features. The HIV specialists evaluated content validity as highly appropriate. The MARS score by the overall raters was between 3-acceptable and 4-good: functionality, 4.38; information, 4.12; aesthetics, 3.96; engagement, 3.37; and subjective quality, 3.25. The DSR approach is effective for implementing usable and useful mHealth. The ESSC app would be feasible and contribute PLWH to retention in care.

Mobile applications (apps) for tobacco cessation: Behaviour change potential and heuristic analysis using the Mobile Application Rating Scale (MARS)

Background Given the high prevalence of tobacco use, India presents a significant challenge in tobacco control. Yet, the support received for tobacco cessation is suboptimal. Hence, the aim was to identify and heuristically evaluate ‘high-quality’ and ‘engaging’ tobacco cessation mobile apps using the Mobile Application Rating Scale (MARS). Also, to categorize and analyse their features with respect to engagement, functionality, aesthetics, and information quality. Methods A systematic search of tobacco cessation apps was done within app stores of prominent smartphone platforms developed by Apple and Android. The following search terms: ‘quit smoking,’ ‘smoking cessation, ‘stop smoking,’ ‘smoking therapy,’ ‘quit tobacco,’ ‘cigarette cessation,’ ‘cold turkey,’ and ‘quit cigarette.’ Pearson’s correlations were used to analyse correlations between app scores (Total score app-quality/mean score) and downloads/ratings and number of downloads with the overall MARS score. A Chi-square test was performed to analyse any association between app focus and app release dates. Results Total MARS scores ranged from 3.1 to 4.9. Quitsure app (4.9), Craving to Quit! app (4.8) and Stop Tobacco Mobile Trainer: Quit Smoking App (4.74) were ranked the highest according to the MARS overall mean score. Older apps focussed more on mere goal setting or substance use, as compared to behaviour change; whereas, recently developed apps are now focussing more on behaviour change. Conclusions The content and functionality of behaviour change-focused apps were of higher quality than those of other app categories. These recently developed mHealth apps can effectively supersede the traditional smoking cessation methods.

Review and content analysis of mobile apps for inflammatory bowel disease management using the mobile application rating scale (MARS): Systematic search in app stores

BackgroundPeople with inflammatory bowel disease (IBD) need tools for self-management of their disease with the ultimate goal of improving medication adherence and health outcomes. Mobile apps represent a novel opportunity to provide self-management for patients with IBD. Many mobile apps have been developed for IBD self-management, but more evidence is needed about the quality of these mobile apps. ObjectiveThis study evaluated mobile apps developed for the IBD community and rated the quality of these apps to provide a roadmap for future development. Materials and methodsThe Apple App Store and Google Play Store were systematically searched to identify IBD mobile apps for patients and physicians based on the IBD-related keywords. We included mobile apps that focus on IBD, are in the English language, and are free. The related app quality was evaluated independently by two reviewers using the Mobile Application Rating Scale (MARS). ResultsWe identified 401 mobile apps. After removing duplicates and unrelated apps, 44 apps were included in the review. Overall, the mean MARS scores were 3.5 (SD = 0.5) on a scale from 1.00 to 5.00, which was the acceptable range.; 12 apps got scores ≥ 4.00. The highest mean domain score belonged to the functionality dimension (mean = 3.9, SD = 0.6) and the lowest belonged to the engagement dimension (mean = 3.2, SD = 0.8). ConclusionThe MARS ratings showed that the IBD mobile apps quality meet acceptable criteria. However, more attention must be paid to design features that improve user interest and engagement, especially among children and adolescents. Healthcare professional involvement is crucial for designing mobile health apps.

Evaluation of open access COVID-19 related mobile applications in India: An application store-based quantitative analysis

Purpose: To assess the features/functionalities and quality of the (open access) COVID-19 specific mobile application for India using the Mobile Application Rating Scale (MARS) and the quality of the reported COVID-19 data using the COVID-19 Data Reporting System (CDRS). Methods: We used an analytical, cross-sectional study in which we reviewed all open access (free) mobile phone-based applications across the application stores, namely Google Android Play Store, iTunes and Google search engine. We used MARS and CDRS to assess the mobile applications applicable to India. Results: We found a total of 247 applications through the iTunes store (n=176), android store (n=70) and Google search (n=1). Out of 247, 70 applications matched the inclusion criteria, and only 42 applications were accessible for detailed evaluation using MARS. The overall mean (SD) MARS score was 3.27 (0.59). The mean (SD) score for application mean quality, app subjective quality and app-specific quality domains were 3.43 (0.43), 2.95 (0.71), and 3.44 (0.82), respectively. Of the 20 applications evaluated using CDRS, Aarogya (Agra) Sarvam Setu and Odisha COVID had the highest normalized score (0.9), whereas Madhya Pradesh COVID response app and WHO Academy COVID-19 had the lowest (0.1). Conclusion: Though the overall quality of the mobile applications is good, the engagement aspect of the mobile application quality needs improvement. Applications providing comprehensive COVID-19 related services are still lacking. The necessity of the hour is to assess the user’s perspective and the impact of application features on COVID-19 prevention and control, either individually or in groups.

Quality Evaluation of Mobile Application for Daily Mood Regulation: A Review and Analysis using the Mobile Application Rating Scale

Purpose: The purpose of this study is to provide an overview of mobile application (app) for mood management and to assess the quality of these application using the Mobile Application Rating Scale (MARS).Methods: The Google Play store was thoroughly explored in order to find apps that could help regulate daily moods. A total of 28 apps were selected. These mobile apps were analyzed with MARS questionnaires, which includes a total of 23 evaluation criteria organized into 6 categories (Engagement, Functionality, Aesthetics, Information, Subjective Quality, and App specific). In addition, we examined the features contained in of 28 different apps, focusing on those that measured mood and provided coping strategies.Results: The mean MARS score for the overall quality of the 28 apps was 3.48±0.81, with a maximum of 5 and a minimum of 0. Most apps received acceptable grades for Engagement and Aesthetics.Conclusion: MARS is a useful strategy for determining which apps can be recommended to users and which features should be modify to improve the quality of apps. This review shows that some apps match predetermined criteria for quality, content, or functionality, underlining the need for additional refining to evidence-based principles.

Evaluation of the Smartphone Applications in Antibiotic Prescription

Introduction: One of the important challenges for physicians is the choic e of the right antibiotics for various diseases. In this regard, a mobile application could be helpful. The main purpose of this study was to compare the quality of mobile applications designed for an antibiotic prescription to help physicians in choosing the right antibiotic . Method : In this study, English non -commercial apps from the Apple App Store and the Google Play Store were searched using relevant keywords. The apps were selected and independently scored by an infectious disease specialist and a pharmacist using the Mobile Application Rating Scale (MARS ). Kendall’s coefficient of concordance was used to assess inter -rater agreement. The Kolmogorov -Smirnov test was used to verify the normal distribution of the quantitative variables. Spearman's rank -order correlation was applied to determine the relationship between MARS scores and quantitative background variables and Mann -Whitney U tests for dichotomous variables. Results: In the initial search until August 2022, 13 apps were eligible for evaluation. The MARS score obtained by applications without in -app advertisements (median: 3.9, IQR: 3.4 -6. 1) was significantly higher than applications containing advertisements (median: 2.9, IQR: 2.3 - 8 . 1) (P=0.029). In the objective domain of MARS, The highest mean domain score belonged to the engagement section (3.9±0.4) and the lowest mean domain score belonged to the functionality section (3.5±0.5). Conclusion: This study indicated that apps designed to help physicians prescribe antibiotics meet acceptable criteria. Considering objective scores of MARS, lower score s in the "engagement" section demonstrated that designers have paid less attention to this section in comparison to the "information quality" section.

Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study.

Women's menstrual cycle is an important component of their overall health. Physiological cycles and associated symptoms can be monitored continuously and used as indicators in various fields. Menstrual apps are accessible and can be used to promote overall female health. However, no study has evaluated these apps' functionality from both consumers' and health care providers' perspectives. As such, the evidence indicating whether the menstrual apps available on the market provide user satisfaction is insufficient. This study was performed to investigate the key content and quality of menstrual apps from the perspectives of health care providers and consumers. We also analyzed the correlations between health care provider and consumer evaluation scores. On the basis of this analysis, we offer technical and policy recommendations that could increase the usability and convenience of future app. We searched the Google Play Store and iOS App Store using the keywords "period" and "menstrual cycle" in English and Korean and identified relevant apps. An app that met the following inclusion criteria was selected as a research app: nonduplicate; with >10,000 reviews; last updated ≤180 days ago; relevant to this topic; written in Korean or English; available free of charge; and currently operational. App quality was evaluated by 6 consumers and 4 health care providers using Mobile Application Rating Scale (MARS) and user version of the Mobile Application Rating Scale (uMARS). We then analyzed the correlations among MARS scores, uMARS scores, star ratings, and the number of reviews. Of the 34 apps, 31 (91%) apps could be used to predict the menstrual cycle, and 2 (6%) apps provided information pertinent to health screening. All apps that scored highly in the MARS evaluation offer a symptom logging function and provide the user with personalized notifications. The "Bom Calendar" app had the highest MARS (4.51) and uMARS (4.23) scores. The MARS (2.22) and uMARS (4.15) scores for the "Menstrual calendar-ovulation & pregnancy calendar" app were different. In addition, there was no relationship between MARS and uMARS scores (r=0.32; P=.06). We compared consumer and health care provider ratings for menstrual apps. Continuous monitoring of app quality from consumer and health care provider perspectives is necessary to guide their development and update content.

Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content.

BackgroundHematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps.ObjectiveThe goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs.MethodsA systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were “hematology,” “blood cancer,” “leukemia,” “lymphoma,” and “myeloma” apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test.ResultsOverall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89%) and monitor symptoms and clinical parameters (11/18, 61%). Health care professionals contributed to the development of 50% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44% (8/18) and 67% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores.ConclusionsThis systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs.

A Survey of Mobile Apps for the Care Management of Patients with Dementia.

Objective: Dementia is a progressive neurocognitive disorder that currently affects approximately 50 million people globally and causes a heavy burden for their families and societies. This study analyzed mobile apps for dementia care in different languages and during the COVID-19 pandemic. Methods: We searched PubMed, Cochrane Collaboration Central Register of Con-trolled Clinical Trials, Cochrane Systematic Reviews, Google Play Store, Apple App Store, and Huawei App Store for mobile applications for dementia care. The Mobile Application Rating Scale (MARS) was used to assess the quality of applications. Results: We included 99 apps for dementia care. No significant difference in MARS scores was noted between the two language apps (Overall MARS: English: 3.576 ± 0.580, Chinese: 3.569 ± 0.746, p = 0.962). In the subscale analysis, English apps had higher scores of perceived impact than Chinese apps but these were not significant (2.654 ± 1.372 vs. 2.000 ± 1.057, p = 0.061). (2) Applications during the COVID-19 pandemic had higher MARS scores than those before the COVID-19 pandemic but these were not significant (during the COVID-19 pandemic: 3.722 ± 0.416; before: 3.699 ± 0.615, p = 0.299). In the sub-scale analysis, apps during the COVID-19 pandemic had higher scores of engagement than apps before the COVID-19 pandemic but these were not significant (3.117 ± 0.594 vs. 2.698 ± 0.716, p = 0.068). Conclusions: Our results revealed that there is a minor but nonsignificant difference between different languages and during the COVID-19 pandemic. Further cooperation among dementia professionals, technology experts, and caregivers is warranted to provide evidence-based and user-friendly information to meet the needs of users.

Turkish Validation of the User Version of the Mobile Application Rating Scale.

As the number of mobile health applications increases, quality assessment becomes a capital feature of any mobile application design. Besides the professional evaluation conducted before marketing the app, the perceptions of the subjects to whom is intended will determine the successful widespread dis- semination. Hence, the implementation of a given app may be impaired by the lack of a validated transla- tion and cross-cultural adaptation. We aimed to validate in the Turkish language the User Version of the Mobile Application Rating Scale, an English original scale designed to assess the quality of mobile health applications. A well-established and predefined process of cross-cultural adaptation and transla- tion to Turkish of the User Version of the Mobile Application Rating Scale according to the World Health Organization guidelines was performed using a common, readily available, free-of-charge application. Internal consistency and reliability were tested in a population sample by Cronbach's α and rWG index, respectively. The total User Version of the Mobile Application Rating Scale score had good internal consistency (Cronbach's α = 0.87). Internal consistencies of its subscales were also acceptable: with Cronbach's α of 0.71, 0.78, 0.71, and 0.73 for engagement, functionality, aesthetics, and information, respectively. Cronbach's α of the satisfaction subscale was 0.46. The User Version of the Mobile Application Rating Scale total and sub- scales scores had a strong within-group agreement, all of them with rwg indexes between 0.78 and 0.87 over baseline to 1 month. The Turkish version of the User Version of the Mobile Application Rating Scale is consistent with the English original version and is a reliable and valid tool to assess the quality of mobile applications by Turkish users.

Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis.

BackgroundPatients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality.ObjectiveThis study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS).MethodsThe German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user.ResultsIn total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app “CED Dokumentation und Tipps” had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values.ConclusionsThe MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care.

A Personalized Approach Bias Modification Smartphone App ("SWiPE") to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study.

BackgroundApproach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement.ObjectiveWe examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use.MethodsIn this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training.ResultsWe recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001).ConclusionsThe findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932pInternational Registered Report Identifier (IRRID)RR2-10.2196/21278

Feasibility of RESP-FIT: Technology-Enhanced Self-Management Intervention for Adults with COPD.

IntroductionChronic obstructive pulmonary disease (COPD) is associated with substantial functional morbidity, including activity-limiting symptoms such as dyspnea and fatigue. Self-management interventions aid in symptomatic management of COPD and have been shown to produce positive outcomes on quality of life (QOL) and reduce hospital admissions.PurposeThe purpose of this randomized controlled longitudinal pilot study was to assess feasibility of the combined Respiratory Fitness (RESP-FIT) + Smartphone Airway Management System (SAMS) program, a 6-week, self-management, technology-enhanced respiratory muscle strength training (RMST) mHealth intervention.Patients and MethodsFeasibility was assessed by evaluating recruitment, retention, acceptability, adherence, and safety data. Data were collected from 30 participants (15 in intervention group, 15 in control) at 3 time points (baseline, 6 weeks, and 14 weeks). The intervention group was requested to perform RMST at regular intervals during the week (5 breaths, 5 times a day, 5 days a week). Bluetooth enabled tracking was used to track training sessions. Data were analyzed using descriptive statistics.ResultsRecruitment was staggered for device usage and was completed in 57 weeks, with near 90% retention from baseline to end-of-intervention. Mobile application rating scale scores and interview data indicated moderate satisfaction. Participants completed 14,388 actions in the app. The most commonly used features were recording of daily symptoms via ecological momentary assessment (EMA) and tracking RMST if assigned to training sessions. Training days were successfully captured using EMA, but Bluetooth enabled training tracking was found to be not feasible. Overall, participants reported satisfaction with the RESP-FIT + SAMS mHealth intervention and found it acceptable.ConclusionRESP-FIT is feasible and enables real-time COPD symptom assessment in the home environment, but additional work is needed to integrate Bluetooth technology into the platform. Ongoing investigations focus on the accuracy of symptom perception, self-efficacy, and momentary factors that impact adherence behaviors.

Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores.

BackgroundWomen consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation.ObjectiveThe aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy.MethodsA systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content.ResultsA total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002).ConclusionsThe results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals.

Promoting Health via mHealth Applications Using a French Version of the Mobile App Rating Scale: Adaptation and Validation Study.

BackgroundIn the recent decades, the number of apps promoting health behaviors and health-related strategies and interventions has increased alongside the number of smartphone users. Nevertheless, the validity process for measuring and reporting app quality remains unsatisfactory for health professionals and end users and represents a public health concern. The Mobile Application Rating Scale (MARS) is a tool validated and widely used in the scientific literature to evaluate and compare mHealth app functionalities. However, MARS is not adapted to the French culture nor to the language.ObjectiveThis study aims to translate, adapt, and validate the equivalent French version of MARS (ie, MARS-F).MethodsThe original MARS was first translated to French by two independent bilingual scientists, and their common version was blind back-translated twice by two native English speakers, culminating in a final well-established MARS-F. Its comprehensibility was then evaluated by 6 individuals (3 researchers and 3 nonacademics), and the final MARS-F version was created. Two bilingual raters independently completed the evaluation of 63 apps using MARS and MARS-F. Interrater reliability was assessed using intraclass correlation coefficients. In addition, internal consistency and validity of both scales were assessed. Mokken scale analysis was used to investigate the scalability of both MARS and MARS-F.ResultsMARS-F had a good alignment with the original MARS, with properties comparable between the two scales. The correlation coefficients (r) between the corresponding dimensions of MARS and MARS-F ranged from 0.97 to 0.99. The internal consistencies of the MARS-F dimensions engagement (ω=0.79), functionality (ω=0.79), esthetics (ω=0.78), and information quality (ω=0.61) were acceptable and that for the overall MARS score (ω=0.86) was good. Mokken scale analysis revealed a strong scalability for MARS (Loevinger H=0.37) and a good scalability for MARS-F (H=0.35).ConclusionsMARS-F is a valid tool, and it would serve as a crucial aid for researchers, health care professionals, public health authorities, and interested third parties, to assess the quality of mHealth apps in French-speaking countries.

Popular Evidence-Based Commercial Mental Health Apps: Analysis of Engagement, Functionality, Aesthetics, and Information Quality.

BackgroundThere is a robust market for mobile health (mHealth) apps focused on self-guided interventions to address a high prevalence of mental health disorders and behavioral health needs in the general population. Disseminating mental health interventions via mHealth technologies may help overcome barriers in access to care and has broad consumer appeal. However, development and testing of mental health apps in formal research settings are limited and far outpaced by everyday consumer use. In addition to prioritizing efficacy and effectiveness testing, researchers should examine and test app design elements that impact the user experience, increase engagement, and lead to sustained use over time.ObjectiveThe aim of this study was to evaluate the objective and subjective quality of apps that are successful across both research and consumer sectors, and the relationships between objective app quality, subjective user ratings, and evidence-based behavior change techniques. This will help inform user-centered design considerations for mHealth researchers to maximize design elements and features associated with consumer appeal, engagement, and sustainability.MethodsWe conducted a user-centered design analysis of popular consumer apps with scientific backing utilizing the well-validated Mobile Application Rating Scale (MARS). Popular consumer apps with research support were identified via a systematic search of the App Store iOS (Apple Inc) and Google Play (Google LLC) and literature review. We evaluated the quality metrics of 19 mental health apps along 4 MARS subscales, namely, Engagement, Functionality, Aesthetics, and Information Quality. MARS total and subscale scores range from 1 to 5, with higher scores representing better quality. We then extracted user ratings from app download platforms and coded apps for evidence-based treatment components. We calculated Pearson correlation coefficients to identify associations between MARS scores, App Store iOS/Google Play consumer ratings, and number of evidence-based treatment components.ResultsThe mean MARS score was 3.52 (SD 0.71), consumer rating was 4.22 (SD 0.54), and number of evidence-based treatment components was 2.32 (SD 1.42). Consumer ratings were significantly correlated with the MARS Functionality subscale (r=0.74, P<.001), Aesthetics subscale (r=0.70, P<.01), and total score (r=0.58, P=.01). Number of evidence-based intervention components was not associated with MARS scores (r=0.085, P=.73) or consumer ratings (r=–0.329, P=.16).ConclusionsIn our analysis of popular research-supported consumer apps, objective app quality and subjective consumer ratings were generally high. App functionality and aesthetics were highly consistent with consumer appeal, whereas evidence-based components were not. In addition to designing treatments that work, we recommend that researchers prioritize aspects of app design that impact the user experience for engagement and sustainability (eg, ease of use, navigation, visual appeal). This will help translate evidence-based interventions to the competitive consumer app market, thus bridging the gap between research development and real-world implementation.

A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study.

BackgroundHeart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease.ObjectiveThe objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study.MethodsThe development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate.ResultsA systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%.ConclusionsThe need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.

Usefulness of a hand therapy application

Study DesignCross-sectional cohort design that collected data by means of a survey. IntroductionPerformance and adherence to a home exercise program (HEP) has been identified as an integral component of hand therapy rehabilitation. Understanding how patients learn along with offering creative options to improve engagement is important. Advancements in technology including the use of smart phone apps should be considered. Purpose of StudyTo determine if a hand therapy app is a useful method for patient education and home exercises for patients receiving hand therapy for an orthopedic injury distal to the shoulder. MethodIndividuals receiving hand therapy at an outpatient hand therapy clinic via a convenience sample (n = 41) were asked to download use The Hand Therapy Application for an individualized exercise program. The Mobile Application Rating Scale (MARS) questionnaire was used to assess the smart phone app. ResultsThe overall MARS score for the hand therapy app was 3.5 out of 5. The MARS also gathered information on the app's engagement, functionality, aesthetics, and subjective quality of the app with mean scores of 3.6, 3.8, and 3.7, respectively. Data was also collected on the app's description accuracy, goals, quality and quantity of information, visual information, credibility, and evidence base. DiscussionParticipants receiving skilled hand therapy gave an overall rating of The Hand Therapy Application as above average for providing information about the participants condition and for HEP instruction. ConclusionThe findings of this study suggests that The Hand Therapy Application should be a consideration as a HEP tool in clinical practice.