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The development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps.
The goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings.
Reviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps.
Of the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4% (199/373) received high ratings (average ratings of 4 or 5) and 47.2% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps.
Our study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes.
Asthma is the leading chronic disease in children and adolescents and one of the most common among adults, with more than 25 million Americans impacted [
Many factors combine to contribute to poor asthma rates and worsen outcomes. Provider practice behaviors, suboptimal access to health care, lack of patient knowledge regarding proper medication use, and patients’ difficulty adhering to medical regimens contribute to poor asthma outcomes [
Mobile health apps and devices to monitor and track health-related questions are a rapidly growing field within the public health, data science, and technology sectors [
However, promotion of new technologies is predicated on the hypothesis that enabling people to quantify their own behaviors will drive health behavior change through contextualization and goal setting [
In recent years, there has been a proliferation of new mobile apps for the self-assessment and self-management of asthma [
The aims of this study were (1) to provide a descriptive overview of asthma mobile apps that are publicly available and (2) to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings.
To examine the average user rating and reviews for asthma apps, the following inclusion criteria were applied for our search: apps must be available for download on Android or iOS platforms, written in English, available within the United States, able to be downloaded onto a smartphone or tablet, and had at least one update within the last 5 years. Apps must also have a primary focus on asthma, with respect to either asthma education or asthma self-management. Because of the potential for bias in ratings due to small sample size, only apps that had more than 10 written reviews were included. Apps were not excluded based on cost for use or intended audience. We started with a comprehensive list of apps that strictly matched our inclusion criteria. The list was expanded by using the following keywords commonly associated with asthma education or asthma management to identify additional asthma apps:
List of asthma mobile apps included in analysis.
Name | Developer | Android | iOS | Last update | Update times | Category |
My Asthma App | Asthma and Respiratory Foundation NZ | N/Aa | X | May 5, 2019 | 6 | Education |
Propeller | Reciprocal Labs | X | N/A | March 28, 2019 | 25 | Management |
SaniQ Asthma | Qurasoft GmbH | X | X | March 19, 2019 | 25 | Management |
Asthma Tracker | Kantonsspital Baselland | N/A | X | March 13, 2019 | 12 | Management |
AirCasting | HabitatMap | N/A | X | March 7, 2019 | N/A | Environmental Data |
Peak Flow | Ben Hills | X | N/A | April 26, 2018 | N/A | Management |
My Asthma Pal | Children’s Medical Center of Dallas | X | X | March 7, 2019 | 6 | Management |
asthmaTrack | dangerDown LLC | N/A | X | January 18, 2018 | 28 | Management |
Breathcount asthma control | Segfoltas | X | N/A | January 9, 2017 | N/A | Management |
AsthmaMD | AsthmaMD, Inc. | X | X | March 10, 2017 | 21 | Management |
aN/A: Not available
To identify specific sentiments within language characteristics of user reviews that are associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating.
An
Of the 10 apps included in the analysis, 6 were available at no cost to users and 4 apps were available for purchase, with a maximum cost of US $2.99; 50% of apps (n=5) were updated in the past 2 years.
As shown in
Stream graph of the number of review counts from 2010 to 2020 is shown in
Stream graph of the review counts for asthma apps from 2010 to 2020.
Bi-gram results of functionalities of highly rated asthma mobile apps.
Bi-gram results of features of highly rated asthma mobile apps.
Distinct patterns of language were observed when comparing highly rated and poorly rated apps. Among the highly rated reviews, bi-grams emerged with respect to features as well as functionality of the app.
Among poorly rated asthma apps, bi-grams (
Bi-gram results of functionalities of poorly rated asthma mobile apps.
Bi-gram results of features of poorly rated asthma apps.
Top words in reviews of poorly rated asthma apps.
This study analyzed ratings and features of publicly available asthma apps to identify user preferences. Our descriptive results confirmed those of prior studies which observed the limited availability of publicly available, up-to-date asthma apps on the market [
Furthermore, our study results demonstrated that asthma app quality varied widely, ranging anywhere from an average user rating of 1.5 out of 5 to 5 out of 5. It also appeared that individual asthma apps varied in their user rating between Android and iOS platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their value [
With the
One potential way to improve long-term engagement, which has been successfully applied to physical activity, is interactions with virtual coaches [
Our study did have several limitations, which should be considered when interpreting its findings. The popularity of an asthma app may not yield information regarding the quality of the asthma content presented in the app with respect to the clinical or scientific literature. Prior studies have observed variability in the quality of asthma information with respect to its consistency with National Asthma Education and Prevention Program guidelines [
Limitations of sentiment analysis include its sensitivity to review content; as such, user ratings may not always correspond to descriptive reviewer feedback. Further, displays of reviews were limited to downloads with a minimum threshold of 10 reviews. However, sentiment analysis has been increasingly applied across a variety of health outcomes [
Our study extends previous research in this field by focusing on the experiences and reviews of asthmatics’ interactions with publicly available asthma apps. Our study results have several implications with respect to informing the development of asthma mobile apps and their recommendation for clinical use. As use of asthma apps have been found to have an impact on several clinical outcomes, including but not limited to control, quality of life, medication adherence, and patient-reported outcomes, improvements to asthma apps should include a focus on user-centered design and experiences. Combining big-data analytic approaches with qualitative data from users may yield additional insights to improve usability and long-term engagement with asthma apps. Further, collaborations between asthma app developers, clinicians, and researchers should include considerations regarding data security, privacy features, and sharing of personal health information which would also increase patient and provider confidence regarding recommending the use of asthma mobile apps to improve asthma self-management.
mobile health
National Asthma Education and Prevention Program
This study was supported by a City University of New York Interdisciplinary Research Grant to MC-R and AK. MC-R is supported by TRANSPORT – The Translational Program of Health Disparities Research Training (5S21MD012474-02).
MC-R and HV led the drafting of the manuscript and supervised the process. HV, XH, and JL contributed to the data analysis. MC-R, AL, and AK contributed to the discussion of data.
None declared.