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The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer.
The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps.
We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5.
In total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: “Bladder cancer manager,” “Kidney cancer manager,” “My prostate cancer manager,” “Target Ovarian Cancer Symptoms Diary,” and “My Cancer Coach.” We observed statistically significant differences in the MARS score between the operating systems and the developer types (
MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality.
Genitourinary cancers represent 25% of all types of cancer [
The chronification of many genitourinary cancers and the special features of newer treatments, such as oral anticancer agents and immunotherapy, have also changed the profile of patients with this type of cancer [
Currently, more than 200 health apps are released daily, and in the last 2 years, the number of available apps has doubled to reach more than 300,000 [
The large number of available health care apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users [
The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the MARS scale to identify high-quality apps.
We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on the iOS and Android platforms.
Our study followed a methodology to select the apps and adhered to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines [
Once the search was completed, all available information on the platform was analyzed, and only apps that were in English or Spanish and intended for patients and caregivers were selected. For this study, we excluded apps aimed specifically at health care professionals, those for charitable purposes or without scientific content, and those not specific to genitourinary cancers. Apps that met the indicated criteria were downloaded and evaluated, regardless of cost. The iOS apps were downloaded to an iPhone 8 (version 12.3.2) and the Android apps were downloaded to a Xiaomi Mi A1 (version 9.0).
The general characteristics of the applications were entered into a database. Recorded characteristics included the name, platform (Android or iOS), cost (€), category (medicine and health and fitness), date of the last update, language, and target type of cancer. The content of the applications was classified into 1 of 3 categories according to its purpose: informative, preventive, and diagnostic. Furthermore, any information about the participation of health professionals in the app design or development was included. Qualified professionals were considered to have contributed to the app contents if the app had been developed by health care organizations such as local health authorities, universities, scientific societies and foundations, and hospitals.
The quality of the apps was then assessed using MARS. This methodology includes 23 evaluation criteria, clustered within 5 domains: (1) “Engagement,” which assesses the entertainment, customization, and interactivity of the app (feedback, reminders, and notifications); (2) “Functionality,” which examines the functionality of the app, ease of use, transition between screens, and intuitive design; (3) “Esthetics,” which assesses graphic design, visual appeal, and stylistic consistency; (4) “Information,” which evaluates the quality of the content (text, measures, and references), determined by the credibility of the source; and (5) “Subjective quality,” which determines whether the app could be recommended to people who might benefit from it, if they would be prepared to pay for it, how many times it would be used, and what overall star rating it would be given. Each evaluation criterion was rated from 1 to 5 (1=Inadequate, 2=Poor, 3=Acceptable, 4=Good, 5=Excellent) [
The quantitative variables were described using mean and standard deviation. The categorical variables were described using frequencies and percentages. The numerical variables were compared using the
The app search provided a total of 1055 apps, of which 51 were finally downloaded (
Study flowchart. MARS: Mobile Application Rating Scale.
At the time of the MARS evaluation, 5 of those 51 applications had been removed from the store or could not be opened, leading to a final total of 46. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. Most of the apps (89%, 41/46) were free, with only 5 apps (11%, 5/46) requiring payment (mean cost of €3.51 [US $3.98], SD 1.21). The general characteristics of the apps are shown in
Most of the apps were informative (63%, 29/46), followed by preventive (24%, 11/46) and diagnostic (13%, 6/46). Only 7 of the 46 apps (15%) were developed by health care organizations, which included 3 scientific societies (43%), 3 universities (43%), and 1 hospital (14%). Regarding the type of cancer, 27/46 (59%) were intended for patients with urological cancers and 21/46 (47%) for those with gynecologic cancers. Apps for urological cancers were intended for prostate cancer in 14/46 apps (30%), testicular cancer in 7/46 (15%), bladder cancer in 4/46 (9%), and kidney cancer in 2/46 (4%). Gynecologic cancers were represented by cervical cancer in 9/46 apps (20%), ovarian cancer in 8/46 (15%), uterine cancer in 2/46 (4%), endometrial cancer in 2/46 (4%), and vulvar cancer in 1/46 (2%). One app contained information on cervical, testicular, and ovarian cancer.
General characteristics of the apps.
Characteristics | Apps, n (%) | |
|
||
|
Android | 31 (67) |
|
Android/iOS | 9 (20) |
|
iOS | 6 (13) |
|
||
|
No | 41 (89) |
|
Yes | 5 (11) |
|
||
|
Medicine | 26 (57) |
|
Health and fitness | 20 (43) |
|
||
|
2014 | 1 (2) |
|
2015 | 3 (7) |
|
2016 | 2 (4) |
|
2017 | 12 (26) |
|
2018 | 28 (61) |
|
||
|
English | 43 (94) |
|
Spanish | 2 (4) |
|
English/Spanish | 1 (2) |
Characteristics of the apps analyzeda.
Name of the app | Type of cancer | Purposeb | Platform | Free | Updated in the last year | Developed by a health organization | Languagec | ||||
|
|
I | P | D | iOS | Android |
|
|
|
E | S |
Ball Checker | Testicular |
|
|
✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
|
✓ |
Best Prostate Cancer Treatment | Prostate | ✓ |
|
|
✓ |
|
✓ | ✓ |
|
✓ |
|
Bladder cancer (Bedieman) | Bladder | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Bladder cancer manager | Bladder |
|
✓ |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
Cancer cervix fact | Cervical | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cáncer de cuello uterino | Cervical | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cáncer de ovarios | Ovarian | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cancer de prostata (Anastore) | Prostate | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cancer de prostata (Pen Drouzi) | Prostate | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cancer de RIÑON | Kidney | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cáncer de vejiga | Bladder | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cáncer testicular (Anass apps) | Testicular | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cancer testicular (Expert Health Studio) | Testicular | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cancer testicular (Health Advice Ideas) | Testicular | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cancer testicular (Pen Drouzi) | Testicular | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cáncer uterino | Uterine | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Cervical cancer (Bedieman) | Cervical | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cervical cancer (Natural health care) | Cervical | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cervical cancer (Nougat spring) | Cervical | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Cervical cancer (Personal Remedies LLC) | Cervical |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
✓ |
|
Common causes of cervical cancer | Cervical |
|
✓ |
|
|
✓ | ✓ |
|
|
✓ |
|
El cancer de vulva | Vulvar | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Endometrial cancer (Bedieman) | Endometrial | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Endometrial cancer (online Global Groups) | Endometrial | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Global Pap App | Cervical |
|
✓ |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
How to prevent ovarian cancer | Ovarian | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
IPCRC (Prostate Ca Calculator) | Prostate |
|
|
✓ |
|
✓ | ✓ |
|
|
✓ |
|
itsaMANTHING-Prostate cancer | Prostate | ✓ |
|
|
✓ | ✓ | ✓ |
|
✓ | ✓ |
|
Kidney cancer manager | Kidney |
|
✓ |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
My Cancer Coach | Prostate | ✓ |
|
|
|
✓ | ✓ | ✓ | ✓ | ✓ |
|
My prostate cancer manager | Prostate |
|
✓ |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
OddBalls-Check Yourself | Testicular |
|
✓ |
|
|
✓ | ✓ |
|
|
✓ |
|
Ovarian cancer (Personal Remedies LLC) | Ovarian |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
✓ |
|
Ovarian Cancer Awareness | Ovarian | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Ovarian cancer symptoms diary | Ovarian |
|
✓ |
|
✓ | ✓ | ✓ |
|
✓ | ✓ |
|
Prostate cancer (Dinatale) | Prostate | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Prostate cancer (Personal Remedies LLC) | Prostate |
|
✓ |
|
✓ | ✓ |
|
✓ |
|
✓ |
|
Prostate Cancer Calculator | Prostate |
|
|
✓ |
|
✓ | ✓ |
|
|
✓ |
|
Prostate PRO-Tracker | Prostate |
|
|
✓ | ✓ |
|
✓ |
|
✓ | ✓ |
|
ProstateCheck | Prostate |
|
|
✓ | ✓ | ✓ |
|
|
✓ |
|
✓ |
Reproductive cancers | Ovarian, cervical, testicular | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Rotterdam Prostate Cancer Risk | Prostate |
|
|
✓ | ✓ | ✓ |
|
✓ | ✓ | ✓ | ✓ |
Target Ovarian Cancer Symptoms Diary | Ovarian |
|
✓ |
|
✓ | ✓ | ✓ | ✓ |
|
✓ |
|
Treat prostate cancer | Prostate | ✓ |
|
|
|
✓ | ✓ |
|
|
✓ |
|
Treating bladder cancer | Bladder | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
Ways to treat uterine cancer | Uterine | ✓ |
|
|
|
✓ | ✓ | ✓ |
|
✓ |
|
aIn apps with the same name, the developer is indicated in parentheses.
bI: informative; P: preventive; D: diagnostic.
cE: English; S: Spanish.
The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95 (
The Functionality scores were similar for most of the apps. The apps provided adequate and rapid movement between the screens and menus. The greatest differences were found in the Engagement domain because of deficiencies in areas such as customization and interactivity. Similar differences were found in the Information domain because of the visual explanation and evidence base. The Esthetics domain showed acceptable scores in one-third of the apps; this was associated with a greater update rate and visual appeal.
Mobile Application Rating Scale scores of the evaluated apps out of 5a.
Name of app | Engagement | Functionality | Esthetics | Information | Subjective quality | Overall |
Bladder cancer manager | 4.60 | 4.63 | 4.83 | 4.57 | 4.50 | 4.63 |
Kidney cancer manager | 4.60 | 4.63 | 4.83 | 4.57 | 4.50 | 4.63 |
My prostate cancer manager | 4.60 | 4.63 | 4.83 | 4.57 | 4.50 | 4.63 |
Target Ovarian Cancer Symptoms Diary | 4.10 | 4.75 | 4.83 | 3.93 | 3.63 | 4.25 |
My Cancer Coach | 4.10 | 4.63 | 3.67 | 4.50 | 4.25 | 4.23 |
Rotterdam Prostate Cancer Risk | 3.20 | 4.63 | 3.67 | 4.43 | 3.25 | 3.83 |
ProstateCheck | 3.40 | 4.88 | 3.50 | 3.36 | 3.25 | 3.68 |
Ball Checker | 3.50 | 4.25 | 3.67 | 4.21 | 2.75 | 3.68 |
Prostate PRO-Tracker | 3.40 | 4.75 | 3.67 | 4.21 | 2.88 | 3.64 |
Global Pap App | 2.90 | 4.88 | 3.67 | 3.71 | 3.00 | 3.63 |
OddBalls - Check yourself | 3.30 | 3.88 | 3.50 | 4.00 | 3.25 | 3.59 |
Prostate Cancer Calculator | 3.80 | 4.63 | 2.00 | 3.71 | 3.5 | 3.53 |
itsaMANTHING-Prostate Cancer | 2.60 | 4.88 | 3.17 | 3.71 | 3.13 | 3.50 |
Endometrial cancer (online Global Groups) | 2.60 | 4.63 | 3.50 | 3.29 | 3.25 | 3.45 |
Prostate cancer (Dinatale) | 2.50 | 4.63 | 3.67 | 3.64 | 2.38 | 3.36 |
IPCRC (Prostate Ca Calculator) | 2.50 | 4.88 | 3.50 | 2.71 | 3.00 | 3.32 |
Treating bladder cancer | 2.50 | 4.50 | 3.67 | 3.29 | 2.63 | 3.32 |
Ovarian Cancer Symptoms Diary | 2.90 | 4.38 | 3.17 | 3.14 | 2.88 | 3.29 |
Cáncer de prostata (Pen Drouzi) | 1.90 | 4.50 | 3.50 | 3.36 | 2.25 | 3.10 |
Cáncer testicular (Pen Drouzi) | 1.90 | 4.50 | 3.50 | 3.36 | 3.25 | 3.10 |
Cervical cancer (Nougat spring) | 2.20 | 4.75 | 2.50 | 2.93 | 2.75 | 3.03 |
Best Prostate Cancer Treatment | 2.40 | 4.00 | 3.33 | 3.21 | 2.13 | 3.02 |
Bladder cancer | 2.10 | 4.63 | 3.00 | 2.86 | 2.38 | 2.99 |
Cervical cancer (Personal Remedies LLC) | 3.20 | 2.25 | 3.50 | 2.86 | 1.88 | 2.74 |
Ovarian cancer (Personal Remedies LLC) | 3.20 | 2.25 | 3.50 | 2.86 | 1.88 | 2.74 |
Prostate cancer (Personal Remedies LLC) | 3.20 | 2.25 | 3.50 | 2.86 | 1.88 | 2.74 |
Cancer testicular (Expert Health Studio) | 1.80 | 3.50 | 3.33 | 3.14 | 1.63 | 2.68 |
Cancer testicular (Health Advice Ideas) | 1.80 | 3.38 | 3.33 | 3.14 | 1.50 | 2.63 |
Reproductive cancers | 1.60 | 4.50 | 3.00 | 2.43 | 1.50 | 2.61 |
Cervical cancer (Natural health care) | 1.70 | 4.38 | 2.33 | 2.86 | 1.75 | 2.60 |
Cervical cancer (Bedieman) | 1.40 | 3.75 | 2.50 | 2.29 | 1.75 | 2.34 |
Endometrial cancer (Bedieman) | 1.40 | 3.75 | 2.50 | 2.29 | 1.75 | 2.34 |
How to prevent ovarian cancer | 1.70 | 3.88 | 2.33 | 2.57 | 1.13 | 2.32 |
Ovarian Cancer Awareness | 1.80 | 4.38 | 2.00 | 1.93 | 1.50 | 2.32 |
Treat prostate cancer | 1.60 | 4.00 | 1.67 | 2.57 | 1.75 | 2.32 |
Cancer de próstata (Anastore) | 1.60 | 3.50 | 2.17 | 2.71 | 1.50 | 2.32 |
Cancer de RIÑON | 1.70 | 3.00 | 1.67 | 2.64 | 1.63 | 2.13 |
Cáncer de vejiga | 1.70 | 3.00 | 1.67 | 2.64 | 1.63 | 2.13 |
Cancer testicular (Anass apps) | 1.70 | 3.00 | 1.67 | 2.64 | 1.63 | 2.13 |
Cancer de cuello uterino | 1.70 | 3.00 | 1.67 | 2.64 | 1.63 | 2.13 |
Cáncer de ovarios | 1.70 | 3.00 | 2.00 | 2.57 | 1.25 | 2.10 |
Cáncer uterino | 1.70 | 3.00 | 1.67 | 2.64 | 1.50 | 2.10 |
El cáncer de vulva | 1.70 | 3.00 | 1.67 | 2.64 | 1.50 | 2.10 |
Common causes of cervical cancer | 1.80 | 3.13 | 1.50 | 2.50 | 1.50 | 2.09 |
Ways to treat uterine cancer | 1.60 | 3.50 | 1.33 | 2.00 | 1.63 | 2.01 |
Cancer cervix fact | 1.40 | 3.63 | 1.33 | 2.14 | 1.25 | 1.95 |
aFor apps with the same name, the developer is indicated in parentheses.
Comparison by the operating system (iOS and Android) revealed an overall MARS score of 3.64 for apps available in the App Store (n=15) and 2.19 for those available in the Play Store (n=40); the difference was statistically significant (
Interrater agreement was substantial across all evaluation criteria, except for the Entertainment and Interest criteria of the Engagement domain and the Subjective Quality criterion “What is your overall star rating for the app?” The joint probability of agreement was >85% in all the items and >90% in 11 of the 23 evaluation criteria and 4 of the 5 domains analyzed (
Results of the Mobile Application Rating Scale evaluation: comparison by different characteristics.
Category | Operating system | Developer | Cost | ||||||||
|
Android (n=40) | iOS (n=15) | Non–health organization (n=39) | Health organization (n=7) | Free (n=41) | Paid (n=5) | |||||
Engagement | 2.30 | 3.45 | <.001 | 2.34 | 3.30 | .01 | 2.40 | 3.24 | .06 | ||
Functionality | 3.87 | 4.13 | .32 | 3.85 | 4.63 | .02 | 4.05 | 3.25 | .03 | ||
Esthetics | 2.75 | 3.84 | <.001 | 2.83 | 3.50 | .10 | 2.86 | 3.53 | .16 | ||
Information | 3.00 | 3.72 | <.001 | 3.00 | 3.88 | .002 | 3.12 | 3.27 | .67 | ||
Subjective quality | 2.18 | 3.05 | .001 | 2.21 | 3.18 | .01 | 2.35 | 2.43 | .88 | ||
Overall | 2.82 | 3.64 | <.001 | 2.85 | 3.70 | .01 | 2.96 | 3.14 | .62 |
Interrater agreement for the Mobile Application Rating Scale domains and evaluation criteria.
Domains and evaluation criteria | Weighted Cohen κ | Agreement (%) | |
|
0.76 | 92.2 | |
|
Entertainment | 0.55 | 89.4 |
|
Interest | 0.56 | 87.8 |
|
Customization | 0.86 | 96.8 |
|
Interactivity | 0.77 | 91.5 |
|
Target group | 0.64 | 88.8 |
|
0.71 | 90.0 | |
|
Performance | 0.68 | 89.9 |
|
Ease of use | 0.62 | 89.4 |
|
Navigation | 0.69 | 87.9 |
|
Gestural design | 0.64 | 87.9 |
|
0.80 | 93.6 | |
|
Layout | 0.75 | 90.8 |
|
Graphics | 0.76 | 93.1 |
|
Visual appeal | 0.91 | 96.8 |
|
0.79 | 93.6 | |
|
Accuracy of the app in the description (App/Play Store) | 0.63 | 89.4 |
|
Goals | 0.72 | 93.6 |
|
Quality of information | 0.67 | 88.7 |
|
Quantity of information | 0.65 | 87.2 |
|
Visual information | 0.86 | 94.1 |
|
Evidence base | 0.66 | 94.1 |
|
Credibility | 0.61 | 89.4 |
|
0.68 | 89.9 | |
|
Would you recommend this app to people who might benefit from it? | 0.64 | 90.4 |
|
Would you pay for this app? | 0.74 | 90.8 |
|
How many times do you think you would use this app in the next 12 months if it was relevant to you? | 0.72 | 90.4 |
|
What is your overall star rating of the app? | 0.48 | 86.7 |
Based on a systematic and validated questionnaire (MARS), our study provided an objective ranking of 46 apps for patients with genitourinary cancers available in the Apple and Android stores. Apps for patients with prostate and cervical cancer accounted for almost half of all the apps evaluated (30% and 17%, respectively). This frequency is consistent with the findings of the Globocan 2018 report [
More than half of the apps (61%) had been updated in the last year and therefore provided better quality information, which is increasingly necessary given the advantages of apps in diagnosis and therapy in this area. Our result is comparable to that obtained in a review of 166 apps for patients with cancer, where it was observed that 52.4% had been updated in the previous year [
Most of the apps included in our study were informative, with generic data on pathophysiology, treatments, and symptoms of individual cancers, as reported elsewhere [
Several methods for the evaluation of mHealth apps have been developed, although in most cases, the absence of a systematic methodology and the fact that they were not developed by scientific professionals made their routine use impossible [
As for the MARS score, our study showed a mean score of 2.98 for the overall quality of the apps, with a score of 3.13 for quality content. These scores were significantly higher than those found by Böhme et al [
In reports based on MARS for assessment of apps aimed at patients with cancer or other diseases, the domain that scored the lowest was Engagement. The main reason is that the apps were unable to make patients feel that they were participating in the management of their disease. We drew the same conclusion, with Engagement being the domain with the poorest mean score compared to the others. According to the literature, the fundamental aspects that can be improved in this section are customization, user interactivity, and entertainment, which leads to a higher score [
The apps that scored best in the MARS evaluation were “Bladder cancer manager,“ ”Kidney cancer manager,“ and ”My prostate cancer manager.“ These apps were available in the App Store and stood out because of their high scores in the Engagement and Esthetics domains, as did the next 2 apps in the ranking, “Target Ovarian Cancer Symptoms Diary” and “My Cancer Coach.” The “Top 5” apps contained reminders and schedules and offered the possibility of registering analytical information and treatments prescribed, thus enabling a greater score in the Subjective Quality domain because they achieve the main goal. Likewise, the 4 best apps had an explicit preventive purpose, in contrast to the informative purpose that was more frequent in the global analysis.
Of note, 9 of the 10 best apps had been updated during 2018, and 5 of the 10 best apps had been developed by a health care organization. This is an important observation because neither of these 2 aspects is specifically evaluated in MARS. The analysis by the domain of the apps developed by health care organizations and those that were not revealed statistically significant differences for each of the items evaluated. Therefore, the quality of health apps is based on the frequency of updating and the participation of health care organizations in their development, thus confirming the hypothesis proposed elsewhere [
The analysis by operating system revealed a statistically significant difference that was more favorable to the apps from the App Store than those from Play Store, probably because verification requirements for publishing and application are stricter for iOS than for Android.
Apps are beginning to show a significant impact on users´ health. Because of that, regulatory authorities are responsible for evaluating these technologies to control their availability in the stores. In 2013 and regarding this issue, the Food and Drug Administration (FDA) published a guide containing recommendations to assess the quality of these apps. However, due to the rise of health apps, an objective, comprehensive and clear evaluation of apps is necessary. This evaluation should allow users and health care professionals (who recommend them to patients) which apps meet minimum standards of quality and safety in their content.
Patients are exposed to unreliable information related to their health so quality certifications are needed to identify those apps that offer the best content for users. For example, App Saludable is a free and open-access certification given to some apps which were developed using strict guidelines in Spain [
MARS is limited by its subjectivity [
The quality of health apps should be evaluated using approaches such as MARS to decide which apps could be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to increase awareness and provide data about the disease, without ensuring coherent interactivity. Although the participation of health professionals in the development of these apps is low, we observed that their participation was associated with the app quality and the recency of updates. Greater scores in quality were observed in iOS apps, although no correlation between quality and price was found.
Food and Drug Administration
Mobile Application Rating Scale
None declared.