%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e71071 %T Mental Health Apps Available in App Stores for Indian Users: Protocol for a Systematic Review %A Mehrotra,Seema %A Tripathi,Ravikesh %A Sengupta,Pramita %A Karishiddimath,Abhishek %A Francis,Angelina %A Sharma,Pratiksha %A Sudhir,Paulomi %A TK,Srikanth %A Rao,Girish N %A Sagar,Rajesh %+ Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India, 91 9448503853, drmehrotra_seema@yahoo.com %K mental health apps %K mHealth %K review of apps %K smartphone apps %K MHApps for Indian users %K India %K mobile phones %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been a surge in mental health apps over the past few years. While these have great potential to address the unmet mental health needs of the population, the recent proliferation of mental health apps in the commercial marketplace has raised several concerns, such as privacy, evidence-based, and quality. Although there is mounting research on the effectiveness of mental health apps, the majority of these are not accessible to the public and most of those available have not been researched. Despite the rapid growth of the digital health market in India, there are no comprehensive reviews of publicly available mental health apps for Indian users. Hence it becomes important to review mental health apps freely available to potential end users in terms of their scope, functions, and quality. Objective: This study aims to systematically evaluate mental health apps available to Indian users in app stores. Methods: This systematic review of mental health apps will be performed following the Target user, Evaluation focus, Connectedness and Health domain approach and the PASSR (Protocol for App Store Systematic Reviews) checklist. Fifteen key search terms covering various mental health conditions and therapies will be used on the Android and iOS stores. The identified apps will be further screened and reviewed based on the inclusion and exclusion criteria. The pool of eligible apps will be downloaded for detailed review. The following steps will be adopted to streamline the review process and interrater consistency. Six apps will be randomly selected from the downloaded apps, for joint discussion and review by a team of 4 primary reviewers and 2 mentors. Following this, a new set of 6 randomly selected apps will be rated independently by the primary reviewers and the differences in ratings will be jointly discussed for generating consensus. Subsequently, the primary reviewers will individually review the remaining apps in the list. Data will be extracted based on predecided parameters such as privacy policy, basic purpose, type of developer, nature of intervention strategies, and guided versus unguided nature. Additionally, the apps will be reviewed for quality using the Mobile Application Rating Scale. The data analysis and synthesis strategy will incorporate descriptive statistics based on quality evaluation using the Mobile Application Rating Scale and examining the content of the apps for generating descriptive information. Results: The initial screening of mental health apps available for Indian users on the Google Play Store and Apple App Store was initiated in October 2024. We expect to complete the detailed systematic review by April 2025. Conclusions: This study will offer a comprehensive review of mental health apps available in digital marketplaces for Indian users and has implications for end users, policy makers, developers, and mental health professionals. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY2024100035; https://inplasy.com/inplasy-2024-10-0035/ International Registered Report Identifier (IRRID): DERR1-10.2196/71071 %M 40239205 %R 10.2196/71071 %U https://www.researchprotocols.org/2025/1/e71071 %U https://doi.org/10.2196/71071 %U http://www.ncbi.nlm.nih.gov/pubmed/40239205 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59997 %T User Perceptions of E-Cigarette Cessation Apps: Content Analysis of App Reviews %A Rodberg,Danielle %A Nawara,Roula %A Taylor,Mischa %A Struik,Laura %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, Canada, 1 4039928122, danielle.rodberg@ubc.ca %K qualitative research %K vaping %K e-cigarette %K mobile phone %K mHealth %K smartphone app %K cessation %K nicotine %K consumer %K perception %K user %K content analysis %K Canada %K experiences %D 2025 %7 15.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaping rates in Canada are continuing to increase. In 2019, 4.7% of Canadians used an electronic cigarette (e-cigarette) in the past 30 days, which rose to 5.8% in 2022. In the same year, young adults aged 20-24 years demonstrated the highest use among Canadians, at 19.7%. Given this, existing interventions are not resulting in the desired outcomes, and smartphone apps have the potential to address this gap. Although limited, current evidence highlights that apps can be an effective cessation support; however, a gap persists in understanding the user experience of vaping cessation apps. Objective: The purpose of this study was to explore the user experience of vaping cessation apps through an analysis of app reviews. More specifically, this study aimed to identify positive and negative experiences of app users, as well as highlight recommendations from app users to improve the quality of these apps. Methods: Vaping cessation apps were identified through searches on the Canadian and US versions of Apple App Store and Android Google Play Store in August 2022. Searches revealed a total of 11 vaping cessation apps with app reviews, which resulted in a total of 310 reviews for analysis. Review material was analyzed using a deductive content analysis approach and divided into the following primary categories: content, functionality, aesthetic, cost, and other. These were further divided into 3 secondary categories (praise, criticism, and recommendations) and various tertiary categories. Results: The most discussed primary categories were content, functionality and cost. Comments regarding content tended to be positive (n=103, 33.2%), praising features, such as hypnosis audio sessions (n=29, 28.2%) and tracking features. In contrast, comments tended to criticize functionality (n=58, 18.7%), indicating issues with the functioning of an app that either made the whole app unusable (n=29, 50%) or a specific feature unusable (n=28, 48.3%). Reviews regarding cost were mixed, with 27 (8.7%) positive comments, the majority of these encompassing reviewers satisfied with their purchase (n=17, 63%), and 38 (12.3%) negative comments, including individuals both unsatisfied with their purchase (n=15, 39.5%) and unsatisfied with the free version (n=12, 31.6%). Conclusions: This study is the first of its kind to evaluate the user experience with vaping cessation apps via an analysis of app reviews. App developers may benefit from reading our findings to identify areas to focus on when developing and updating apps. Our study forms a basis for the development of future vaping interventions, as well as future studies. Future research should be conducted on vaping cessation interventions with an emphasis on the user experience because there is limited research available for comparison with the promising results from this study. %M 40233344 %R 10.2196/59997 %U https://www.jmir.org/2025/1/e59997 %U https://doi.org/10.2196/59997 %U http://www.ncbi.nlm.nih.gov/pubmed/40233344 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e65782 %T Mobile Apps and Wearable Devices for Cardiovascular Health: Narrative Review %A Chauhan,Gauri Kumari %A Vavken,Patrick %A Jacob,Christine %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %K cardiovascular diseases %K cardiovascular health %K Germany %K Austria %K Switzerland %K wearables %K apps %K smartphones %K Swiss Apple App %K Google Play Store %K reviews %K morbidity %K mortality %K well-being %K care management %K health technologies %D 2025 %7 4.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular diseases (CVDs) continue to be the leading cause of global morbidity and mortality. Aiming to reduce the risk of CVD development and better manage them, an increasing number of individuals are adopting mobile health (mHealth) apps and wearable devices (wearables). These technologies provide critical insights into heart health and fitness, supporting users to monitor their lifestyle behaviors and adhere to preventative medication. Objective: In this review, we aimed to investigate the current state of mHealth apps and wearables designed for cardiovascular health, with a specific focus on the DACH region (Germany, Austria, and Switzerland). We assessed the benefits these technologies provide to clinicians and patients, particularly in addressing unmet needs like sex-specific symptoms, while also examining their potential integration into the broader health care ecosystem. Methods: To identify heart health apps, a keyword search was performed on both the Swiss Apple App Store and Google Play Stores. A separate search was performed on Google to identify heart health wearables. The identified apps and wearables were evaluated using the foundational and contextual criteria of the sociotechnical framework for assessing patient-facing eHealth tools. Results: After filtering out apps and wearables that did not meet our inclusion criteria, 20 apps and 22 wearables were included in the review. While all the apps were available in the DACH region, only 30% (6/20) were specifically designed for these countries. Only 25% (5/20) of the apps included sex-specific information; 40% (8/20) provided information from evidence-based research, 35% (7/20) provided general health information without academic and clinical references, and 25% (5/20) did not include any evidence-based or general health information. While 20% (4/20) of the included apps had clinical integration features such as clinician dashboards, only 10% (2/20) had the potential to effectively enhance clinician workflows. Privacy policies were present in 95% (19/20) of the apps, with 75% (15/20) adhering to General Data Protection Regulation (GDPR) regulations; 1 app had no data protection policy. Only 20% (4/20) of the apps were medically certified. For wearables, only 9% (2/22) were tailored to the DACH region, and 40% (9/22) addressed women’s health. While around 60% (13/22) offered features to support clinical integration, only 9% (2/22) had the potential to improve clinical workflows. More than half (12/22) of the wearables were medically certified, and 77% (17/22) referenced scientific or peer-reviewed research. All wearables included a privacy policy. Conclusions: While many mHealth tools for cardiovascular health are available, only a few provide meaningful value to both patients and clinicians or have the potential to integrate effectively into the health care system. Women’s sex-specific needs are often overlooked, and the benefits for clinicians are limited. In addition, mHealth apps largely lack robust evidence, whereas wearables showed comparatively stronger support through evidence-based and medical certification. %R 10.2196/65782 %U https://mhealth.jmir.org/2025/1/e65782 %U https://doi.org/10.2196/65782 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64098 %T Digital Health Resilience and Well-Being Interventions for Military Members, Veterans, and Public Safety Personnel: Environmental Scan and Quality Review %A Allen,Rashell R %A Malik,Myrah A %A Aquin,Carley %A Herceg,Lucijana %A Brémault-Phillips,Suzette %A Sevigny,Phillip R %+ School and Clinical Child Psychology, Faculty of Education, University of Alberta, 1121-87 Avenue, Edmonton, AB, T6G2G5, Canada, 1 7804920415, wozniak@ualberta.ca %K public safety personnel %K veteran %K military member %K web-based program %K resources %K resilience %K mobile app %K quality review %K well-being %K military %K environmental %K review %D 2025 %7 1.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. Objective: We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. Methods: Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. Results: In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members—PTSD Coach and Virtual Hope Box—received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP—PeerConnect and R2MR—have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations—PTSD Coach and VetChange—received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. Conclusions: In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population’s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed. %M 40168068 %R 10.2196/64098 %U https://mhealth.jmir.org/2025/1/e64098 %U https://doi.org/10.2196/64098 %U http://www.ncbi.nlm.nih.gov/pubmed/40168068 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56296 %T Application of Behavior Change Techniques and Rated Quality of Smoking Cessation Apps in China: Content Analysis %A Hong,Qiumian %A Wei,Shuochi %A Duoliken,Hazizi %A Jin,Lefan %A Zhang,Ning %K smoking cessation %K behavior change techniques %K mobile application %K content analysis %K China %D 2025 %7 24.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science–based techniques are being incorporated into smoking cessation apps remains unknown. Objectives: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps. Methods: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps. Results: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100%), prompting review of goals (8/9, 88.89%), prompting self-monitoring of one’s smoking behavior (7/9, 77.78%), and assessing current and past smoking behavior (7/9, 77.78%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score (β=.74; P=.02; R2=0.52) and higher information score (β=.76; P=.02; R2=0.52). Conclusions: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking. %R 10.2196/56296 %U https://mhealth.jmir.org/2025/1/e56296 %U https://doi.org/10.2196/56296 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64565 %T Testing and Iterative Improvement of the CEN ISO/TS 82304-2 Health App Quality Assessment: Pilot Interrater Reliability Study %A Frey,Anna-Lena %A Matei,Diana %A Phillips,Ben %A McCabe,Adam %A Fuller,Rachel %A Laibarra,Begoña %A Alonso,Laura %A de la Hoz,Victor %A Pratdepadua Bufill,Carme %A Llebot Casajuana,Berta %A D'Avenio,Giuseppe %A Sottile,Pier Angelo %A Rocchi,Laura Melania %A Errera,Matteo %A Laaissaoui,Yasmine %A Cardinal,Michael %A Kok,Menno %A Hoogendoorn,Petra %+ National eHealth Living Lab, Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands, 31 654341785, a.p.y.hoogendoorn@lumc.nl %K health apps %K mobile health %K digital health %K quality evaluation %K assessment framework %K interrater reliability %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: With the increasing use of health apps and ongoing concerns regarding their safety, effectiveness, and data privacy, numerous health app quality assessment frameworks have emerged. However, assessment initiatives experience difficulties scaling, and there is currently no comprehensive, consistent, internationally recognized assessment framework. Therefore, health apps often need to undergo several quality evaluations to enter different markets, leading to duplication of work. The CEN ISO/TS 82304‑2 health app assessment seeks to address this issue, aiming to provide an internationally accepted quality evaluation through a network of assessment organizations located in different countries. Objective: This study aimed to develop and evolve the draft CEN ISO/TS 82304-2 assessment handbook and developer guidance by testing them across organizations in several countries. Methods: Assessment organizations from 5 countries were engaged to evaluate 24 health apps using the evolving CEN ISO/TS 82304-2 assessment across 3 evaluation rounds. The information submitted by a given health app developer was evaluated by 2 assessment organizations, and interrater reliability was examined. In addition, app developers and assessors were asked to report how much time they spent on information collation or evaluation and to rate the clarity of the developer guidance or assessor handbook, respectively. The collected data were used to iteratively improve the handbook and guidance between rounds. Results: The interrater reliability between assessment organizations improved from round 1 to round 2 and stayed relatively stable between rounds 2 and 3, with 80% (55/69) of assessment questions demonstrating moderate or better (Gwet AC1>0.41) agreement in round 3. The median time required by developers to prepare the assessment information was 8 hours and 59 minutes (IQR 5.7-27.1 hours) in round 3, whereas assessors reported a median evaluation time of 8 hours and 46 minutes (IQR 7.1-11.0 hours). The draft guidance and handbook were generally perceived as clear, with a median round-3 clarity rating of 1.73 (IQR 1.64-1.90) for developers and 1.78 (IQR 1.71-1.89) for assessors (0=“very unclear”, 1=“somewhat unclear”, and 2=“completely clear”). Conclusions: To our knowledge, this is the first study to examine the consistency of health app evaluations across organizations located in different countries. Given that the CEN ISO/TS 82304-2 guidance and handbook are still under development, the interrater reliability findings observed at this early stage are promising, and this study provided valuable information for further refinement of the assessment. This study marks an important first step toward establishing the CEN ISO/TS 82304-2 assessment as a consistent, cross-national health app evaluation. It is envisioned that the assessment will ultimately help avoid duplication of work, prevent inequities by facilitating access to smaller markets for developers, and build trust among users, thereby increasing the adoption of high-quality health apps. %M 40063936 %R 10.2196/64565 %U https://formative.jmir.org/2025/1/e64565 %U https://doi.org/10.2196/64565 %U http://www.ncbi.nlm.nih.gov/pubmed/40063936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53823 %T Exploring Heart Disease–Related mHealth Apps in India: Systematic Search in App Stores and Metadata Analysis %A Dubbala,Keerthi %A Prizak,Roshan %A Metzler,Ingrid %A Rubeis,Giovanni %+ Division of Biomedical and Public Health Ethics, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6646194677, keerthi.dubbala@kl.ac.at %K mobile health apps %K mHealth apps %K heart disease %K data collection methods %K natural language processing %K metadata analysis %K Apple App Store %K Google Play Store %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for the disparities caused by mHealth apps is crucial for achieving health equity. There is a noticeable gap in research that comprehensively assesses the entire spectrum of existing health apps and extensively explores apps for specific health priorities from a health care and public health perspective. In this context, with its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. Objective: This study aimed to create a comprehensive dataset of mHealth apps available in India with an initial focus on heart disease (HD)–related apps. Methods: We collected individual app data from apps in the “medical” and “health and fitness” categories from the Google Play Store and the Apple App Store in December 2022 and July 2023, respectively. Using natural language processing techniques, we selected HD apps, performed statistical analysis, and applied latent Dirichlet allocation for clustering and topic modeling to categorize the resulting HD apps. Results: We collected 118,555 health apps from the Apple App Store and 108,945 health apps from the Google Play Store. Within these datasets, we found that approximately 1.7% (1990/118,555) of apps on the Apple App Store and 0.5% (548/108,945) on the Google Play Store included support for Indian languages. Using monograms and bigrams related to HD, we identified 1681 HD apps from the Apple App Store and 588 HD apps from the Google Play Store. HD apps make up only a small fraction of the total number of health apps available in India. About 90% (1496/1681 on Apple App Store and 548/588 on Google Play Store) of the HD apps were free of cost. However, more than 70% (1329/1681, 79.1% on Apple App Store and 423/588, 71.9% on Google Play Store) of HD apps had no reviews and rating-scores, indicating low overall use. Conclusions: Our study proposed a robust method for collecting and analyzing metadata from a wide array of mHealth apps available in India through the Apple App Store and Google Play Store. We revealed the limited representation of India’s linguistic diversity within the health and medical app landscape, evident from the negligible presence of Indian-language apps. We observed a scarcity of mHealth apps dedicated to HD, along with a lower level of user engagement, as indicated by reviews and app ratings. While most HD apps are financially accessible, uptake remains a challenge. Further research should focus on app quality assessment and factors influencing user adoption. %M 40063078 %R 10.2196/53823 %U https://www.jmir.org/2025/1/e53823 %U https://doi.org/10.2196/53823 %U http://www.ncbi.nlm.nih.gov/pubmed/40063078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51517 %T Exploration of Reproductive Health Apps’ Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis %A Zadushlivy,Nina %A Biviji,Rizwana %A Williams,Karmen S %+ Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, New York, NY, 10027, United States, 1 918 816 0915, Karmen.Williams@sph.cuny.edu %K data privacy policy %K reproductive health apps %K Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective %K THESIS %K THESIS evaluation %K women’s health %K menstrual health %K mobile health %K mHealth %K menstruating persons’ health %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps—Clue, Flo, Period Tracker by GP Apps, and Stardust—as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps’ use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. %M 40053713 %R 10.2196/51517 %U https://www.jmir.org/2025/1/e51517 %U https://doi.org/10.2196/51517 %U http://www.ncbi.nlm.nih.gov/pubmed/40053713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56862 %T Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study %A Nonaka,Sayuri %A Fujii,Susumu %A Yamada,Kosuke Chris %K health care %K disaster medicine %K mobile app %K survey %K disaster situations %K self-reliance %K Japan %K disaster response %K mobile phone %D 2025 %7 5.3.2025 %9 %J JMIR Form Res %G English %X Background: Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster. Objective: This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization. Methods: We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios. Results: Among the 70 free apps, the predominant functions included “recording” (n=60 cases, 86%) and “measurement” (n=47 cases, 67%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but “content provision” (n=54 cases, 70%) was the most prevalent. Furthermore, the “content provision” function was particularly common in the “purposes of use” categories “sleep” (χ211=29; P<.001), “relaxation” (χ211=14.6; P<.001), and “exercise” (χ211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster. Conclusions: The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps. %R 10.2196/56862 %U https://formative.jmir.org/2025/1/e56862 %U https://doi.org/10.2196/56862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65214 %T Behavior Change Support Systems for Self-Treating Procrastination: Systematic Search in App Stores and Analysis of Motivational Design Archetypes %A Kirchner-Krath,Jeanine %A Schmidt-Kraepelin,Manuel %A Schmähl,Katharina %A Schütz,Christoph %A Morschheuser,Benedikt %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160844062, manuel.schmidt-kraepelin@kit.edu %K procrastination %K mobile apps %K cluster analysis %K motivational design %K persuasive technology %K behavior change support systems %K behavior change techniques %K mobile health %K mHealth %K mobile phone %K artificial intelligence %K AI %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The phenomenon of procrastination refers to an individual’s conscious decision to postpone the completion of tasks despite being aware of its adverse consequences in the future. Extant research in this field shows that procrastination is associated with increased levels of anxiety and stress and the likelihood of developing depression and calls for the development of suitable interventions that support individuals in making lasting positive changes to their procrastination behaviors. In parallel, practice has produced a plethora of behavior change support systems (BCSSs) that aim to provide a low-threshold, accessible alternative to in-person therapeutic approaches. Most of these BCSSs can be considered motivational BCSSs that combine functional, utilitarian components with hedonic and eudaimonic design elements to empower self-treatment. Although early studies have suggested the potential benefits of such BCSSs, research on understanding their specific design characteristics and support of individuals in self-treating procrastination is still in its infancy. Objective: In response to this gap between practice and research, we aimed to analyze and systemize the multitude of practical design efforts in motivational BCSSs for the self-treatment of procrastination and identify the main design archetypes that have emerged. Methods: We conducted a 3-step research approach. First, we identified 127 behavior change support apps for procrastination through a systematic screening process in the German and US Apple App Store and Google Play Store. Second, we systematically coded the identified apps in terms of the behavior change techniques targeted by their functional design and hedonic or eudaimonic design elements. Third, we conducted a 2-step cluster analysis to identify archetypes of motivational design in behavior change support apps to combat procrastination. Results: A variety of motivational designs have been developed and implemented in practice, and our analysis identified five main archetypes: (1) structured progress monitor, (2) self-improvement guide, (3) productivity adventure, (4) emotional wellness coach, and (5) social focus companion. The identified archetypes target different psychological determinants of procrastination and successfully use a variety of hedonic and eudaimonic design elements that extend beyond the current state of research. Conclusions: The results of our study provide a foundation for future research endeavors that aim to examine the comparative effects of motivational design archetypes and develop more effective interventions tailored to individual needs. For practitioners, the findings reveal the contemporary design space of motivational BCSSs to support the self-treatment of procrastination and may serve as blueprints that can guide the design of future systems. For individuals seeking support and health professionals treating procrastination, our study systemizes the landscape of apps, thereby facilitating the selection of one that best aligns with the patient’s individual needs. %M 39977017 %R 10.2196/65214 %U https://www.jmir.org/2025/1/e65214 %U https://doi.org/10.2196/65214 %U http://www.ncbi.nlm.nih.gov/pubmed/39977017 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e64550 %T Reviewing Mobile Apps for Teaching Human Anatomy: Search and Quality Evaluation Study %A Rivera García,Guadalupe Esmeralda %A Cervantes López,Miriam Janet %A Ramírez Vázquez,Juan Carlos %A Llanes Castillo,Arturo %A Cruz Casados,Jaime %+ Tecnológico Nacional de México, Instituto Tecnológico Superior de Pánuco, Av. Artículo Tercero Constitucional, Colonia Solidaridad, Pánuco, Veracruz, 93990, Mexico, 52 846 1064254, esmeralda.rivera@itspanuco.edu.mx %K anatomy %K Google Play %K mobile health %K mHealth %K Mobile App Rating Scale %K MARS %D 2025 %7 14.2.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: Mobile apps designed for teaching human anatomy offer a flexible, interactive, and personalized learning platform, enriching the educational experience for both students and health care professionals. Objective: This study aimed to conduct a systematic review of the human anatomy mobile apps available on Google Play, evaluate their quality, highlight the highest scoring apps, and determine the relationship between objective quality ratings and subjective star ratings. Methods: The Mobile App Rating Scale (MARS) was used to evaluate the apps. The intraclass correlation coefficient was calculated using a consistency-type 2-factor random model to measure the reliability of the evaluations made by the experts. In addition, Pearson correlations were used to analyze the relationship between MARS quality scores and subjective evaluations of MARS quality item 23. Results: The mobile apps with the highest overall quality scores according to the MARS (ie, sections A, B, C, and D) were Organos internos 3D (anatomía) (version 4.34), Sistema óseo en 3D (Anatomía) (version 4.32), and VOKA Anatomy Pro (version 4.29). To measure the reliability of the MARS quality evaluations (sections A, B, C, and D), the intraclass correlation coefficient was used, and the result was “excellent.” Finally, Pearson correlation results revealed a significant relationship (r=0.989; P<.001) between the quality assessments conducted by health care professionals and the subjective evaluations of item 23. Conclusions: The average evaluation results of the selected apps indicated a “good” level of quality, and those with the highest ratings could be recommended. However, the lack of scientific backing for these technological tools is evident. It is crucial that research centers and higher education institutions commit to the active development of new mobile health apps, ensuring their accessibility and validation for the general public. %M 39951706 %R 10.2196/64550 %U https://mededu.jmir.org/2025/1/e64550 %U https://doi.org/10.2196/64550 %U http://www.ncbi.nlm.nih.gov/pubmed/39951706 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e66852 %T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study %A Asadollahi,Fateme %A Ebrahimzadeh Zagami,Samira %A Eslami,Saeid %A Latifnejad Roudsari,Robab %+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com %K pregnancy %K prenatal care %K mobile health apps %K mHealth %K women’s health %K health care providers %K quality assessment %K content evaluation %K suitability assessment %K digital health %K smartphones %K eHealth %K telehealth %K telemedicine %K health promotion %K technology %K functionality %K systematic search %D 2025 %7 13.2.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 %M 39946714 %R 10.2196/66852 %U https://apinj.jmir.org/2025/1/e66852 %U https://doi.org/10.2196/66852 %U http://www.ncbi.nlm.nih.gov/pubmed/39946714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49654 %T Good-Quality mHealth Apps for Endometriosis Care: Systematic Search %A Sirohi,Diksha %A Ng,Cecilia HM %A Bidargaddi,Niranjan %A Slater,Helen %A Parker,Melissa %A Hull,M Louise %A O'Hara,Rebecca %+ Robinson Research Institute, Adelaide Medical School, University of Adelaide, Ground Floor, 55 King William Road, North Adelaide, 5006, Australia, 61 0883131527, d.sirohi@uqconnect.edu.au %K adenomyosis %K endometriosis %K m-health apps %K mobile apps %K digital health %K pelvic pain %K self-learning %K clinicians %K mHealth %K application %K endometriomas %K chocolate cysts %K uterus %K womb %K pain management %K digital health %K women's health %K mobile phone %D 2025 %7 7.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps. Objective: This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included “endometriosis,” “adenomyosis,” and “pelvic pain.” mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ≥3.5 were classified as “good” according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care. Results: In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (≥3.5) in the domains of usability (16/19, 84.2%), visual design (14/19, 73.7%), user engagement (11/19, 57.9%), and content (15/19, 78.9%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6%), therapeutic alliance (9/19, 47.4%), and general subjective evaluation (6/19, 31.6%). Conclusions: Although time and geographical location can influence the search results, we identified 6 “good-quality” endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user’s endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps. Trial Registration: PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj %M 39918848 %R 10.2196/49654 %U https://www.jmir.org/2025/1/e49654 %U https://doi.org/10.2196/49654 %U http://www.ncbi.nlm.nih.gov/pubmed/39918848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65139 %T Comparative Evaluation of Consumer Wearable Devices for Atrial Fibrillation Detection: Validation Study %A Wouters,Femke %A Gruwez,Henri %A Smeets,Christophe %A Pijalovic,Anessa %A Wilms,Wouter %A Vranken,Julie %A Pieters,Zoë %A Van Herendael,Hugo %A Nuyens,Dieter %A Rivero-Ayerza,Maximo %A Vandervoort,Pieter %A Haemers,Peter %A Pison,Laurent %K atrial fibrillation %K AF %K mobile health %K photoplethysmography %K electrocardiography %K smartphone %K consumer wearable device %K wearable devices %K detection %K electrocardiogram %K ECG %K mHealth %D 2025 %7 9.1.2025 %9 %J JMIR Form Res %G English %X Background: Consumer-oriented wearable devices (CWDs) such as smartphones and smartwatches have gained prominence for their ability to detect atrial fibrillation (AF) through proprietary algorithms using electrocardiography or photoplethysmography (PPG)–based digital recordings. Despite numerous individual validation studies, a direct comparison of interdevice performance is lacking. Objective: This study aimed to evaluate and compare the ability of CWDs to distinguish between sinus rhythm and AF. Methods: Patients exhibiting sinus rhythm or AF were enrolled through a cardiology outpatient clinic. The participants were instructed to perform heart rhythm measurements using a handheld 6-lead electrocardiogram (ECG) device (KardiaMobile 6L), a smartwatch-derived single-lead ECG (Apple Watch), and two PPG-based smartphone apps (FibriCheck and Preventicus) in a random sequence, with simultaneous 12-lead reference ECG as the gold standard. Results: A total of 122 participants were included in the study: median age 69 (IQR 61-77) years, 63.9% (n=78) men, 25% (n=30) with AF, 9.8% (n=12) without prior smartphone experience, and 73% (n=89) without experience in using a smartwatch. The sensitivity to detect AF was 100% for all devices. The specificity to detect sinus rhythm was 96.4% (95% CI 89.5%-98.8%) for KardiaMobile 6L, 97.8% (95% CI 91.6%‐99.5%) for Apple Watch, 98.9% (95% CI 92.5%‐99.8%) for FibriCheck, and 97.8% (95% CI 91.5%‐99.4%) for Preventicus (P=.50). Insufficient quality measurements were observed in 10.7% (95% CI 6.3%-17.5%) of cases for both KardiaMobile 6L and Apple Watch, 7.4% (95% CI 3.9%‐13.6%) for FibriCheck, and 14.8% (95% CI 9.5%‐22.2%) for Preventicus (P=.21). Participants preferred Apple Watch over the other devices to monitor their heart rhythm. Conclusions: In this study population, the discrimination between sinus rhythm and AF using CWDs based on ECG or PPG was highly accurate, with no significant variations in performance across the examined devices. Trial Registration: ClinicalTrials.gov NCT06023290; https://clinicaltrials.gov/study/NCT06023290 %R 10.2196/65139 %U https://formative.jmir.org/2025/1/e65139 %U https://doi.org/10.2196/65139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53677 %T Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation %A Bernard,Renaldo M %A Seijas,Vanessa %A Davis,Micheal %A Volkova,Anel %A Diviani,Nicola %A Lüscher,Janina %A Sabariego,Carla %+ Swiss Paraplegic Research, Guido A Zäch-Strasse 4, Nottwil, 6207, Switzerland, 41 419396654, carla.sabariego@paraplegie.ch %K mobile phone %K mobile health %K mHealth %K eHealth %K telemedicine %K telehealth %K spinal cord injury %K self-management %K internet-based intervention %K world wide web %K systematic review %K review %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones. Objective: This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms. Methods: A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting. Results: The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77%), while 31% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps. Conclusions: Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise. %M 39700493 %R 10.2196/53677 %U https://mhealth.jmir.org/2024/1/e53677 %U https://doi.org/10.2196/53677 %U http://www.ncbi.nlm.nih.gov/pubmed/39700493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51978 %T Characterizing Performance on a Suite of English-Language NeuroUX Mobile Cognitive Tests in a US Adult Sample: Ecological Momentary Cognitive Testing Study %A Paolillo,Emily W %A Bomyea,Jessica %A Depp,Colin A %A Henneghan,Ashley M %A Raj,Anunay %A Moore,Raeanne C %+ Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, 92093, United States, 1 619 543 5378, r6moore@health.ucsd.edu %K digital health %K cognition %K cognitive aging %K neuropsychology %K mobile health %K psychometrics %K mobile phone %K Ecological Momentary Assessment %K EMA %K NeuroUX %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples. Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan. Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone). Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age—but not other demographics—was associated with finding the tests more challenging. Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research. %M 39586088 %R 10.2196/51978 %U https://www.jmir.org/2024/1/e51978 %U https://doi.org/10.2196/51978 %U http://www.ncbi.nlm.nih.gov/pubmed/39586088 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60079 %T Mental Health Care Navigation Tools in Australia: Infoveillance Study %A Woods,Cindy E %A Furst,Mary-Anne %A Dissanayake,Manoj %A Koerner,Jane %A de Miquel,Carlota %A Lukersmith,Sue %A Rosenberg,Sebastian %A Salvador-Carulla,Luis %K digital health %K infoveillance %K mental health %K mental health care %K navigation tools %K Australia %K fragmentation %K digital mental healthcare %K web-based digital resources %K diagnostic screening %K accessibility %K user friendly %D 2024 %7 22.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective: This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods: A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results: From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27% (n=27) provided referral information, 20% (n=21) offered geolocated service maps, 12% (n=12) included diagnostic screening capabilities, and 7% (n=7) delineated care pathways. Conclusions: The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia’s mental health system. %R 10.2196/60079 %U https://publichealth.jmir.org/2024/1/e60079 %U https://doi.org/10.2196/60079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60787 %T Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review %A Wang,Tzu %A Huang,Yen-Ming %A Chan,Hsun-Yu %+ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S Rd, Zhongzheng Dist, Taipei City, 100025, Taiwan, 886 33668784, yenming927@ntu.edu.tw %K Asia %K adherence %K application %K feature %K medication %K mobile %D 2024 %7 8.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. %M 39514859 %R 10.2196/60787 %U https://www.jmir.org/2024/1/e60787 %U https://doi.org/10.2196/60787 %U http://www.ncbi.nlm.nih.gov/pubmed/39514859 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57289 %T Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation %A Báez Gutiérrez,Nerea %A Rodríguez Ramallo,Héctor %A Mendoza-Zambrano,Elva María %A Brown Arreola,Berenice %A Santos Ramos,Bernardo %A Abdel-kader Martín,Laila %A Otero Candelera,Remedios %K pulmonary hypertension %K mobile apps %K smartphone %K eHealth %K mHealth %K app %K hypertension %K chronic condition %K mobile health app %K monitoring %K systematic search %K app development %K clinical validation %K evaluation %K pulmonary %D 2024 %7 30.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management. %R 10.2196/57289 %U https://mhealth.jmir.org/2024/1/e57289 %U https://doi.org/10.2196/57289 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64525 %T Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis %A Zhu,Di %A Al Mahmud,Abdullah %A Liu,Wei %A Wang,Dahua %+ Centre for Design Innovation, School of Design and Architecture, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 392143830, aalmahmud@swin.edu.au %K mobile apps %K digital storytelling %K older adults %K mobile phone %K cognitive impairment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. %M 39446478 %R 10.2196/64525 %U https://aging.jmir.org/2024/1/e64525 %U https://doi.org/10.2196/64525 %U http://www.ncbi.nlm.nih.gov/pubmed/39446478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52424 %T Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis %A Fernandez-Lazaro,Cesar I %A Santamaría,Gema %A Fernandez Milano,Annika %A Martin-Vergel,Maria I %A Fernandez-Lazaro,Diego %K mobile apps %K mHealth %K mobile health %K app %K nutritional %K nutrition %K dietary %K eating %K diet %K food %K lifestyle %K Spain %K Spanish %K chronic diseases %K chronic %K review %K quality %K MARS %K Mobile App Rating Scale %K uMARS %K user version of the Mobile App Rating Scale %K assessment %K mobile phone %D 2024 %7 4.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users. %R 10.2196/52424 %U https://mhealth.jmir.org/2024/1/e52424 %U https://doi.org/10.2196/52424 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50364 %T Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment %A Zhang,Chenchen %A Guo,Xing %A Zhu,Rui %A Hou,Wenjie %A Wang,Lingmeng %A Wang,Fuzhi %A Zhang,Li %A Luo,Dan %+ School of Health Administration, Bengbu Medical College, 2600 Donghai Blvd, Longzihu District, Bengbu, 233030, China, 86 13865073216, luodan1981@bbmc.edu.cn %K vaccination service app %K Mobile Application Rating Scale %K MARS %K quality evaluation %K app %K apps %K application %K applications %K quality %K evaluation %K rating %K mHealth %K mobile health %K service %K services %K service content %K user evaluation %K vaccine %K vaccines %K public health %D 2024 %7 3.10.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. Objective: Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. Methods: The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. Results: In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=–5.301; P<.001) and the subjective quality score (z=–4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=–2.55; P=.80) and the subjective quality score (z=–0.137; P=.89). There was good intragroup consistency among the raters. Conclusions: In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall. %M 39361418 %R 10.2196/50364 %U https://ojphi.jmir.org/2024/1/e50364 %U https://doi.org/10.2196/50364 %U http://www.ncbi.nlm.nih.gov/pubmed/39361418 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58101 %T mHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis %A Skeens,Micah A %A Jackson,Daniel I %A Sutherland-Foggio,Malcolm S %A Sezgin,Emre %K mHealth %K mobile health %K mobile application %K mobile apps %K digital health %K digital technology %K digital intervention %K smartphones %K cancer %K oncology %K pediatric cancer %K paediatric cancer %K pediatric oncology %K paediatric oncology %K systematic analysis %K systematic analyses %K review %K mobile phone %D 2024 %7 1.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The substantial increase in smartphone ownership has led to a rise in mobile health (mHealth) app use. Developing tailored features through mHealth apps creates a pathway to address the health care needs of pediatric patients with cancer and their families who have complex care needs. However, few apps are designed specifically to integrate with pediatric cancer care. Objective: This study reports a systematic search and analysis of mHealth apps available on the Apple App (iOS) and Google Play (Android) stores designed for pediatric cancer through a list of features that serve (1) patients, (2) caregivers, or (3) both audiences. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed apps for pediatric patients with cancer and caregivers available as of January 30, 2024. We searched the Apple App and Google Play stores with a list of keyword combinations focusing on pediatric cancer care. The inclusion criteria were (1) specifically apps targeted toward pediatric patients with cancer, their families, or both; (2) available in either app store; and (3) available in English. Apps were assessed using the Mobile Application Rating Scale (MARS). The MARS is a quality assessment for mHealth apps, including components of engagement, functionality, aesthetics, and informational quality (5-point Likert scale items—1: low and 5: high quality). Results: In total, 22 apps were identified and 17 of those apps were available on both platforms. The most popular features (n=12) were resource sharing, symptom tracking, reminders, care team connections, journaling, community support, medication tracking, data visualizations, and appointment tracking. Features and interfaces were designed for caregivers (n=9) more frequently than the patients (n=7) while a subset of apps created options for both users (n=6). A total of 16 apps received positive reviews (mean 4.4, SD 0.59; Min=3.1, Max=5.0). A small subset (n=3) achieved over 5000 downloads; however, the majority (n=15) had fewer than 500. More than half (n=12) of the apps were not available in English. Apps requested access to a range of device functionalities to operate (mean 2.72, SD 3.13; Min=0, Max=10). Out of 22, a total of 17 apps were publicly accessible. The mean MARS scores for the apps ranged from 1.71 (SD 0.75) to 4.33 (SD 0.82). Overall, apps scored high on functionality (mean 3.72, SD 0.54) but low on engagement (mean 3.02, SD 0.93). Conclusions: Our review highlights the promising yet underdeveloped potential of mHealth apps in pediatric oncology care, underscoring the need for more inclusive, comprehensive, and integrative digital health solutions. Future developments should actively involve key stakeholders from the pediatric oncology community, including patients, families, and health care professionals, to ensure the apps meet specific needs while addressing linguistic and cultural barriers. %R 10.2196/58101 %U https://pediatrics.jmir.org/2024/1/e58101 %U https://doi.org/10.2196/58101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53805 %T Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment %A Liu,Ming %A Wu,Xiaoqian %A Li,Ziyu %A Tan,Dongmei %A Huang,Cheng %+ College of Medical Informatics, Chongqing Medical University, 1 Yixueyuan Road Yuzhong District, Chongqing, 400016, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K Mobile apps %K Eye care %K Myopia %K MARS %K Children %K Adolescent %K Quality Assessment %K Content Analysis %K mhealth %K China %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59%) were developed by commercial organizations and 12 (41%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62%), eye exercises (16/29, 55%), and eye-care education (16/29, 55%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users’ needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control. %M 39269760 %R 10.2196/53805 %U https://mhealth.jmir.org/2024/1/e53805 %U https://doi.org/10.2196/53805 %U http://www.ncbi.nlm.nih.gov/pubmed/39269760 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54509 %T Reliability Issues of Mobile Nutrition Apps for Cardiovascular Disease Prevention: Comparative Study %A Ho,Dang Khanh Ngan %A Chiu,Wan-Chun %A Kao,Jing-Wen %A Tseng,Hsiang-Tung %A Lin,Cheng-Yu %A Huang,Pin-Hsiang %A Fang,Yu-Ren %A Chen,Kuei-Hung %A Su,Ting-Ying %A Yang,Chia-Hui %A Yao,Chih-Yuan %A Su,Hsiu-Yueh %A Wei,Pin-Hui %A Chang,Jung-Su %K mobile apps %K mHealth %K dietary assessment %K validity %K cardiovascular disease prevention %K app %K apps %K applications %K application %K nutrition %K cardiovascular %K nutrients %K fitness %K diet %K mobile health %D 2024 %7 4.9.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored. Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts. Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]–Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD. Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from −13.8% to −40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from −26.3% to −60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app’s core database is the source of the problems rather than just mismatches or variances in external FCDs. Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps’ reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves. %R 10.2196/54509 %U https://mhealth.jmir.org/2024/1/e54509 %U https://doi.org/10.2196/54509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49714 %T The SoCAP (Social Communication, Affiliation, and Presence) Taxonomy of Social Features: Scoping Review of Commercially Available eHealth Apps %A Kwok,Ian %A Freedman,Melanie %A Kamsickas,Lisa %A Lattie,Emily G %A Yang,Dershung %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K eHealth %K digital interventions %K social features %K taxonomy %K computer-human interaction %K social connection %K engagement %K eHealth apps %K intervention %K mental health %K behavioral health %K mobile app %D 2024 %7 3.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth interventions have proven to be valuable resources for users with diverse mental and behavioral health concerns. As these technologies continue to proliferate, both academic researchers and commercial app creators are leveraging the use of features that foster a sense of social connection on these digital platforms. Yet, the literature often insufficiently represents the functionality of these key social features, resulting in a lack of understanding of how they are being implemented. Objective: This study aimed to conduct a methodical review of commercially available eHealth apps to establish the SoCAP (social communication, affiliation, and presence) taxonomy of social features in eHealth apps. Our goal was to examine what types of social features are being used in eHealth apps and how they are implemented. Methods: A scoping review of commercially available eHealth apps was conducted to develop a taxonomy of social features. First, a shortlist of the 20 highest-rated eHealth apps was derived from One Mind PsyberGuide, a nonprofit organization with trained researchers who rate apps based on their (1) credibility, (2) user experience, and (3) transparency. Next, both mobile- and web-based versions of each app were double-coded by 2 trained raters to derive a list of social features. Subsequently, the social features were organized by category and tested on other apps to ensure their completeness. Results: Four main categories of social features emerged: (1) communication features (videoconferencing, discussion boards, etc), (2) social presence features (chatbots, reminders, etc), (3) affiliation and identity features (avatars, profiles, etc), and (4) other social integrations (social network and other app integrations). Our review shows that eHealth apps frequently use resource-intensive interactions (eg, videoconferencing with a clinician and phone calls from a facilitator), which may be helpful for participants with high support needs. Furthermore, among commercially available eHealth apps, there is a strong reliance on automated features (eg, avatars, personalized multimedia, and tailored content) that enhance a sense of social presence without requiring a high level of input from a clinician or staff member. Conclusions: The SoCAP taxonomy includes a comprehensive list of social features and brief descriptions of how these features work. This classification system will provide academic and commercial eHealth app creators with an understanding of the various social features that are commonly implemented, which will allow them to apply these features to enhance their own apps. Future research may include comparing the synergistic effects of various combinations of these social features. %M 39226544 %R 10.2196/49714 %U https://www.jmir.org/2024/1/e49714 %U https://doi.org/10.2196/49714 %U http://www.ncbi.nlm.nih.gov/pubmed/39226544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59013 %T Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024 %A Goeldner,Moritz %A Gehder,Sara %+ Working Group for Data-Driven Innovation, Hamburg University of Technology, Am Schwarzenberg-Campus 4, Hamburg, 21073, Germany, 49 40428784777, moritz.goeldner@tuhh.de %K digital health application %K DiGA %K data-driven analysis %K clinical evidence %K health economics %K positive care effect %K medical benefit %K patient-relevant structural and procedural improvements %K pSVV %K digital health care act %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately €200 to €700 (€1=US $1.07), averaging at a median of €514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of €221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. %M 39208415 %R 10.2196/59013 %U https://www.jmir.org/2024/1/e59013 %U https://doi.org/10.2196/59013 %U http://www.ncbi.nlm.nih.gov/pubmed/39208415 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54064 %T Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review %A Bhawra,Jasmin %A Elsahli,Nadine %A Patel,Jamin %+ CHANGE Research Lab, School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K climate change %K digital health %K ecoanxiety %K environmental hazards %K food security %K mental health %K scoping review %K smartphone apps %K digital apps %K mobile health %K mobile phone %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people’s way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change–related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change–related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. %M 39042453 %R 10.2196/54064 %U https://publichealth.jmir.org/2024/1/e54064 %U https://doi.org/10.2196/54064 %U http://www.ncbi.nlm.nih.gov/pubmed/39042453 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52179 %T Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review %A Moorthy,Preetha %A Weinert,Lina %A Schüttler,Christina %A Svensson,Laura %A Sedlmayr,Brita %A Müller,Julia %A Nagel,Till %+ Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 8078, preetha.moorthy@medma.uni-heidelberg.de %K wearables %K mobile health %K mHealth %K mobile phone %K usability methods %K usability attributes %K evaluation frameworks %K health care %D 2024 %7 5.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users’ acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. Objective: This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. Methods: We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords “wearable devices,” “mobile apps,” “mHealth apps,” “physiological data,” “usability,” “user experience,” and “user evaluation” were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. Conclusions: Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations. %M 38578671 %R 10.2196/52179 %U https://mhealth.jmir.org/2024/1/e52179 %U https://doi.org/10.2196/52179 %U http://www.ncbi.nlm.nih.gov/pubmed/38578671 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e51592 %T Patient-Centered Chronic Wound Care Mobile Apps: Systematic Identification, Analysis, and Assessment %A Dege,Tassilo %A Glatzel,Bernadette %A Borst,Vanessa %A Grän,Franziska %A Goller,Simon %A Glatzel,Caroline %A Goebeler,Matthias %A Schmieder,Astrid %K chronic wounds %K chronic leg ulcers %K mobile applications %K evaluation %K mental health %K Mobile Application Rating Scale %K System Usability Scale %K affinity for technology interaction %K ATI %K teledermatology %K disease management %K health app %K skin %K eHealth %K telemedicine %K mHealth %K mobile health %K app %K apps %K applications %K quality %K rating %K wound %K wounds %K chronic %K ulcer %K ulcers %K sore %K sores %K dermatology %K chronic wound %D 2024 %7 21.3.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published. Objective: The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians. Methods: Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians. Results: This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6). Conclusions: The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups. %R 10.2196/51592 %U https://mhealth.jmir.org/2024/1/e51592 %U https://doi.org/10.2196/51592 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54866 %T Quality Assessment of Smartphone Medication Management Apps in France: Systematic Search %A Toïgo,Mickael %A Marc,Julie %A Hayot,Maurice %A Moulis,Lionel %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Campus Santé, IURC, 641 avenue du Doyen Gaston Giraud, Montpellier, 34090, France, 33 684014834, Francois.carbonnel@umontpellier.fr %K medication adherence %K mobile apps %K telemedicine %K reminder system %K behavioral therapy %K mHealth %K mobile health %K app %K apps %K applications %K smartphone apps %K medication %K medications %K adherence %K search %K searches %K searching %K systematic %K App Store %K Google Play %K French %K reminder %K reminders %K MARS %K quality %K Mobile App Rating Scale %K mobile phone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adherence to medication is estimated to be around 50% for chronically ill patients in high-income countries. Improving the effectiveness of adherence interventions could have a far greater impact on population health than any improvement in specific medical treatments. Mobile health (mHealth) is one of the most effective solutions for helping patients improve their medication intake, notably through the use of mobile apps with reminder systems. With more than 327,000 apps available in the mHealth field, it is difficult for health care professionals and patients alike to choose which apps to recommend and use. Objective: We aim to carry out a systematic search of medication management smartphone apps available in France that send reminders to patients and assess their quality using a validated scale. Methods: Mobile apps were identified in October and November 2022 after a systematic keyword search on the 2 main app download platforms: App Store (Apple Inc) and Google Play Store. Inclusion criteria were free availability, date of last update, and availability in French. Next, 2 health care professionals independently evaluated the included apps using the French version of the Mobile App Rating Scale (MARS-F), an objective scoring system validated for assessing the overall quality of apps in the mHealth field. An intraclass correlation coefficient was calculated to determine interrater reliability. Results: In total, 960 apps were identified and 49 were selected (25 from the App Store and 24 from the Google Play Store). Interrater reliability was excellent (intraclass correlation coefficient 0.92; 95% CI 0.87-0.95; P<.001). The average MARS-F score was 3.56 (SD 0.49) for apps on the App Store and 3.51 (SD 0.46) for those on the Google Play Store, with 10 apps scoring above 4 out of 5. Further, 2 apps were tested in at least one randomized controlled trial and showed positive results. The 2 apps with the highest ratings were Mediteo rappel de médicaments (Mediteo GmbH) and TOM rappel medicaments, pilule (Innovation6 GmbH), available on both platforms. Each app’s MARS-F score was weakly correlated with user ratings on the App Store and moderately correlated on the Google Play Store. Conclusions: To our knowledge, this is the first study that used a validated scoring system to evaluate medication management apps that send medication reminders. The quality of the apps was heterogeneous, with only 2 having been studied in a randomized controlled trial with positive results. The evaluation of apps in real-life conditions by patients is necessary to determine their acceptability and effectiveness. Certification of apps is also essential to help health care professionals and patients identify validated apps. %M 38498042 %R 10.2196/54866 %U https://mhealth.jmir.org/2024/1/e54866 %U https://doi.org/10.2196/54866 %U http://www.ncbi.nlm.nih.gov/pubmed/38498042 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e55177 %T Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment %A McKay,Fiona %A Chan,Lilian %A Cerio,Rebecca %A Rickards,Sandra %A Hastings,Phillipa %A Reakes,Kate %A O'Brien,Tracey %A Dunn,Matthew %K e-cigarettes %K quit vaping apps %K health apps %K behavior change apps %K behavior application %K behavior %K app %K application %K vaping %K smoking %K review %K vapes %K cessation %K support %K smartphone app %K well-being %K vape %K mobile device %K vaping cessation %D 2024 %7 15.3.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. Objective: A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. Methods: A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms “vape”; “vaping”; “e-cigarette”; and “cessation,” “quit,” or “quitting” in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. Results: An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user’s willingness for behavior change and providing feedback on current actions in comparison to future goals. Conclusions: The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development. %R 10.2196/55177 %U https://mhealth.jmir.org/2024/1/e55177 %U https://doi.org/10.2196/55177 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e49055 %T Mobile Apps for Common Noncommunicable Disease Management: Systematic Search in App Stores and Evaluation Using the Mobile App Rating Scale %A Cheah,Khang Jin %A Abdul Manaf,Zahara %A Fitri Mat Ludin,Arimi %A Razalli,Nurul Huda %A Mohd Mokhtar,Norfilza %A Md Ali,Sawal Hamid %K mHealth apps %K mobile health %K health apps %K chronic diseases %K self-management %K app quality %K apps %K app %K application %K applications %K quality %K MARS %K Mobile App Rating Scale %K mHealth %K chronic %K review methods %K review methodology %K review of apps %D 2024 %7 12.3.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: The success of mobile apps in improving the lifestyle of patients with noncommunicable diseases through self-management interventions is contingent upon the emerging growth in this field. While users of mobile health (mHealth) apps continue to grow in number, little is known about the quality of available apps that provide self-management for common noncommunicable diseases such as diabetes, hypertension, and obesity. Objective: We aimed to investigate the availability, characteristics, and quality of mHealth apps for common noncommunicable disease health management that included dietary aspects (based on the developer’s description), as well as their features for promoting health outcomes and self-monitoring. Methods: A systematic search of English-language apps on the Google Play Store (Google LLC) and Apple App Store (Apple Inc) was conducted between August 7, 2022, and September 13, 2022. The search terms used included weight management, obesity, diabetes, hypertension, cardiovascular diseases, stroke, and diet. The selected mHealth apps’ titles and content were screened based on the description that was provided. Apps that were not designed with self-management features were excluded. We analyzed the mHealth apps by category and whether they involved health care professionals, were based on scientific testing, and had self-monitoring features. A validated and multidimensional tool, the Mobile App Rating Scale (MARS), was used to evaluate each mHealth app’s quality based on a 5-point Likert scale from 1 (inadequate) to 5 (excellent). Results: Overall, 42 apps were identified. Diabetes-specific mHealth apps accounted for 7% (n=3) of the market, hypertension apps for 12% (n=5), and general noncommunicable disease management apps for 21% (n=9). About 38% (n=16) of the apps were for managing chronic diseases, while 74% (n=31) were for weight management. Self-management features such as weight tracking, BMI calculators, diet tracking, and fluid intake tracking were seen in 86% (n=36) of the apps. Most mHealth apps (n=37, 88%) did not indicate whether there was involvement of health professionals in app development. Additionally, none of the apps reported scientific evidence demonstrating their efficacy in managing health. The overall mean MARS score was 3.2 of 5, with a range of 2.0 to 4.1. Functionality was the best-rated category (mean score 3.9, SD 0.5), followed by aesthetics (mean score 3.2, SD 0.9), information (mean score 3.1, SD 0.7), and engagement (mean score 2.9, SD 0.6). Conclusions: The quality of mHealth apps for managing chronic diseases was heterogeneous, with roughly half of them falling short of acceptable standards for both quality and content. The majority of apps contained scant information about scientific evidence and the developer’s history. To increase user confidence and accomplish desired health outcomes, mHealth apps should be optimized with the help of health care professionals. Future studies on mHealth content analysis should focus on other diseases as well. %R 10.2196/49055 %U https://mhealth.jmir.org/2024/1/e49055 %U https://doi.org/10.2196/49055 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52996 %T Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review %A Shin,Jung-hye %A Shields,Rachael %A Lee,Jenny %A Skrove,Zachary %A Tredinnick,Ross %A Ponto,Kevin %A Fields,Beth %+ Department of Design Studies, University of Wisconsin-Madison, 1300 Linden Dr, Madison, WI, 53706-1524, United States, 1 608 890 3704, jshin9@wisc.edu %K mobile app %K mobile applications %K mHealth %K mobile health %K app %K apps %K application %K applications %K mobile phone %K mobile app rating system %K occupational therapy %K home assessment %K web accessibility %K aging in place %K accessible %K accessibility %K quality %K rating %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K systematic %K synthesis %K syntheses %K PRISMA %K Google Play %K content analysis %K functionality %K WCAG %D 2024 %7 11.3.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. Objective: This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. Methods: mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps’ effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. Results: A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the “good” quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app’s functionality. Conclusions: Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place. %M 38466987 %R 10.2196/52996 %U https://mhealth.jmir.org/2024/1/e52996 %U https://doi.org/10.2196/52996 %U http://www.ncbi.nlm.nih.gov/pubmed/38466987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45904 %T Smartphone Apps for Food Purchase Choices: Scoping Review of Designs, Opportunities, and Challenges %A Benthem de Grave,Remco %A Bull,Christopher N %A Monjardino de Souza Monteiro,Diogo %A Margariti,Eleni %A McMurchy,Gareth %A Hutchinson,Joseph William %A Smeddinck,Jan David %+ Open Lab, School of Computing, Newcastle University, Open Lab, Floor 1, Urban Sciences Building, Newcastle Helix, Newcastle upon Tyne, NE4 5TG, United Kingdom, 44 1912084630, r.benthemdegrave2@newcastle.ac.uk %K behavior change %K mobile apps %K food choices %K grocery shopping %K sustainability %K healthy eating %K digital health %K mobile phone %D 2024 %7 6.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps can aid consumers in making healthier and more sustainable food purchases. However, there is still a limited understanding of the different app design approaches and their impact on food purchase choices. An overview of existing food purchase choice apps and an understanding of common challenges can help speed up effective future developments. Objective: We examined the academic literature on food purchase choice apps and provided an overview of the design characteristics, opportunities, and challenges for effective implementation. Thus, we contribute to an understanding of how technologies can effectively improve food purchase choice behavior and provide recommendations for future design efforts. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we considered peer-reviewed literature on food purchase choice apps within IEEE Xplore, PubMed, Scopus, and ScienceDirect. We inductively coded and summarized design characteristics. Opportunities and challenges were addressed from both quantitative and qualitative perspectives. From the quantitative perspective, we coded and summarized outcomes of comparative evaluation trials. From the qualitative perspective, we performed a qualitative content analysis of commonly discussed opportunities and challenges. Results: We retrieved 55 articles, identified 46 unique apps, and grouped them into 5 distinct app types. Each app type supports a specific purchase choice stage and shares a common functional design. Most apps support the product selection stage (selection apps; 27/46, 59%), commonly by scanning the barcode and displaying a nutritional rating. In total, 73% (8/11) of the evaluation trials reported significant findings and indicated the potential of food purchase choice apps to support behavior change. However, relatively few evaluations covered the selection app type, and these studies showed mixed results. We found a common opportunity in apps contributing to learning (knowledge gain), whereas infrequent engagement presents a common challenge. The latter was associated with perceived burden of use, trust, and performance as well as with learning. In addition, there were technical challenges in establishing comprehensive product information databases or achieving performance accuracy with advanced identification methods such as image recognition. Conclusions: Our findings suggest that designs of food purchase choice apps do not encourage repeated use or long-term adoption, compromising the effectiveness of behavior change through nudging. However, we found that smartphone apps can enhance learning, which plays an important role in behavior change. Compared with nudging as a mechanism for behavior change, this mechanism is less dependent on continued use. We argue that designs that optimize for learning within each interaction have a better chance of achieving behavior change. This review concludes with design recommendations, suggesting that food purchase choice app designers anticipate the possibility of early abandonment as part of their design process and design apps that optimize the learning experience. %M 38446500 %R 10.2196/45904 %U https://www.jmir.org/2024/1/e45904 %U https://doi.org/10.2196/45904 %U http://www.ncbi.nlm.nih.gov/pubmed/38446500 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55003 %T Evaluation of Patient-Facing Mobile Apps to Support Physiotherapy Care: Systematic Review %A Merolli,Mark %A Francis,Jill J %A Vallance,Patrick %A Bennell,Kim L %A Malliaras,Peter %A Hinman,Rana S %+ Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Parkville, Melbourne, 3052, Australia, 61 383443689, merollim@unimelb.edu.au %K physiotherapy %K physical therapy %K digital health intervention %K mobile app %K behavior change technique %K behavior change %K exercise %K systematic review %K quality %K rehabilitation %K BCT %K mHealth %K mobile health %K app %K apps %K physical activity %K fitness %K synthesis %K syntheses %K review methods %K review methodology %K search %K searches %K searching %K systematic %K mobile phone %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimize the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite their importance, behavior change strategies are often missing in patient management. Evaluating mobile apps that physiotherapists can use to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps and exploring their key features that can support behavior change and physiotherapy care are important aspects of such an evaluation. Objective: The primary aim of this study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs, and their behavior change potential. Methods: A systematic review of mobile apps in app stores was undertaken. The Apple App Store and Google Play were searched using a 2-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion and exclusion criteria were applied: apps had to be intended for use by patients and be self-contained (or stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1. App quality was assessed using the Mobile App Rating Scale, and the App Behavior Change Scale was used to assess the app’s potential to change behavior. Results: In total, 1240 apps were screened, and 35 were included. Of these 35 apps, 22 (63%) were available on both the Apple App Store and Google Play platforms. In total, 24 (69%) were general in their focus (eg, not condition-specific), with the remaining 11 (31%) being more specific (eg, knee rehabilitation and pelvic floor training). The mean app quality score (Mobile App Rating Scale) was 3.7 (SD 0.4) of 5 (range 2.8-4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were instruction on how to perform a behavior (n=32), action planning (n=30), and self-monitoring of behavior (n=28). The mean behavior change potential score (App Behavior Change Scale) was 8.5 (SD 3.1) of 21 (range 3-15). Conclusions: Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, the potential for behavior change varied widely across apps. International Registered Report Identifier (IRRID): RR2-10.2196/29047 %M 38437018 %R 10.2196/55003 %U https://mhealth.jmir.org/2024/1/e55003 %U https://doi.org/10.2196/55003 %U http://www.ncbi.nlm.nih.gov/pubmed/38437018 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e52169 %T “Internet+Nursing Service” Mobile Apps in China App Stores: Functionality and Quality Assessment Study %A Yuan,Shuo %A Liu,Min %A Peng,Yuqi %A Hu,Jinrui %A Li,Bingyan %A Ding,Xia %A Xie,Lunfang %K mobile phone %K mobile applications %K home care services %K telemedicine %K nursing services %K China %K apps %D 2024 %7 16.2.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: As the Chinese society ages and the concern for health and quality of life grows, the demand for care services in China is increasing. The widespread use of internet technology has greatly improved the convenience and efficiency of web-based services. As a result, the Chinese government has been implementing “Internet+Nursing Services” since 2019, with mobile apps being the primary tools for users to access these services. The quality of these apps is closely related to user experience and the smooth use of services. Objective: This study aims to evaluate the functionality, services, and quality of “Internet+Nursing Service” apps; identify weaknesses; and provide suggestions for improving service programs and the research, development, improvement, and maintenance of similar apps. Methods: In December 2022, two researchers searched for “Internet+Nursing Service” apps by applying the search criteria on the Kuchuan mobile app monitoring platform. After identifying the apps to be included based on ranking criteria, they collected information such as the app developer, app size, version number, number of downloads, user ratings, and number and names of services. Afterward, 5 trained researchers independently evaluated the quality of the apps by using the Chinese version of the user version of the Mobile App Rating Scale (uMARS-C). The total uMARS-C score was based on the average of the five evaluators’ ratings. Results: A total of 17 “Internet+Nursing Service” apps were included. Among these, 12 (71%) had been downloaded more than 10,000 times, 11 (65%) had user ratings of 4 or higher, the median app size was 62.67 (range 22.71‐103; IQR 37.51-73.47) MB, 16 (94%) apps provided surgical wound dressing change services, 4 (24%) covered first-tier cities, and only 1 (6%) covered fourth-tier cities. The median total uMARS-C score was 3.88 (range 1.92-4.92; IQR 3.71-4.05), which did not correlate with app store user ratings (r=0.003; P=.99). The quality of most apps (11/17, 65%) was average. Most apps (12/17, 71%) were rated as “good” or above (≥4 points) in terms of information quality, layout, graphics, performance, and ease of use; however, the vast majority of apps were rated as “fair” or even “poor” (<4 points) in terms of credibility (14/17, 82%) and demand (16/17, 94%). Conclusions: “Internet+Nursing Service” apps need to broaden their service coverage, increase service variety, and further optimize their service structure. The overall quality of these apps is generally poor. App developers should collaborate with medical professionals and communicate with target users before launching their products to ensure accurate content, complete functionality, and good operation that meets user needs. %R 10.2196/52169 %U https://mhealth.jmir.org/2024/1/e52169 %U https://doi.org/10.2196/52169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53262 %T mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis %A Zhou,Tianyu %A Salman,David %A McGregor,Alison %+ Department of Surgery and Cancer, Imperial College London, MSk lab, Sir Michael Uren Hub, 86 Wood Lan, London, W12 0BZ, United Kingdom, 44 7421760832, t.zhou20@imperial.ac.uk %K smartphone %K mHealth %K mobile health %K low back pain %K self-management %K treatment interventions %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rapid development of mobile health (mHealth) technology, many health apps have been introduced to the commercial market for people with back pain conditions. However, little is known about their content, quality, approaches to care for low back pain (LBP), and associated risks of use. Objective: The aims of this research were to (1) identify apps for the self-management of LBP currently on the market and (2) assess their quality, intervention content, theoretical approaches, and risk-related approaches. Methods: The UK iTunes and Google Play stores were initially searched for apps related to the self-management of LBP in May 2022. A repeat search in June 2023 was conducted to ensure that any relevant new apps developed in the last year were incorporated into the review. A total of 3 keywords recommended by the Cochrane Back and Neck Group were used to search apps “low back pain,” “back pain,” and “lumbago.” The quality of the apps was assessed by using the 5-point Mobile App Rating Scale (MARS). Results: A total of 69 apps (25 iOS and 44 Android) met the inclusion criteria. These LBP self-management apps mainly provide recommendations on muscle stretching (n=51, 73.9%), muscle strengthening (n=42, 60.9%), core stability exercises (n=32, 46.4%), yoga (n=19, 27.5%), and information about LBP mechanisms (n=17, 24.6%). Most interventions (n=14, 78%) are consistent with the recommendations in the National Institute for Health and Care Excellence (NICE) guidelines. The mean (SD) MARS overall score of included apps was 2.4 (0.44) out of a possible 5 points. The functionality dimension was associated with the highest score (3.0), whereas the engagement and information dimension resulted in the lowest score (2.1). Regarding theoretical and risk-related approaches, 18 (26.1%) of the 69 apps reported the rate of intervention progression, 11 (15.9%) reported safety checks, only 1 (1.4%) reported personalization of care, and none reported the theoretical care model or the age group targeted. Conclusions: mHealth apps are potentially promising alternatives to help people manage their LBP; however, most of the LBP self-management apps were of poor quality and did not report the theoretical approaches to care and their associated risks. Although nearly all apps reviewed included a component of care listed in the NICE guidelines, the model of care delivery or embracement of care principles such as the application of a biopsychosocial model was unclear. %M 38300700 %R 10.2196/53262 %U https://mhealth.jmir.org/2024/1/e53262 %U https://doi.org/10.2196/53262 %U http://www.ncbi.nlm.nih.gov/pubmed/38300700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49514 %T Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos %A Holland,Lena %A Kanzow,Amelie Friederike %A Wiegand,Annette %A Kanzow,Philipp %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str 40, Göttingen, 37075, Germany, 49 551 3960870, philipp.kanzow@med.uni-goettingen.de %K consumer health information %K dental erosion %K dental sciences %K digital media %K erosive tooth wear %K evidence-based dentistry %K health education %K information quality %K internet %K shared decision making %D 2024 %7 31.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the declining prevalence of dental caries, noncarious tooth defects such as erosive tooth wear have gained increased attention over the past decades. While patients more frequently search the internet for health-related information, the quality of patient-centered, web-based health information on erosive tooth wear is currently unknown. Objective: This study aimed to assess the quality of patient-centered, web-based health information (websites and YouTube videos) on erosive tooth wear. Methods: German-language websites were systematically identified through 3 electronic search engines (google.de, bing.de or yahoo.de, and duckduckgo.com) in September 2021. Eligible websites were independently assessed for (1) technical and functional aspects via the LIDA instrument, (2) readability via the Flesch reading-ease score, (3) comprehensiveness of information via a structured checklist, and (4) generic quality and risk of bias via the DISCERN instrument by 2 different reviewers. An overall quality score (ie, higher scores being favored) generated from all 4 domains was used as the primary outcome. Quality scores from each domain were separately analyzed as secondary outcomes and compared by the Friedman test. The effect of practice-specific variables on quality scores of websites from private dental offices was assessed using generalized linear modeling. Eligible YouTube videos were judged based on (1) the comprehensiveness of information, (2) viewers’ interaction, and (3) viewing rate. The comprehensiveness of information was compared between websites and YouTube videos using the Wilcoxon rank-sum test. Results: Overall, 231 eligible websites and 7 YouTube videos were identified and assessed. The median overall quality of the websites was 33.6% (IQR 29.8%-39.2%). Secondary outcome scores amounted to 64.3% (IQR 59.8%-69.0%) for technical and functional aspects, 40.0% (IQR 34.0%-49.0%) for readability, 11.5% (IQR 3.9%-26.9%) for comprehensiveness of information, and 16.7% (IQR 8.3%-23.3%) for generic quality. While the comprehensiveness of information and generic quality received low scores, technical and functional aspects as well as readability resulted in higher scores (both Padjusted<.001). Regarding practice-specific variables, websites from private dental offices outside Germany (P=.04; B=–6.64, 95% CI –12.85 to –0.42) or from dentists who are a dental society member (P=.049; B=–3.55, 95% CI –7.09 to –0.01) resulted in lower readability scores (ie, were more difficult to read), while a shorter time since dentists’ examination resulted in higher readability scores (P=.01; B=0.24 per year, 95% CI 0.05-0.43). The comprehensiveness of information from YouTube videos was 34.6% (IQR 13.5%-38.5%). However, the comprehensiveness of information did not vary between websites and YouTube videos (P=.09). Additionally, viewers’ interaction (1.7%, IQR 0.7%-3.4%) and viewing rates (101%, IQR 54.6%-112.6%) were low. Conclusions: The quality of German-language, patient-centered, web-based information on erosive tooth wear was limited. Especially, the comprehensiveness and trustworthiness of the available information were insufficient. Web-based information on erosive tooth wear requires improvement to inform patients comprehensively and reliably. %M 38167299 %R 10.2196/49514 %U https://www.jmir.org/2024/1/e49514 %U https://doi.org/10.2196/49514 %U http://www.ncbi.nlm.nih.gov/pubmed/38167299 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52573 %T Evaluation of Chinese HIV Mobile Apps by Researchers and Patients With HIV: Quality Evaluation Study %A Liu,Peng %A Wang,Lingmeng %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600 Donghai Road, Bengbu, 233030, China, 86 0552 3173195, wfz.bbmc@foxmail.com %K HIV %K mobile app %K evaluation %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Against the backdrop of globalization, China remains one of the most heavily burdened countries in Asia with regard to AIDS. However, many high-risk groups and patients affected by AIDS may be less likely to actively seek care from medical institutions because of fear of experiencing shame or discrimination. Mobile apps provide a promising avenue for supporting the prevention, diagnosis, and treatment of AIDS. However, a comprehensive systematic evaluation of these mobile apps’ functionality and quality has not been conducted yet. Objective: This study aims to identify the available mobile apps for AIDS in China, assess and discuss the functional features and quality of these Chinese AIDS mobile apps, and offer decision support for patients and clinical practitioners in accessing high-quality AIDS mobile apps. Furthermore, based on the evaluation results, recommendations for improvement will be provided. Methods: A systematic search was conducted on the Qimai app data platform, the Aladdin WeChat applet data platform, and WeChat to identify mobile apps related to AIDS. A snowball sampling method was used to supplement the potentially overlooked apps. The selected mobile apps underwent a rigorous screening process based on unified criteria. Subsequently, assessments were independently undertaken by 3 separate researchers and 2 patients with HIV, using both the Mobile App Rating Scale (MARS) and the User Mobile App Rating Scale (uMARS). Quantitative interpretations of the data were facilitated by the MedCalc statistical software (version 20.217, MedCalc Software). Results: A total of 2901 AIDS mobile apps were included in the study, with 2897 identified through information retrieval and an additional 4 added via snowball sampling. After a rigorous selection process, 21 apps were determined to be usable. Among them, the Hong Feng Wan app achieved the highest combined average score, calculated based on the MARS (3.96, SD 0.33) and uMARS (4.47, SD 0.26). Overall, there was no significant correlation between MARS and uMARS (rapp quality total score=0.41; P=.07; rsubjective quality=0.39; P=.08). A notable issue was the widespread lack of user privacy protection, with only 24% (5/21) of the apps offering this feature. Conclusions: The number of available Chinese AIDS mobile apps is limited, with WeChat applets dominating the market. Nonetheless, the performance of WeChat mini-apps is generally inferior to that of independent apps, and there may be significant discrepancies between assessments conducted by researchers and those provided by genuine end users, emphasizing the necessity of involving real users in the development and evaluation of HIV mobile apps. In addition, developers of these Chinese HIV mobile apps need to devote attention to improving privacy protection mechanisms, in addition to considering the evaluations of researchers and real users. This will help attract more users and increase user loyalty. %M 38277215 %R 10.2196/52573 %U https://mhealth.jmir.org/2024/1/e52573 %U https://doi.org/10.2196/52573 %U http://www.ncbi.nlm.nih.gov/pubmed/38277215 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48428 %T Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps %A Alhuwail,Dari %A Alhouti,Aisha %A Alsarhan,Latifah %+ Information Science Department, College of Life Sciences, Kuwait University, P.O. Box 5969, Sabah AlSalem University City, Safat 13060, Kuwait, 965 24633214, dari.alhuwail@ku.edu.kw %K apps %K Arabic %K awareness %K breast cancer %K consumer health informatics %K education %K mHealth %K mobile health %K privacy %K quality %K security %K smartphone %K women %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: سرطان الثدي – فحص سرطان الثدي – علاج سرطان الثدي – مرض سرطان الثدي – أعراض سرطان الثدي – فحص الثدي (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google’s search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Results: Only 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps. %M 38227353 %R 10.2196/48428 %U https://cancer.jmir.org/2024/1/e48428 %U https://doi.org/10.2196/48428 %U http://www.ncbi.nlm.nih.gov/pubmed/38227353 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48625 %T Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review %A Ribaut,Janette %A DeVito Dabbs,Annette %A Dobbels,Fabienne %A Teynor,Alexandra %A Mess,Elisabeth Veronica %A Hoffmann,Theresa %A De Geest,Sabina %+ Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 61 207 09 16, sabina.degeest@unibas.ch %K telemedicine %K smartphone %K mobile apps %K program evaluation %K decision-making %K systematic review %K mobile phone %D 2024 %7 15.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. Objective: Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. Methods: We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. Results: Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more—mainly related to ethical, legal, and social aspects—resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. Conclusions: This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064 %M 38224477 %R 10.2196/48625 %U https://mhealth.jmir.org/2024/1/e48625 %U https://doi.org/10.2196/48625 %U http://www.ncbi.nlm.nih.gov/pubmed/38224477 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47295 %T Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation %A Robinson,Billy %A Proimos,Eleni %A Zou,Daniel %A Gong,Enying %A Oldenburg,Brian %A See,Katharine %+ Department of Respiratory Medicine, Northern Health, 185 Cooper St, Epping, 3076, Australia, 61 38405 8000, billymed1994@gmail.com %K asthma %K mobile health %K mHealth %K app %K mobile %K chronic disease %K systematic review %K smartphone %K review methodology %K respiratory %K compliance %K guideline %K guidelines %K review of apps %K evaluation %K quality %K best practices %K apps %K mobile phone %D 2024 %7 10.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ≥3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record “asthma symptoms,” which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 %M 38198204 %R 10.2196/47295 %U https://mhealth.jmir.org/2024/1/e47295 %U https://doi.org/10.2196/47295 %U http://www.ncbi.nlm.nih.gov/pubmed/38198204 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50293 %T Dissemination Strategies for mHealth Apps: Systematic Review %A Moungui,Henri Claude %A Nana-Djeunga,Hugues Clotaire %A Anyiang,Che Frankline %A Cano,Mireia %A Ruiz Postigo,Jose Antonio %A Carrion,Carme %+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 672192283, henrimoungui@yahoo.fr %K mobile health %K mHealth %K mobile health apps %K mHealth apps %K dissemination %K marketing strategies %K digital marketing %K engagement %K onboarding %K systematic review %K systematic %K market %K marketing %K app %K apps %K adoption %K consumer %K mobile phone %D 2024 %7 5.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. Objective: The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. Methods: A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. Results: Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. Conclusions: mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use. %M 38180796 %R 10.2196/50293 %U https://mhealth.jmir.org/2024/1/e50293 %U https://doi.org/10.2196/50293 %U http://www.ncbi.nlm.nih.gov/pubmed/38180796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50226 %T The Most Popular Commercial Weight Management Apps in the Chinese App Store: Analysis of Quality, Features, and Behavior Change Techniques %A Geng,Lan %A Jiang,Genyan %A Yu,Lingling %A Xu,Yueming %A Huang,Wei %A Chen,Zhiqi %A Qi,Xiaoyan %A Zhang,Ting %A Zhao,Mei %+ School of Nursing, Anhui Medical University, No.15 Feicui Road, Hefei, 230601, China, 86 551 63869167, zhaomei@ahmu.edu.cn %K quality %K mobile health %K mobile apps %K weight loss %K weight management %K apps %K MARS %K China %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many smartphone apps designed to assist individuals in managing their weight are accessible, but the assessment of app quality and features has predominantly taken place in Western countries. Nevertheless, there is a scarcity of research evaluating weight management apps in China, which highlights the need for further investigation in this area. Objective: This study aims to conduct a comprehensive search for the most popular commercial Chinese smartphone apps focused on weight management and assess their quality, behavior change techniques (BCTs), and content-related features using appropriate evaluation scales. Additionally, the study sought to investigate the associations between the quality of various domains within weight management apps and the number of incorporated BCTs and app features. Methods: In April 2023, data on weight management apps from the iOS and Android app stores were downloaded from the Qimai Data platform. Subsequently, a total of 35 weight management apps were subjected to screening and analysis by 2 researchers. The features and quality of the apps were independently assessed by 6 professionals specializing in nutrition management and health behavioral change using the Mobile Application Rating Scale (MARS). Two registered dietitians, who had experience in app development and coding BCTs, applied the established 26-item BCT taxonomy to verify the presence of BCTs. Mean (SD) scores and their distributions were calculated for each section and item. Spearman correlations were used to assess the relationship between an app’s quality and its technical features, as well as the number of incorporated BCTs. Results: The data set included a total of 35 apps, with 8 available in the Android Store, 10 in the Apple Store, and 17 in both. The overall quality, with a mean MARS score of 3.44 (SD 0.44), showed that functionality was the highest scoring domain (mean 4.18, SD 0.37), followed by aesthetics (mean 3.43, SD 0.42), engagement (mean 3.26, SD 0.64), and information (mean 2.91, SD 0.52), which had the lowest score. The mean number of BCTs in the analyzed apps was 9.17 (range 2-18 BCTs/app). The most common BCTs were “prompt review of behavioral goals” and “provide instruction,” present in 31 apps (89%). This was followed by “prompt self-monitoring of behavior” in 30 apps (86%), “prompt specific goal setting” in 29 apps (83%), and “provide feedback on performance” in 27 apps (77%). The most prevalent features in the analyzed apps were the need for web access (35/35, 100%), monitoring/tracking (30/35, 86%), goal setting (29/35, 83%), and sending alerts (28/35, 80%). The study also revealed strong positive correlations among the number of BCTs incorporated, app quality, and app features. This suggests that apps with a higher number of BCTs tend to have better overall quality and more features. Conclusions: The study found that the overall quality of weight management apps in China is moderate, with a particular weakness in the quality of information provided. The most prevalent BCTs in these apps were reviewing behavioral goals, providing guidance, self-monitoring of behavior, goal setting, and offering performance feedback. The most common features were the need for web access, monitoring and tracking, goal setting, and sending alerts. Notably, higher-quality weight management apps in China tended to incorporate more BCTs and features. These findings can be valuable for developers looking to improve weight management apps and enhance their potential to drive behavioral change in weight management. %M 37999950 %R 10.2196/50226 %U https://mhealth.jmir.org/2023/1/e50226 %U https://doi.org/10.2196/50226 %U http://www.ncbi.nlm.nih.gov/pubmed/37999950 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47043 %T Quality of Digital Health Interventions Across Different Health Care Domains: Secondary Data Analysis Study %A Hyzy,Maciej %A Bond,Raymond %A Mulvenna,Maurice %A Bai,Lu %A Dix,Alan %A Daly,Robert %A Frey,Anna-Lena %A Leigh,Simon %+ School of Computing, Ulster University, Ulster University, York St, Belfast, BT15 1ED, United Kingdom, 44 7526852505, maciejmarekzych@gmail.com %K digital health interventions scoring %K digital health interventions %K digital health %K mHealth assessment %K mobile health %K ORCHA assessment %K Organisation for the Review of Care and Health Apps %K quality assessment %K quantifying DHIs %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are more than 350,000 digital health interventions (DHIs) in the app stores. To ensure that they are effective and safe to use, they should be assessed for compliance with best practice standards. Objective: The objective of this paper was to examine and compare the compliance of DHIs with best practice standards and adherence to user experience (UX), professional and clinical assurance (PCA), and data privacy (DP). Methods: We collected assessment data from 1574 DHIs using the Organisation for the Review of Care and Health Apps Baseline Review (OBR) assessment tool. As part of the assessment, each DHI received a score out of 100 for each of the abovementioned areas (ie, UX, PCA, and DP). These 3 OBR scores are combined to make up the overall ORCHA score (a proxy for quality). Inferential statistics, probability distributions, Kruskal-Wallis, Wilcoxon rank sum test, Cliff delta, and Dunn tests were used to conduct the data analysis. Results: We found that 57.3% (902/1574) of the DHIs had an Organisation for the Review of Care and Health Apps (ORCHA) score below the threshold of 65. The overall median OBR score (ORCHA score) for all DHIs was 61.5 (IQR 51.0-73.0) out of 100. A total of 46.2% (12/26) of DHI’s health care domains had a median equal to or above the ORCHA threshold score of 65. For the 3 assessment areas (UX, DP, and PCA), DHIs scored the highest for the UX assessment 75.2 (IQR 70.0-79.6), followed by DP 65.1 (IQR 55.0-73.4) and PCA 49.6 (IQR 31.9-76.1). UX scores had the least variance (SD 13.9), while PCA scores had the most (SD 24.8). Respiratory and urology DHIs were consistently highly ranked in the National Institute for Health and Care Excellence Evidence Standards Framework tiers B and C based on their ORCHA score. Conclusions: There is a high level of variability in the ORCHA scores of DHIs across different health care domains. This suggests that there is an urgent need to improve compliance with best practices in some health care areas. Possible explanations for the observed differences might include varied market maturity and commercial interests within the different health care domains. More investment to support the development of higher-quality DHIs in areas such as ophthalmology, allergy, women’s health, sexual health, and dental care may be needed. %M 37995121 %R 10.2196/47043 %U https://mhealth.jmir.org/2023/1/e47043 %U https://doi.org/10.2196/47043 %U http://www.ncbi.nlm.nih.gov/pubmed/37995121 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46937 %T Association Between the Characteristics of mHealth Apps and User Input During Development and Testing: Secondary Analysis of App Assessment Data %A Frey,Anna-Lena %A Baines,Rebecca %A Hunt,Sophie %A Kent,Rachael %A Andrews,Tim %A Leigh,Simon %+ Organisation for the Review of Care and Health Apps, V2, Sci-Tech Daresbury, Keckwick Lane, Daresbury, WA4 4FS, United Kingdom, 44 01925 606542, anna.frey@orchahealth.com %K patient and public involvement %K user involvement %K mobile apps %K digital health %K mobile health %K quality assessment %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User involvement is increasingly acknowledged as a central part of health care innovation. However, meaningful user involvement during the development and testing of mobile health apps is often not fully realized. Objective: This study aims to examine in which areas user input is most prevalent and whether there is an association between user inclusion and compliance with best practices for mobile health apps. Methods: A secondary analysis was conducted on an assessment data set of 1595 health apps. The data set contained information on whether the apps had been developed or tested with user input and whether they followed best practices across several domains. Background information was also available regarding the apps’ country of origin, targeted condition areas, subjective user ratings, download numbers, and risk (as per the National Institute for Health and Care Excellence Evidence Standards Framework [ESF]). Descriptive statistics, Mann-Whitney U tests, and Pearson chi-square analyses were applied to the data. Results: User involvement was reported by 8.71% (139/1595) of apps for only the development phase, by 33.67% (537/1595) of apps for only the testing phase, by 21.88% (349/1595) of apps for both phases, and by 35.74% (570/1595) of apps for neither phase. The highest percentage of health apps with reported user input during development was observed in Denmark (19/24, 79%); in the condition areas of diabetes (38/79, 48%), cardiology (15/32, 47%), pain management (20/43, 47%), and oncology (25/54, 46%); and for high app risk (ESF tier 3a; 105/263, 39.9%). The highest percentage of health apps with reported user input during testing was observed in Belgium (10/11, 91%), Sweden (29/34, 85%), and France (13/16, 81%); in the condition areas of neurodiversity (42/52, 81%), respiratory health (58/76, 76%), cardiology (23/32, 72%), and diabetes (56/79, 71%); and for high app risk (ESF tier 3a; 176/263, 66.9%). Notably, apps that reported seeking user input during testing demonstrated significantly more downloads than those that did not (P=.008), and user inclusion was associated with better compliance with best practices in clinical assurance, data privacy, risk management, and user experience. Conclusions: The countries and condition areas in which the highest percentage of health apps with user involvement were observed tended to be those with higher digital maturity in health care and more funding availability, respectively. This suggests that there may be a trade-off between developers’ willingness or ability to involve users and the need to meet challenges arising from infrastructure limitations and financial constraints. Moreover, the finding of a positive association between user inclusion and compliance with best practices indicates that, where no other guidance is available, users may benefit from prioritizing health apps developed with user input as the latter may be a proxy for broader app quality. %M 37991822 %R 10.2196/46937 %U https://mhealth.jmir.org/2023/1/e46937 %U https://doi.org/10.2196/46937 %U http://www.ncbi.nlm.nih.gov/pubmed/37991822 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e52377 %T App Characteristics and Accuracy Metrics of Available Digital Biomarkers for Autism: Scoping Review %A Ponzo,Sonia %A May,Merle %A Tamayo-Elizalde,Miren %A Bailey,Kerri %A Shand,Alanna J %A Bamford,Ryan %A Multmeier,Jan %A Griessel,Ivan %A Szulyovszky,Benedek %A Blakey,William %A Valentine,Sophie %A Plans,David %+ Healios Limited, 4A Tileyard, Tileyard Rd, London, N7 9AH, United Kingdom, 44 0330 124 4222, sonia.ponzo@healios.org.uk %K autism %K diagnostics %K digital biomarkers %K digital health %K mobile apps %K neurodevelopmental conditions %D 2023 %7 17.11.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Diagnostic delays in autism are common, with the time to diagnosis being up to 3 years from the onset of symptoms. Such delays have a proven detrimental effect on individuals and families going through the process. Digital health products, such as mobile apps, can help close this gap due to their scalability and ease of access. Further, mobile apps offer the opportunity to make the diagnostic process faster and more accurate by providing additional and timely information to clinicians undergoing autism assessments. Objective: The aim of this scoping review was to synthesize the available evidence about digital biomarker tools to aid clinicians, researchers in the autism field, and end users in making decisions as to their adoption within clinical and research settings. Methods: We conducted a structured literature search on databases and search engines to identify peer-reviewed studies and regulatory submissions that describe app characteristics, validation study details, and accuracy and validity metrics of commercial and research digital biomarker apps aimed at aiding the diagnosis of autism. Results: We identified 4 studies evaluating 4 products: 1 commercial and 3 research apps. The accuracy of the identified apps varied between 28% and 80.6%. Sensitivity and specificity also varied, ranging from 51.6% to 81.6% and 18.5% to 80.5%, respectively. Positive predictive value ranged from 20.3% to 76.6%, and negative predictive value fluctuated between 48.7% and 97.4%. Further, we found a lack of details around participants’ demographics and, where these were reported, important imbalances in sex and ethnicity in the studies evaluating such products. Finally, evaluation methods as well as accuracy and validity metrics of available tools were not clearly reported in some cases and varied greatly across studies. Different comparators were also used, with some studies validating their tools against the Diagnostic and Statistical Manual of Mental Disorders criteria and others through self-reported measures. Further, while in most cases, 2 classes were used for algorithm validation purposes, 1 of the studies reported a third category (indeterminate). These discrepancies substantially impact the comparability and generalizability of the results, thus highlighting the need for standardized validation processes and the reporting of findings. Conclusions: Despite their popularity, systematic evaluations and syntheses of the current state of the art of digital health products are lacking. Standardized and transparent evaluations of digital health tools in diverse populations are needed to assess their real-world usability and validity, as well as help researchers, clinicians, and end users safely adopt novel tools within clinical and research practices. %M 37976084 %R 10.2196/52377 %U https://mhealth.jmir.org/2023/1/e52377 %U https://doi.org/10.2196/52377 %U http://www.ncbi.nlm.nih.gov/pubmed/37976084 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41779 %T Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation %A Weber,Summer Joy %A Mulvaney,Shelagh A %A Faiola,Anthony %A Brown,Madeline %A Koyama,Tatsuki %A Sun,Lili %A Goggans,Susanna Lynn %A Hull,Pamela Carmen %+ Markey Cancer Center, University of Kentucky, 760 Press Avenue, Suite 460, Lexington, KY, 40536, United States, 1 859 562 3233, pam.hull@uky.edu %K goal setting %K goal tracking %K nutrition %K health behavior %K nutrition %K parents %K children %K mobile apps %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. Objective: This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps’ general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). Methods: Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. Results: Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. Conclusions: Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals. %M 37831486 %R 10.2196/41779 %U https://pediatrics.jmir.org/2023/1/e41779 %U https://doi.org/10.2196/41779 %U http://www.ncbi.nlm.nih.gov/pubmed/37831486 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e46881 %T Content and Quality of Mobile Apps for the Monitoring of Musculoskeletal or Neuropathic Pain in Australia: Systematic Evaluation %A Simmich,Joshua %A Ross,Megan Heather %A Andrews,Nicole Emma %A Vaezipour,Atiyeh %A Russell,Trevor Glen %K pain %K monitoring %K digital health %K mobile application %K digital health %K mobile app %K pain management %K pain level %K chronic pain %K smartphone %K musculoskeletal pain %K neuropathic pain %K remote %D 2023 %7 13.9.2023 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps offer a potential mechanism for people with persistent pain to monitor pain levels conveniently within their own environment and for clinicians to remotely monitor their patients’ pain. However, the quality of currently available apps and the usefulness of included features from a clinical perspective are not known. Objective: The aim of this study was to examine the content and quality of currently available smartphone apps designed for monitoring the intensity or presence of musculoskeletal or neuropathic pain. Methods: A systematic search was performed in the Australian Apple and Google Play stores. Apps were included if they were designed to monitor the intensity or presence of musculoskeletal or neuropathic pain and were available in the English language within the Australian app stores. Data pertaining to the intended use of the app and clinical population were extracted by using a custom-designed data extraction form, and app quality was assessed by using the 23-item Mobile App Rating Scale. Results: Of the 2190 apps screened, 49 met the inclusion criteria. Apps were primarily designed for adult users (36/49, 73%) with nonspecific musculoskeletal or neuropathic pain conditions, arthritis, and joint pain. All apps monitored pain intensity, with almost half (23/49, 47%) also specifying pain location. Overall, the mean quality scores from the Mobile App Rating Scale ranged from 1.5 to 4.4 (out of 5.0). Between 20% (10/49) and 22% (11/49) of apps involved clinicians, consumers, or both in their development, and 20% (10/49) had published literature related to the development or use of the app in clinical scenarios. Although 71% (35/49) had data sharing features, only 5 apps enabled client-clinician communication through the app. Conclusions: The overall quality of mobile apps that are currently available for monitoring pain intensity is acceptable. Presently, mobile apps for remote pain monitoring lack functionality for clinicians to view data between consults. Both users and clinicians should be aware of the limitations of these apps and make informed choices in using or recommending apps that best suit the clinical need. %R 10.2196/46881 %U https://mhealth.jmir.org/2023/1/e46881 %U https://doi.org/10.2196/46881 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47502 %T Availability, Quality, and Evidence-Based Content of mHealth Apps for the Treatment of Nonspecific Low Back Pain in the German Language: Systematic Assessment %A Ulrich,Lauro %A Thies,Phillip %A Schwarz,Annika %+ Faculty of Social Sciences, City University of Applied Sciences Bremen, Am Brill 2-4, Bremen, 28195, Germany, 49 176 151 40 227, annika.schwarz@hs-bremen.de %K mobile health %K mobile apps %K smartphone %K nonspecific low back pain %K German language %K intervention %K digital health %K home exercise %K digital rehabilitation %K workout %K mobile phone %D 2023 %7 13.9.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. Objective: We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. Methods: A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. Results: In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence–based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as “Yes” was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of “Yes” for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in “Section B–Functionality” (mean 3.81, SD 0.54). Conclusions: Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. Trial Registration: Open Science Framework Registries sq435; https://osf.io/sq435 %M 37703072 %R 10.2196/47502 %U https://mhealth.jmir.org/2023/1/e47502 %U https://doi.org/10.2196/47502 %U http://www.ncbi.nlm.nih.gov/pubmed/37703072 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42044 %T Categorization and Analysis of Primary Care mHealth Apps Related to Breast Health and Breast Cancer: Systematic Search in App Stores and Content Analysis %A Kanodia,Sweekrity %A Thalabard,Jean Christophe %A Lhoste,Kevin %+ System Engineering and Evolution Dynamics, Université Paris Cité, Inserm, 8 bis Rue Charles V, Paris, 75004, France, 33 0753458521, sweekrity.kanodia@cri-paris.org %K breast cancer %K breast self-examination %K BSE %K primary care %K mobile applications %K mobile apps %K breast health %K early diagnosis %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common cause of cancer mortality among women globally. The use of mobile health tools such as apps and games is increasing rapidly, even in low- and middle-income countries, to promote early diagnosis and to manage care and support of survivors and patients. Objective: The primary objective of this review was to categorize selected mobile health apps related to breast health and prevention of breast cancer, based on features such as breast self-examination (BSE) training and reminders, and to analyze their current dissemination. An ancillary objective was to highlight the limitations of existing tools and suggest ways to improve them. Methods: We defined strict inclusion and exclusion criteria, which required apps to have titles or descriptions that suggest that they were designed for the general public, and not for patients with breast cancer or health workers. Apps that focused on awareness and primary care via self-check were included, while those that focused on topics such as alternative treatments and medical news were excluded. Apps that were not specifically related to breast cancer were also excluded. Apps (in any language) that appeared in the search with keywords were included. The database consisted of apps from AppAgg and Google Play Store. Only 85 apps met the inclusion criteria. Selected apps were categorized on the basis of their alleged interactive features. Descriptive statistics were obtained, and available language options, the number of downloads, and the cost of the apps were the main parameters reviewed. Results: The selected apps were categorized on the basis of the following features: education, BSE training, reminders, and recording. Of the 85 selected apps, 72 (84.7%) focused on disseminating breast cancer information. BSE training was provided by only 47% (n=40) of the apps, and very few had reminder (n=26, 30.5%) and recording (n=11, 12.9%) features. The median number of downloads was the highest for apps with recording features (>1000 downloads) than those with education, BSE training, reminder, and recording features (>5000 downloads). Most of these apps (n=74, 83.5%) were monolingual, and around 80.3% (n=49) of these apps were in English. Almost all the apps on Google Play Store were free of charge. Conclusions: Although there exist several apps on Google Play Store to promote awareness about breast health and cancer, the usefulness of most of them appears debatable. To provide a complete breast health package to the users, such apps must have all of the following features: reminders or notifications and symptom recording and tracking. There is still an urgent need to scientifically evaluate existing apps in the target populations in order to make them more functional and user-friendly. %M 37676704 %R 10.2196/42044 %U https://cancer.jmir.org/2023/1/e42044 %U https://doi.org/10.2196/42044 %U http://www.ncbi.nlm.nih.gov/pubmed/37676704 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45258 %T Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review %A Schulze,Annett %A Lindemann,Ann-Kathrin %A Brand,Fabian %A Geppert,Johanna %A Menning,Axel %A Stehr,Paula %A Reifegerste,Doreen %A Rossmann,Constanze %+ Department of Risk Communication, German Federal Institute for Risk Assessment, Max-Dohrn-Str 8-10, Berlin, 10589, Germany, 49 18412 52002, annett.schulze@bfr.bund.de %K mobile health %K mHealth %K caregiver %K parental %K prevention %K first aid %K pediatric %K review method %K injuries %K health app %K needs %K mobile phone %D 2023 %7 6.9.2023 %9 Review %J Interact J Med Res %G English %X Background: Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective: This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods: In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app’s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions: The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies. %M 37672312 %R 10.2196/45258 %U https://www.i-jmr.org/2023/1/e45258 %U https://doi.org/10.2196/45258 %U http://www.ncbi.nlm.nih.gov/pubmed/37672312 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42415 %T Stress Management Apps: Systematic Search and Multidimensional Assessment of Quality and Characteristics %A Paganini,Sarah %A Meier,Evelyn %A Terhorst,Yannik %A Wurst,Ramona %A Hohberg,Vivien %A Schultchen,Dana %A Strahler,Jana %A Wursthorn,Max %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Sandfangweg 4, Freiburg, 79102, Germany, 49 76120345, sarah.paganini@sport.uni-freiburg.de %K stress management %K mobile app %K mHealth %K mobile health %K quality assessment %K review %K evidence base %K availability %D 2023 %7 29.8.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Chronic stress poses risks for physical and mental well-being. Stress management interventions have been shown to be effective, and stress management apps (SMAs) might help to transfer strategies into everyday life. Objective: This review aims to provide a comprehensive overview of the quality and characteristics of SMAs to give potential users or health professionals a guideline when searching for SMAs in common app stores. Methods: SMAs were identified with a systematic search in the European Google Play Store and Apple App Store. SMAs were screened and checked according to the inclusion criteria. General characteristics and quality were assessed by 2 independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the following four dimensions: (1) engagement, (2) functionality, (3) esthetics, and (4) information. In addition, the theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the 5 top-rated SMAs were assessed and derived. Results: Of 2044 identified apps, 121 SMAs were included. Frequently implemented strategies (also in the 5 top-rated SMAs) were psychoeducation, breathing, and mindfulness, as well as the use of monitoring and reminder functions. Of the 121 SMAs, 111 (91.7%) provided a privacy policy, but only 44 (36.4%) required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14.0% (17/121) of the SMAs. The average quality of the included apps was above the cutoff score of 3.5 (mean 3.59, SD 0.50). The MARS-G dimensions yielded values above this cutoff score (functionality: mean 4.14, SD 0.47; esthetics: mean 3.76, SD 0.73) and below this score (information: mean 3.42, SD 0.46; engagement: mean 3.05, SD 0.78). Most theory-based stress management strategies were regenerative stress management strategies. The evidence base for 9.1% (11/121) of the SMAs could be identified, indicating significant group differences in several variables (eg, stress or depressive symptoms) in favor of SMAs. Moreover, 38.0% (46/121) of the SMAs were no longer available after a 2-year period. Conclusions: The moderate information quality, scarce evidence base, constraints in data privacy and security features, and high volatility of SMAs pose challenges for users, health professionals, and researchers. However, owing to the scalability of SMAs and the few but promising results regarding their effectiveness, they have a high potential to reach and help a broad audience. For a holistic stress management approach, SMAs could benefit from a broader repertoire of strategies, such as more instrumental and mental stress management strategies. The common characteristics of SMAs with top-rated quality can be used as guidance for potential users and health professionals, but owing to the high volatility of SMAs, enhanced evaluation frameworks are needed. %M 37642999 %R 10.2196/42415 %U https://mhealth.jmir.org/2023/1/e42415 %U https://doi.org/10.2196/42415 %U http://www.ncbi.nlm.nih.gov/pubmed/37642999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39929 %T Planting Seeds for the Future: Scoping Review of Child Health Promotion Apps for Parents %A Blakeslee,Sarah B %A Vieler,Kristin %A Horak,Ingo %A Stritter,Wiebke %A Seifert,Georg %+ Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30 450 566058, sarah.blakeslee@charite.de %K scoping review %K child health promotion %K parents %K mobile apps %K health apps %K digital prevention %K behavior change %K mHealth %D 2023 %7 20.7.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Increasingly, parents use child health promotion apps to find health information. An overview of child health promotion apps for parents currently does not exist. The scope of child health topics addressed by parent apps is thus needed, including how they are evaluated. Objective: This scoping review aims to describe existing reported mobile health (mHealth) parent apps of middle- to high-income countries that promote child health. The focus centers on apps developed in the last 5 years, showing how the reported apps are evaluated, and listing reported outcomes found. Methods: A scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines to identify parent apps or web-based programs on child health promotion published between January 2016 and June 2021 in 5 databases: PubMed, ERIC, IEEE Xplore, Web of Science, and Google Scholar. Separate sources were sought through an expert network. Included studies were summarized and analyzed through a systematic and descriptive content analysis, including keywords, year of publication, country of origin, aims/purpose, study population/sample size, intervention type, methodology/method(s), broad topic(s), evaluation, and study outcomes. Results: In total, 39 studies met the inclusion criteria from 1040 database and 60 expert-identified studies. Keywords reflected the health topics and app foci. About 64% (25/39) of included studies were published after 2019 and most stemmed from the United States, Australian, and European-based research. Studies aimed to review or evaluate apps or conducted app-based study interventions. The number of participants ranged from 7 to 1200. Quantitative and qualitative methods were used. Interventions included 28 primary studies, 6 app feasibility studies, and 5 app or literature reviews. Eight separate topics were found: parental feeding and nutrition, physical activity, maternal-child health, parent-child health, healthy environment, dental health, mental health, and sleep. Study intervention evaluations cited behavior change theories in 26 studies and evaluations were carried out with a variety of topic-specific, adapted, self-developed, or validated questionnaires and evaluation tools. To evaluate apps, user input and qualitative evaluations were often combined with surveys and frequently rated with the Mobile App Rating Scale. Outcomes reported some positive effects, while several intervention studies saw no effect at all. Effectively evaluating changes in behavior through apps, recruiting target groups, and retaining app engagement were challenges cited. Conclusions: New parents are a key target group for child health apps, but evaluating child health promotion apps remains a challenge. Whether tailored to parent needs or adapted to the specific topic, apps should be rooted in a transparent theoretical groundwork. Applicable lessons for parent apps from existing research are to tailor app content, include intuitive and adaptive features, and embed well-founded parameters for long-term effect evaluation on child health promotion. %M 37471125 %R 10.2196/39929 %U https://mhealth.jmir.org/2023/1/e39929 %U https://doi.org/10.2196/39929 %U http://www.ncbi.nlm.nih.gov/pubmed/37471125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45984 %T Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps %A Lin,Xiaowen %A Martinengo,Laura %A Jabir,Ahmad Ishqi %A Ho,Andy Hau Yan %A Car,Josip %A Atun,Rifat %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Singapore, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agent %K chatbot %K mental health %K mobile health %K mHealth %K behavior change %K apps %K Mobile Application Rating Scale %K MARS %K mobile phone %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users’ mental health. Objective: This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. Methods: The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple’s App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. Results: We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 “Social support (emotional),” 4.1 “Instructions for how to perform a behavior,” 11.2 “Reduce negative emotions,” and 6.1 “Demonstration of the behavior.” One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. Conclusions: Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions. %M 37463036 %R 10.2196/45984 %U https://www.jmir.org/2023/1/e45984 %U https://doi.org/10.2196/45984 %U http://www.ncbi.nlm.nih.gov/pubmed/37463036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35858 %T Mobile Apps for Dietary and Food Timing Assessment: Evaluation for Use in Clinical Research %A Gioia,Siena %A Vlasac,Irma M %A Babazadeh,Demsina %A Fryou,Noah L %A Do,Elizabeth %A Love,Jessica %A Robbins,Rebecca %A Dashti,Hassan S %A Lane,Jacqueline M %+ Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA, EBRC104, United States, 1 617 525 7829, jlane@broadinstitute.org %K dietary assessment %K mobile phone %K smartphone %K nutrition apps %K dietary record %K circadian rhythms %K food diary %K food timing %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, health mobile apps have become an increasingly popular tool used by clinicians and researchers to track food consumption and exercise. However, many consumer apps lack the technological features for facilitating the capture of critical food timing details. Objective: This study aimed to introduce users to 11 apps from US app stores that recorded both dietary intake and food timing to establish which one would be the most appropriate for clinical research. Methods: To determine a viable app that recorded both dietary intake and food timing for use in a food timing–related clinical study, we evaluated the time stamp data, usability, privacy policies, the accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment that were available on US app stores. The following apps were selected using a keyword search of related terms and reviewed: text entry apps—Cronometer, DiaryNutrition, DietDiary, FoodDiary, Macros, and MyPlate; image entry apps—FoodView and MealLogger; and text plus image entry apps—Bitesnap, myCircadianClock, and MyFitnessPal. Results: Our primary goal was to identify apps that recorded food time stamps, which 8 (73%) of the 11 reviewed apps did. Of the 11 apps, only 4 (36%) allowed users to edit the time stamps. Next, we sought to evaluate the usability of the apps using the System Usability Scale across 2 days, and 82% (9/11) of the apps received favorable scores for usability. To enable use in research and clinical settings, the privacy policies of each app were systematically reviewed using common criteria, with 1 (9%) Health Insurance Portability and Accountability Act–compliant app (Cronometer). Furthermore, protected health information was collected by 9 (82%) of the 11 apps. Finally, to assess the accuracy of the nutrient estimates generated by these apps, we selected 4 sample food items and a 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared with the nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research database. In terms of the 3-day food record, the apps were found to consistently underestimate daily calories and macronutrients compared with the Nutrition Data System for Research output. Conclusions: Overall, we found that the Bitesnap app provided flexible dietary and food timing functionality capable of being used in research and clinical settings, whereas most other apps lacked in the necessary food timing functionality or user privacy. %M 37327038 %R 10.2196/35858 %U https://formative.jmir.org/2023/1/e35858 %U https://doi.org/10.2196/35858 %U http://www.ncbi.nlm.nih.gov/pubmed/37327038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41807 %T Characterizing Consumer Smartphone Apps for Virtual Reality–Based Exposure Therapy: Content Analysis %A Sunkara,Charvi %A Thakkar,Rajvi %A Ong,Triton %A Bunnell,Brian E %+ Doxy.me Research, Doxy.me Inc, 3445 Winton Place, Suite #114, Rochester, NY, 14623, United States, 1 8444369963, triton.ong@doxy.me %K virtual reality %K exposure therapy %K phobia %K apps %K smartphones %K VR %K smartphone apps %K mobile phone apps %K content analysis %K treatment %K clinical evaluation %K phobia %K consumer apps %K mHealth apps %D 2023 %7 14.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. Objective: The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. Methods: We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. Results: The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. Conclusions: None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions. %M 37058343 %R 10.2196/41807 %U https://www.jmir.org/2023/1/e41807 %U https://doi.org/10.2196/41807 %U http://www.ncbi.nlm.nih.gov/pubmed/37058343 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40921 %T Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study %A Ko,Siyeon %A Lee,Jisan %A An,Doyeon %A Woo,Hyekyung %+ Department of Health Administration, College of Nursing & Health, Kongju National University, 56 Gongjudaehak-ro, Gongju-Si, Chungcheongnam-do, Republic of Korea, 82 10 3350 3486, hkwoo@kongju.ac.kr %K mobile app %K period %K menstrual cycle %K mHealth %K mobile health %K evaluation %K women’s health %K health care provider %K consumer %K menstrual app %K digital health app %K health screening %K consumer satisfaction %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions: 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. %M 36857125 %R 10.2196/40921 %U https://mhealth.jmir.org/2023/1/e40921 %U https://doi.org/10.2196/40921 %U http://www.ncbi.nlm.nih.gov/pubmed/36857125 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43522 %T Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment %A Yang,Seongwoo %A Bui,Cam Nhung %A Park,Kyounghoon %+ HERINGS, The Institute of Advanced Clinical & Biomedical Research, 14F, 560, Eonju-ro, Gangnam-gu, Seoul, 06144, Republic of Korea, 82 269493523, khpark@heringsglobal.com %K app %K breast cancer %K quality assessment %K mobile health %K mHealth %K digital health %K digital health intervention %K cancer management %K tablet %K prevention %K survivor %K peer-support %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. Objective: The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. Methods: Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords “breast cancer” in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. Results: The initial search identified 1148 apps, 69 (6%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). Conclusions: The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes. %M 36821352 %R 10.2196/43522 %U https://mhealth.jmir.org/2023/1/e43522 %U https://doi.org/10.2196/43522 %U http://www.ncbi.nlm.nih.gov/pubmed/36821352 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40552 %T Changes in Mobile Health Apps Usage Before and After the COVID-19 Outbreak in China: Semilongitudinal Survey %A Yang,Le %A Wu,Jiadong %A Mo,Xiaoxiao %A Chen,Yaqin %A Huang,Shanshan %A Zhou,Linlin %A Dai,Jiaqi %A Xie,Linna %A Chen,Siyu %A Shang,Hao %A Rao,Beibei %A Weng,Bingtao %A Abulimiti,Ayiguli %A Wu,Siying %A Xie,Xiaoxu %+ School of Public Health, Fujian Medical University, No. 1 Xuefu North Road, Fuzhou University New District, Fuzhou, 350122, China, 86 059122862023, xiexiaoxu@aliyun.com %K application %K China %K COVID-19 %K mHealth %K health management %K mobile health %K technology %K app %K survey %K data %K user %K user experience %K vaccination %K download %K healthcare %K development %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. Objective: We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. Methods: We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For user experience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Results: Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showed that rehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4%; postpandemic: 146/178, 82.0%; P=.006) steadily increased after the outbreak. Conclusions: mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion. %M 36634256 %R 10.2196/40552 %U https://publichealth.jmir.org/2023/1/e40552 %U https://doi.org/10.2196/40552 %U http://www.ncbi.nlm.nih.gov/pubmed/36634256 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39093 %T Design Principles in mHealth Interventions for Sustainable Health Behavior Changes: Protocol for a Systematic Review %A Yang,Lin %A Kuang,Angela %A Xu,Claire %A Shewchuk,Brittany %A Singh,Shaminder %A Quan,Hude %A Zeng,Yong %+ Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Room 505, Holy Cross Centre, 2210 2nd St SW,, Calgary, AB, T2S 3C3, Canada, 1 4036988156, lin.yang@albertahealthservices.ca %K behavior change %K intervention %K mHealth %K personalization %K dialogue %K mobile health %K mobile app %K self-management %D 2023 %7 22.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent years, mHealth has increasingly been used to deliver behavioral interventions for disease prevention and self-management. Computing power in mHealth tools can provide unique functions beyond conventional interventions in provisioning personalized behavior change recommendations and delivering them in real time, supported by dialogue systems. However, design principles to incorporate these features in mHealth interventions have not been systematically evaluated. Objective: The goal of this review is to identify best practices for the design of mHealth interventions targeting diet, physical activity, and sedentary behavior. We aim to identify and summarize the design characteristics of current mHealth tools with a focus on the following features: (1) personalization, (2) real-time functions, and (3) deliverable resources. Methods: We will conduct a systematic search of electronic databases, including MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science for studies published since 2010. First, we will use keywords that combine mHealth, interventions, chronic disease prevention, and self-management. Second, we will use keywords that cover diet, physical activity, and sedentary behavior. Literature found in the first and second steps will be combined. Finally, we will use keywords for personalization and real-time functions to limit the results to interventions that have reported these design features. We expect to perform narrative syntheses for each of the 3 target design features. Study quality will be evaluated using the Risk of Bias 2 assessment tool. Results: We have conducted a preliminary search of existing systematic reviews and review protocols on mHealth-supported behavior change interventions. We have identified several reviews that aimed to evaluate the efficacy of mHealth behavior change interventions in a range of populations, evaluate methodologies for assessing mHealth behavior change randomized trials, and assess the diversity of behavior change techniques and theories in mHealth interventions. However, syntheses on the unique features of mHealth intervention design are absent in the literature. Conclusions: Our findings will provide a basis for developing best practices for designing mHealth tools for sustainable behavior change. Trial Registration: PROSPERO CRD42021261078; https://tinyurl.com/m454r65t International Registered Report Identifier (IRRID): PRR1-10.2196/39093 %M 36811938 %R 10.2196/39093 %U https://www.researchprotocols.org/2023/1/e39093 %U https://doi.org/10.2196/39093 %U http://www.ncbi.nlm.nih.gov/pubmed/36811938 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44123 %T The Feasibility of Using Smartphone Sensors to Track Insomnia, Depression, and Anxiety in Adults and Young Adults: Narrative Review %A Alamoudi,Doaa %A Breeze,Emma %A Crawley,Esther %A Nabney,Ian %+ Department of Computer Science, University of Bristol, Merchant Venturers’ Building, Woodland Road, Bristol, BS8 1UB, United Kingdom, 44 117 928 3000, d.alamoudi@bristol.ac.uk %K mHealth %K digital %K health %K mental health %K insomnia %K technology %K sleep %K risk %K cardiovascular disease %K diabetes %K men %K mortality %K sleep disorder %K anxiety %K depression %K heart disease %K obesity %K dementia %K sensor %K intervention %K young adult %D 2023 %7 17.2.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Since the era of smartphones started in early 2007, they have steadily turned into an accepted part of our lives. Poor sleep is a health problem that needs to be closely monitored before it causes severe mental health problems, such as anxiety or depression. Sleep disorders (eg, acute insomnia) can also develop to chronic insomnia if not treated early. More specifically, mental health problems have been recognized to have casual links to anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. Several researchers have used mobile sensors to monitor sleep and to study changes in individual mood that may cause depression and anxiety. Objective: Extreme sleepiness and insomnia not only influence physical health, they also have a significant impact on mental health, such as by causing depression, which has a prevalence of 18% to 21% among young adults aged 16 to 24 in the United Kingdom. The main body of this narrative review explores how passive data collection through smartphone sensors can be used in predicting anxiety and depression. Methods: A narrative review of the English language literature was performed. We investigated the use of smartphone sensors as a method of collecting data from individuals, regardless of whether the data source was active or passive. Articles were found from a search of Google Scholar records (from 2013 to 2020) with keywords including “mobile phone,” “mobile applications,” “health apps,” “insomnia,” “mental health,” “sleep monitoring,” “depression,” “anxiety,” “sleep disorder,” “lack of sleep,” “digital phenotyping,” “mobile sensing,” “smartphone sensors,” and “sleep detector.” Results: The 12 articles presented in this paper explain the current practices of using smartphone sensors for tracking sleep patterns and detecting changes in mental health, especially depression and anxiety over a period of time. Several researchers have been exploring technological methods to detect sleep using smartphone sensors. Researchers have also investigated changes in smartphone sensors and linked them with mental health and well-being. Conclusions: The conducted review provides an overview of the possibilities of using smartphone sensors unobtrusively to collect data related to sleeping pattern, depression, and anxiety. This provides a unique research opportunity to use smartphone sensors to detect insomnia and provide early detection or intervention for mental health problems such as depression and anxiety if insomnia is detected. %M 36800211 %R 10.2196/44123 %U https://mhealth.jmir.org/2023/1/e44123 %U https://doi.org/10.2196/44123 %U http://www.ncbi.nlm.nih.gov/pubmed/36800211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37716 %T mHealth Apps Targeting Obesity and Overweight in Young People: App Review and Analysis %A Vlahu-Gjorgievska,Elena %A Burazor,Andrea %A Win,Khin Than %A Trajkovik,Vladimir %+ School of Computing and Information Technology, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 42214606, elenavg@uow.edu.au %K behavior change techniques %K user interface design patterns %K mHealth apps %K obesity %K lifestyle %K mobile app %K mobile health %K mobile phone %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low. Objective: The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs). Methods: A search for apps was conducted in Google Play Store using the following search string: [“best weight loss app for obese teens 2020”] OR [“obesity applications for teens”] OR [“popular weight loss applications”]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app. Results: The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app “Morphe,” intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings. Conclusions: The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness. %M 36656624 %R 10.2196/37716 %U https://mhealth.jmir.org/2023/1/e37716 %U https://doi.org/10.2196/37716 %U http://www.ncbi.nlm.nih.gov/pubmed/36656624 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e39881 %T Mobile Health Apps for Patient-Centered Care: Review of United States Rheumatoid Arthritis Apps for Engagement and Activation %A Cozad,Melanie J %A Crum,Marissa %A Tyson,Hannah %A Fleming,Perry R %A Stratton,Jeanine %A Kennedy,Ann Blair %A Lindley,Lisa C %A Horner,Ronnie D %+ Health Services Research and Administration Department, College of Public Health, University of Nebraska Medical Center, 9843650 Nebraska Medical Center, Omaha, NE, 68198-4350, United States, 1 757 613 1569, mcozad@unmc.edu %K rheumatoid arthritis %K rheumatism %K arthritis %K mobile app %K mobile applications %K mHealth %K patient engagement %K patient activation %K patient-centered care %K patient centred %K person centered %K Mobile Application Rating Scale %K social cognitive theory %K mobile health %K review %K systematic search %K app feature %K content analysis %K functionality %K user rating %K patient rating %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rheumatoid arthritis (RA) is a highly dynamic and individualized disease in terms of its patterns of symptomatic flare-ups and periods of remission. Patient-centered care (PCC) aligns patients’ lifestyle goals with their preferences for managing symptoms and side effects through the selection of therapies appropriate for disease management. Mobile health (mHealth) apps have the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC. Objective: The objective of this study was to evaluate the patient-centeredness of United States–based rheumatoid arthritis mobile apps in terms of patient engagement and activation. Methods: A search of mobile apps on 2 major United States app stores (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA by adapting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for mobile health app screening based on the literature. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along 2 dimensions: engagement and activation. Results: A total of 202 mobile apps were initially identified, and 20 remained after screening. Two apps emerged with the greatest ability to facilitate PCC. Both apps were scored as having acceptable or good patient engagement according to the MARS. These 2 apps also had high patient activation according to social cognitive theory, with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA. Conclusions: We found very few mobile apps available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile apps expands, the design of mobile apps needs to integrate patients to ensure that their functionality promotes engagement and activation. More research is needed to understand how mobile app use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory. %M 36469397 %R 10.2196/39881 %U https://mhealth.jmir.org/2022/12/e39881 %U https://doi.org/10.2196/39881 %U http://www.ncbi.nlm.nih.gov/pubmed/36469397 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e39819 %T Effectiveness of Mobile Medical Apps in Ensuring Medication Safety Among Patients With Chronic Diseases: Systematic Review and Meta-analysis %A Zhou,Ting ting %A Wang,Rui %A Gu,Si jia %A Xie,Li ling %A Zhao,Qing hua %A Xiao,Ming zhao %A Chen,Yu lu %+ Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Youyi Road, No.1, Chongqing, 400001, China, 86 13340224366, cyfyy_xieliling@163.com %K mobile application %K medication safety %K systematic review %K meta-analysis %K mobile health %K mHealth %K health app %K adherence %K pharmaceutical %K drug safety %K medication error %K drug error %K review methodology %K search strategy %K eHealth %K digital health %K adverse event %K adverse effect %D 2022 %7 22.11.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety. Objective: Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients' medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis. Methods: The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases—PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants’ characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis. Results: We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app’s features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58). Conclusions: We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072 %M 36413386 %R 10.2196/39819 %U https://mhealth.jmir.org/2022/11/e39819 %U https://doi.org/10.2196/39819 %U http://www.ncbi.nlm.nih.gov/pubmed/36413386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40347 %T Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review %A Bear,Holly Alice %A Ayala Nunes,Lara %A DeJesus,John %A Liverpool,Shaun %A Moltrecht,Bettina %A Neelakantan,Lakshmi %A Harriss,Elinor %A Watkins,Edward %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865613127, holly.bear@psych.ox.ac.uk %K adolescent mental health %K smartphones %K mobile apps %K apps %K implementation science %K mobile phone %D 2022 %7 9.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking. Objective: This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years. Results: Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation. Conclusions: Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations. Trial Registration: PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f %M 36350704 %R 10.2196/40347 %U https://www.jmir.org/2022/11/e40347 %U https://doi.org/10.2196/40347 %U http://www.ncbi.nlm.nih.gov/pubmed/36350704 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38793 %T Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis %A DeWitt,Akeiylah %A Kientz,Julie %A Liljenquist,Kendra %+ Department of Human-Centered Design and Engineering, 423 Sieg Building, Seattle, WA, 98195, United States, 1 206 543 2567, adewitt@uw.edu %K mobile health technologies %K early childhood health promotion %K child development %K parent support technologies %K pediatrics %K parenting %K mobile app %K mobile health %K mHealth %K mobile phone %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. Objective: This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child’s developmental health. Methods: To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). Results: We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. Conclusions: Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences. %M 36346656 %R 10.2196/38793 %U https://pediatrics.jmir.org/2022/4/e38793 %U https://doi.org/10.2196/38793 %U http://www.ncbi.nlm.nih.gov/pubmed/36346656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39869 %T mHealth Technologies for Managing Problematic Pornography Use: Content Analysis %A Henry,Nathan %A Donkin,Liesje %A Williams,Matt %A Pedersen,Mangor %+ Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland, 1010, New Zealand, 64 9 921 9666 ext 7304, nathan.henry@aut.ac.nz %K pornography %K compulsive sexual behavior disorder %K CSBD %K mobile health %K mHealth %K problematic pornography use %K PPU %K mobile intervention %K just-in-time adaptive intervention %K smartphone-based therapy %K addiction %K internet addiction %K behavioral addiction %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps. Objective: This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction. Methods: The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis. Results: In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety. Conclusions: There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption. %M 36227634 %R 10.2196/39869 %U https://formative.jmir.org/2022/10/e39869 %U https://doi.org/10.2196/39869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227634 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e41282 %T Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Bourgeois,Denis %A Kabuth,Bernard %A Baltenneck,Nicolas %A Nusbaum,Fanny %A Burge,Valérie %A Roy,Sylvain %A Buchheit,Sophie %A Carrion-Martinaud,Marie-Line %A Massoubre,Catherine %A Fraticelli,Laurie %A Dussart,Claude %+ Health Systemic Process, Research Unit UR4129, University Claude Bernard Lyon 1, University of Lyon, 7 rue Guillaume Paradin, Lyon, 69372, France, 33 0478785745, florence.carrouel@univ-lyon1.fr %K mobile apps %K behavior change %K mental %K prevention %K mobile health %K mHealth %K lifestyle %K French %K well-being %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 800 million people, representing 11% of the world’s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. Objective: This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale–French (MARS-F). Methods: Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. Results: The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. Conclusions: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users. %M 36223178 %R 10.2196/41282 %U https://mhealth.jmir.org/2022/10/e41282 %U https://doi.org/10.2196/41282 %U http://www.ncbi.nlm.nih.gov/pubmed/36223178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37866 %T Information Resources Among Flemish Pregnant Women: Cross-sectional Study %A Lanssens,Dorien %A Thijs,Inge M %A Dreesen,Pauline %A Van Hecke,Ann %A Coorevits,Pascal %A Gaethofs,Gitte %A Derycke,Joyce %A Tency,Inge %+ Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, University of Hasselt, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K pregnancy app %K mobile app %K questionnaire %K pregnancy %K pregnant %K mHealth %K mobile health %K cross-sectional %K user need %K user expectation %K survey %K maternal %K maternity %K user experience %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. %M 36222794 %R 10.2196/37866 %U https://formative.jmir.org/2022/10/e37866 %U https://doi.org/10.2196/37866 %U http://www.ncbi.nlm.nih.gov/pubmed/36222794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36818 %T Separating Features From Functionality in Vaccination Apps: Computational Analysis %A Shaw Jr,George %A Nadkarni,Devaki %A Phann,Eric %A Sielaty,Rachel %A Ledenyi,Madeleine %A Abnowf,Razaan %A Xu,Qian %A Arredondo,Paul %A Chen,Shi %+ Public Health Sciences, School of Data Science, University of North Carolina, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 704 562 0021, gshaw11@uncc.edu %K vaccines %K mobile health %K mHealth %K principal component analysis %K PCA %K k-means clustering %K information exchange %K mobile phone %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps’ design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps’ descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. %M 36222791 %R 10.2196/36818 %U https://formative.jmir.org/2022/10/e36818 %U https://doi.org/10.2196/36818 %U http://www.ncbi.nlm.nih.gov/pubmed/36222791 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38940 %T The Current State of Mobile Apps Owned by Large Pediatric Hospitals in the United States: Systematic Search and Analysis on Google Play and Apple App Stores %A Lieser,Tyler %A Huang,Yungui %A Sezgin,Emre %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Xrd, Columbus, OH, 43215, United States, 1 6147222210, tyler.lieser@nationwidechildrens.org %K pediatric %K child %K hospital %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K hospital-owned app %K telehealth %K review %K app feature %K accessibility %K patient experience %K functionality %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric hospitals in the United States are increasingly leveraging patient-facing mobile apps as their digital front doors for patients, families, and caretakers. These mobile health apps are sanctioned by pediatric hospitals to inform the public or populations about pediatric care to provide individualized information, to enhance communication, and to improve patient experience. Yet the functionalities and user feedback of these hospital mobile apps have not been systematically investigated. Objective: Our aim was to understand the current state of hospital-owned mobile apps provided by large pediatric hospitals, comparatively analyze and report the services provided, and identify potential gaps to inform developers and providers. The American Hospital Association defines large hospitals as those having a bed count of more than 400. Methods: We conducted a systematic search on Google Play and Apple App Store to identify all hospital-owned mobile apps from the large pediatric hospitals included in our review. Our inclusion criteria were (1) apps provided by large pediatric hospitals; (2) hospital-owned apps available in Apple App Store and Google Play; and (3) apps that are provided for general populations. Specialty apps that serve specific user groups or populations focusing on education, telehealth, specific conditions or procedures, or apps intended for research or clinician use were excluded. The features and functionality of the included apps were examined. Results: Of the 16 pediatric hospitals included in our review, 4 (25%) had no general patient-facing apps, 4 (25%) had one app, and 8 (50%) had more than one app available on Google Play or Apple App Store. The 12 hospitals with at least one mobile app had a combined total of 72 apps. Of these 72 apps, 61 (85%) were considered specialty and were excluded from our review, leaving a total of 11 (15%) apps to analyze. Among the 11 apps analyzed, the most common feature was appointment scheduling or reminder (n=9, 82%). Doctor search (n=8, 73%) and patient resources (n=8, 73%) were the second most common, followed by payment, billing, or claims (n=7, 64%), patient portal integration (n=6, 55%), personal health management (n=6, 55%), hospital way finding (n=5, 45%), message a provider (n=4, 36%), urgent care wait times (n=4, 36%), video chat (n=4, 36%), and health information access (n=4, 36%). Parking information (n=3, 27%) was the least common. Conclusions: Out of the 16 pediatric hospitals identified for our review, 75% (n=12) offer mobile apps. Based on the most common features, these apps were intended to help improve accessibility for patients and families in terms of finding providers, scheduling appointments, and accessing patient resources. We believe the findings will inform pediatric hospital administrators, developers, and other stakeholders to improve app feature offerings and increase their impact on service accessibility and patient experience. %M 36201385 %R 10.2196/38940 %U https://pediatrics.jmir.org/2022/4/e38940 %U https://doi.org/10.2196/38940 %U http://www.ncbi.nlm.nih.gov/pubmed/36201385 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37497 %T Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores %A Messner,Eva-Maria %A Sturm,Niklas %A Terhorst,Yannik %A Sander,Lasse B %A Schultchen,Dana %A Portenhauser,Alexandra %A Schmidbaur,Simone %A Stach,Michael %A Klaus,Jochen %A Baumeister,Harald %A Walter,Benjamin M %+ Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany, 49 0731 5000, benjamin.walter@uniklinik-ulm.de %K gastrointestinal diseases %K mHealth %K mobile health %K MARS %K Mobile Application Rating Scale %K systematic review %K app quality %K gastrointestinal %K mobile app %K app %D 2022 %7 5.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps. %M 36197717 %R 10.2196/37497 %U https://www.jmir.org/2022/10/e37497 %U https://doi.org/10.2196/37497 %U http://www.ncbi.nlm.nih.gov/pubmed/36197717 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e33826 %T Promoting Adolescent Sexual and Reproductive Health in North America Using Free Mobile Apps: Environmental Scan %A Benoit,James Russell Andrew %A Louie-Poon,Samantha %A Kauser,Samar %A Meherali,Salima %+ Faculty of Nursing, University of Alberta, 5-147 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6E1S1, Canada, 1 780 777 1864, jrbenoit@ualberta.ca %K mHealth %K mobile health %K adolescent %K sexual and reproductive health %K environmental scan %K mobile app %K sexual health %K reproductive health %K health %K sexual %K reproductive %K MARS %K Mobile App Rating Scale %K digital health %K adolescents %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Neglecting adolescents’ sexual and reproductive health (SRH) can affect multiple domains of development. Promoting healthy adolescent SRH is increasingly done using mobile phone apps. Providing SRH information via mobile phones can positively influence SRH outcomes including improving knowledge, reducing sexual risk behavior, and increasing the use of health services. A systematic approach to establishing and evaluating the quality of adolescent SRH mobile apps is urgently needed to rigorously evaluate whether they are a viable and effective strategy for reaching adolescents and improving adolescent SRH knowledge and behaviors in particular. Objective: This study aimed to conduct an environmental scan to produce an inventory of adolescent SRH–specific mobile apps with descriptions of their purpose, structure, operations, and quality of evidence. Methods: We used a literature review to develop 15 search terms for adolescent SRH–related apps in the Canadian and US Apple and Google app stores. After generating the search results, inclusion and exclusion criteria were applied. Using the remaining apps, we built an evidence table of app information, and app reviewers assessed each included app using the Mobile App Rating Scale. App assessments were then used to highlight trends between apps and identify gaps in app quality. Results: In total, 2761 apps were identified by our searches, of which 1515 were duplicates. Of the 1246 remaining apps, 15 met the criteria for further assessment. Across all subdomains, on a scale of 1-5, the mean app score was 3.4/5. The Functionality subdomain had the highest mean score of 4.1/5, whereas the Engagement subdomain had the lowest score of 2.9/5. The top 4 apps were Tia: Female Health Advisor (4.7/5), Under the Stethoscope (4.2/5), Condom Credit Card (4.1/5), and Shnet (3.7/5). Conclusions: This environmental scan aimed to provide a comprehensive overview of the mobile apps developed to promote adolescent SRH knowledge and outcomes. Of the 15 mobile apps available to provide information related to adolescent SRH, few provided comprehensive, reliable, and evidence-based SRH information. Areas of strength included the apps’ gestural design, performance, ease of use, and navigation. Areas of weakness included app goals, evidence base, and app customization options. These results can be used to conduct future studies evaluating the use and efficacy of mobile apps on health knowledge and behaviors and promote adolescent SRH. %M 36194450 %R 10.2196/33826 %U https://pediatrics.jmir.org/2022/4/e33826 %U https://doi.org/10.2196/33826 %U http://www.ncbi.nlm.nih.gov/pubmed/36194450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39813 %T Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study %A Hudson,Georgie %A Negbenose,Esther %A Neary,Martha %A Jansli,Sonja M %A Schueller,Stephen M %A Wykes,Til %A Jilka,Sagar %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7AL, United Kingdom, 44 7708715627, sagar.jilka@warwick.ac.uk %K well-being %K apps %K patient and public involvement %K coproduction %K mental health %K service user %K technology %K mobile health %K mHealth %K digital %K mobile phone %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective: This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods: A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results: We found low agreement between the participants’ and professionals’ ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants’ star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions: As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps. %M 36149733 %R 10.2196/39813 %U https://formative.jmir.org/2022/9/e39813 %U https://doi.org/10.2196/39813 %U http://www.ncbi.nlm.nih.gov/pubmed/36149733 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e35851 %T Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content %A Báez Gutiérrez,Nerea %A Rodríguez Ramallo,Héctor %A Fernández González,Marcos %A Abdel-Kader Martín,Laila %+ Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot, s/n, Sevilla, 41013, Spain, 34 688 933 454, hector.rodriguez.sspa@juntadeandalucia.es %K hematological malignancies %K mobile apps %K smartphone %K eHealth %K mHealth %K cancer %K mobile app %K mobile health %K hematology %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hematological 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. Objective: The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs. Methods: A 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. Results: Overall, 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. Conclusions: This 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. %M 36125860 %R 10.2196/35851 %U https://mhealth.jmir.org/2022/9/e35851 %U https://doi.org/10.2196/35851 %U http://www.ncbi.nlm.nih.gov/pubmed/36125860 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e39454 %T Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis %A Lu,Sheng-Chieh %A Xu,Mindy %A Wang,Mei %A Hardi,Angela %A Cheng,Abby L %A Chang,Su-Hsin %A Yen,Po-Yin %+ Department of Symptom Research, University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd, Houston, TX, 77030, United States, 1 7137944453, Slu4@mdanderson.org %K mental health %K mobile health %K smartphone apps %K intervention dose effectiveness %K systematic review and meta-analysis %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment “dose” is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. Objective: Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. Methods: We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. Results: We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=–.10, 95% CI –0.14 to –0.06, I2=0%) but not on depression (Hedge g=–.08, 95% CI –0.23 to 0.07, I2=4%). Interventions of at least 7 weeks’ duration had larger effect sizes on anxiety symptom reduction. Conclusions: There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation. %M 36069841 %R 10.2196/39454 %U https://mental.jmir.org/2022/9/e39454 %U https://doi.org/10.2196/39454 %U http://www.ncbi.nlm.nih.gov/pubmed/36069841 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e39682 %T mHealth Apps for Low Back Pain Self-management: Scoping Review %A Rintala,Aki %A Rantalainen,Roy %A Kaksonen,Anu %A Luomajoki,Hannu %A Kauranen,Kari %+ Faculty of Social Services and Health Care, LAB University of Applied Sciences, Mukkulankatu 19, Lahti, 15120, Finland, 358 447085254, aki.rintala@lab.fi %K low back pain %K mobile health %K mHealth %K app %K disability %K self-management %K mobile phone %D 2022 %7 26.8.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The role of self-management in health promotion, as well as prevention and rehabilitation, is increasing through the use of mobile health (mHealth) apps. Such mHealth apps are also increasingly being used for self-management of low back pain (LBP), but their effectiveness has not been sufficiently explored. Objective: The aim of this scoping review was to provide an overview of the literature on self-management mHealth apps and their effects on the levels of pain and disability in people with LBP. Methods: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, including a priori research questions. A literature search was conducted in 2 databases (PubMed and PEDro) for studies published between January 1, 2015, and June 17, 2021. Interventional, cohort, or case series studies with an interventional period were included if the mHealth app included built-in self-management content, the app was used for self-management for people with LBP, and the study reported outcomes regarding pain and disability in people with LBP. Results: In total, 7 studies were selected for the review with overall 2307 persons with LBP, of whom 1328 (57.56%) were women. Among the studies (5/7, 71%) that reported the type of pain, 85% (390/459) of the participants were experiencing chronic LBP. A total of 5 different mHealth apps were identified, of which 4 contributed to a statistically significant reduction in LBP and clinically meaningful changes. Of the 7 studies, 4 (57%) used 4 different assessments for disability, of which 3 (75%) showed statistically significant improvements in the level of functional ability of participants in the experimental groups using an mHealth app with built-in self-management content for LBP. Conclusions: This scoping review supports the conclusion that people with LBP may benefit from mHealth apps that provide self-management content. However, the generalizability of the findings is limited because of heterogeneity in the pain characterization of the included participants and the intervention durations. More high-quality studies with longer follow-up periods to investigate personalized mHealth approaches are recommended for LBP self-management. %M 36018713 %R 10.2196/39682 %U https://mhealth.jmir.org/2022/8/e39682 %U https://doi.org/10.2196/39682 %U http://www.ncbi.nlm.nih.gov/pubmed/36018713 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e37290 %T System Usability Scale Benchmarking for Digital Health Apps: Meta-analysis %A Hyzy,Maciej %A Bond,Raymond %A Mulvenna,Maurice %A Bai,Lu %A Dix,Alan %A Leigh,Simon %A Hunt,Sophie %+ School of Computing, Ulster University, Ulster University School Office, 16G24 Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 7526852505, maciejmarekzych@gmail.com %K mHealth SUS scores meta-analysis %K SUS for digital health %K digital health apps usability %K mHealth usability %K SUS meta-analysis %K mHealth %K mobile app %K mobile health %K digital health %K System Usability Scale %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS was not specifically designed to evaluate mobile apps, or in particular digital health apps (DHAs). Objective: The aim of this study was to examine whether the widely used SUS distribution for benchmarking (mean 68, SD 12.5) can be used to reliably assess the usability of DHAs. Methods: A search of the literature was performed using the ACM Digital Library, IEEE Xplore, CORE, PubMed, and Google Scholar databases to identify SUS scores related to the usability of DHAs for meta-analysis. This study included papers that published the SUS scores of the evaluated DHAs from 2011 to 2021 to get a 10-year representation. In total, 117 SUS scores for 114 DHAs were identified. R Studio and the R programming language were used to model the DHA SUS distribution, with a 1-sample, 2-tailed t test used to compare this distribution with the standard SUS distribution. Results: The mean SUS score when all the collected apps were included was 76.64 (SD 15.12); however, this distribution exhibited asymmetrical skewness (–0.52) and was not normally distributed according to Shapiro-Wilk test (P=.002). The mean SUS score for “physical activity” apps was 83.28 (SD 12.39) and drove the skewness. Hence, the mean SUS score for all collected apps excluding “physical activity” apps was 68.05 (SD 14.05). A 1-sample, 2-tailed t test indicated that this health app SUS distribution was not statistically significantly different from the standard SUS distribution (P=.98). Conclusions: This study concludes that the SUS and the widely accepted benchmark of a mean SUS score of 68 (SD 12.5) are suitable for evaluating the usability of DHAs. We speculate as to why physical activity apps received higher SUS scores than expected. A template for reporting mean SUS scores to facilitate meta-analysis is proposed, together with future work that could be done to further examine the SUS benchmark scores for DHAs. %M 35980732 %R 10.2196/37290 %U https://mhealth.jmir.org/2022/8/e37290 %U https://doi.org/10.2196/37290 %U http://www.ncbi.nlm.nih.gov/pubmed/35980732 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e34355 %T mHealth Apps for Musculoskeletal Rehabilitation: Systematic Search in App Stores and Content Analysis %A Ryan,Shíofra %A Ní Chasaide,Noirín %A O' Hanrahan,Shane %A Corcoran,Darragh %A Caulfield,Brian %A Argent,Rob %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland, 353 017162313, shiofra.ryan@insight-centre.org %K mHealth %K musculoskeletal rehabilitation %K app %K home exercise program %K home exercise %K telehealth %K mobile health %K connected health %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective: The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods: A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results: A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%). Conclusions: The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies. %M 35916688 %R 10.2196/34355 %U https://rehab.jmir.org/2022/3/e34355 %U https://doi.org/10.2196/34355 %U http://www.ncbi.nlm.nih.gov/pubmed/35916688 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 3 %P e28153 %T Diabetes Self-management Apps: Systematic Review of Adoption Determinants and Future Research Agenda %A Alaslawi,Hessah %A Berrou,Ilhem %A Al Hamid,Abdullah %A Alhuwail,Dari %A Aslanpour,Zoe %+ School of Health & Social Wellbeing, University of the West of England, 2B03 Glenside Campus, Bristol, BS16 1DD, United Kingdom, 44 1173284053 ext 4053, ilhem.berrou@uwe.ac.uk %K diabetes self-management %K mobile apps %K mobile health %K mHealth adoption %K mobile phone %D 2022 %7 28.7.2022 %9 Review %J JMIR Diabetes %G English %X Background: Most diabetes management involves self-management. Effective self-management of the condition improves diabetes control, reduces the risk of complications, and improves patient outcomes. Mobile apps for diabetes self-management (DSM) can enhance patients’ self-management activities. However, they are only effective if clinicians recommend them, and patients use them. Objective: This study aimed to explore the determinants of DSM apps’ use by patients and their recommendations by health care professionals (HCPs). It also outlines the future research agenda for using DSM apps in diabetes care. Methods: We systematically reviewed the factors affecting the adoption of DSM apps by both patients and HCPs. Searches were performed using PubMed, Scopus, CINAHL, Cochrane Central, ACM, and Xplore digital libraries for articles published from 2008 to 2020. The search terms were diabetes, mobile apps, and self-management. Relevant data were extracted from the included studies and analyzed using a thematic synthesis approach. Results: A total of 28 studies met the inclusion criteria. We identified a range of determinants related to patients’ and HCPs’ characteristics, experiences, and preferences. Young female patients were more likely to adopt DSM apps. Patients’ perceptions of the benefits of apps, ease of use, and recommendations by patients and other HCPs strongly affect their intention to use DSM apps. HCPs are less likely to recommend these apps if they do not perceive their benefits and may not recommend their use if they are unaware of their existence or credibility. Young and technology-savvy HCPs were more likely to recommend DSM apps. Conclusions: Despite the potential of DSM apps to improve patients’ self-care activities and diabetes outcomes, HCPs and patients remain hesitant to use them. However, the COVID-19 pandemic may hasten the integration of technology into diabetes care. The use of DSM apps may become a part of the new normal. %M 35900826 %R 10.2196/28153 %U https://diabetes.jmir.org/2022/3/e28153 %U https://doi.org/10.2196/28153 %U http://www.ncbi.nlm.nih.gov/pubmed/35900826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e36691 %T Mobile Apps for People With Rare Diseases: Review and Quality Assessment Using Mobile App Rating Scale %A Hatem,Sarah %A Long,Janet C %A Best,Stephanie %A Fehlberg,Zoe %A Nic Giolla Easpaig,Bróna %A Braithwaite,Jeffrey %+ Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia, 61 0298502225, janet.long@mq.edu.au %K mobile apps %K self-management %K social support %K rare disease %K mobile phone %D 2022 %7 26.7.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile apps are becoming increasingly popular, with 5.70 million apps available in early 2021. Smartphones can provide portable and convenient access to health apps. Here, we consider apps for people with one of the estimated 7000 rare conditions, which are defined as having an incidence of <1 in 2000. The needs of people with rare conditions are known to be different from those of people with more common conditions. The former may be socially isolated (not knowing anyone else who has the condition) and may not be able to find reliable information about the disorder. Objective: The aim of this review is to search for apps developed specifically for people diagnosed with a rare disease and to assess them for quality using the Mobile App Rating Scale (MARS). We examine features that address 6 identified needs of people with a rare disorder and make recommendations for future developers. Methods: Google Play Store (Android) and Apple App Store (iOS) were searched for relevant health-related apps specifically for rare diseases. The search included the names of 10 rare disease groups. App quality was determined using MARS, assessing app engagement, functionality, aesthetics, and information. Results: We found 29 relevant apps (from a total of 2272) addressing 14 rare diseases or disease groups. The most common rare conditions addressed were cystic fibrosis (n=6), hemophilia (n=5), and thalassemia (n=5). The most common app features were web-based information and symptom trackers. The mean MARS score was 3.44 (SD 0.84). Lowest scores were for engagement. Conclusions: Most apps provided factual and visual information, providing tools for self-monitoring and resources to help improve interactions during health consultations. App origin and quality varied greatly. Developers are recommended to consider ways to make appropriate apps more easily identifiable to consumers, to always include high-quality information, improve engagement, provide qualitative evaluations of the app, and include consumers and clinicians in the design. %M 35881435 %R 10.2196/36691 %U https://www.jmir.org/2022/7/e36691 %U https://doi.org/10.2196/36691 %U http://www.ncbi.nlm.nih.gov/pubmed/35881435 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36974 %T Quality Assessment of Digital Health Applications: Protocol for a Scoping Review %A Giebel,Godwin Denk %A Schrader,Nils Frederik %A Speckemeier,Christian %A Abels,Carina %A Börchers,Kirstin %A Wasem,Jürgen %A Blase,Nikola %A Neusser,Silke %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 2011833180, godwin.giebel@medman.uni-due.de %K digital health application %K mHealth %K mHealth app %K quality assurance %K quality assessment %K mobile health %K application %K protocol %K app %K digital health %K telehealth %K eHealth %D 2022 %7 20.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: All over the world, development and usage of mobile health (mHealth) apps is increasing. While apps offer numerous opportunities to improve health care, there are associated problems that differ significantly from those of traditional health care services. Further investigations on the quality of mHealth apps are needed to address these problems. Objective: This study aims to identify and map research on quality assessment and quality assurance of mHealth apps and their transferability to continuous quality assurance of mHealth apps. Methods: The scoping review will follow published methodological frameworks for scoping studies as well as Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria. Electronic databases (Medline, EMBASE, and PsycINFO), reference lists of relevant articles, and websites of relevant institutions will be searched. Two reviewers will independently assess eligibility of articles. Therefore, a 2-stage (title and abstract, followed by full text) screening process was conducted. Quality management systems and quality assessment tools will be analyzed and included in our review. Particular focus is placed on quality dimensions. Results: This scoping review provides an overview of the available evidence and identifies research gaps regarding continuous quality assessment of mHealth apps. Thereby, relevant quality dimensions and criteria can be identified and their eligibility and relevance for the development of a continuous quality assurance system of mHealth apps can be determined. Our results are planned to be submitted to an indexed, peer-reviewed journal in the second half of 2022. Conclusions: This is the first review in the context of continuous quality assurance of mHealth apps. Our results will be used within the research “Continuous quality assurance of Digital Health Applications” (“QuaSiApps”) project funded by the German Federal Joint Committee. International Registered Report Identifier (IRRID): DERR1-10.2196/36974 %M 35857359 %R 10.2196/36974 %U https://www.researchprotocols.org/2022/7/e36974 %U https://doi.org/10.2196/36974 %U http://www.ncbi.nlm.nih.gov/pubmed/35857359 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e35195 %T Data Management and Privacy Policy of COVID-19 Contact-Tracing Apps: Systematic Review and Content Analysis %A Bardus,Marco %A Al Daccache,Melodie %A Maalouf,Noel %A Al Sarih,Rayan %A Elhajj,Imad H %+ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0121 414 3344, marco.bardus@gmail.com %K COVID-19 %K mobile applications %K contact tracing %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 digital contact-tracing apps were created to assist public health authorities in curbing the pandemic. These apps require users’ permission to access specific functions on their mobile phones, such as geolocation, Bluetooth or Wi-Fi connections, or personal data, to work correctly. As these functions have privacy repercussions, it is essential to establish how contact-tracing apps respect users’ privacy. Objective: This study aimed to systematically map existing contact-tracing apps and evaluate the permissions required and their privacy policies. Specifically, we evaluated the type of permissions, the privacy policies’ readability, and the information included in them. Methods: We used custom Google searches and existing lists of contact-tracing apps to identify potentially eligible apps between May 2020 and November 2021. We included contact-tracing or exposure notification apps with a Google Play webpage from which we extracted app characteristics (eg, sponsor, number of installs, and ratings). We used Exodus Privacy to systematically extract the number of permissions and classify them as dangerous or normal. We computed a Permission Accumulated Risk Score representing the threat level to the user’s privacy. We assessed the privacy policies’ readability and evaluated their content using a 13-item checklist, which generated a Privacy Transparency Index. We explored the relationships between app characteristics, Permission Accumulated Risk Score, and Privacy Transparency Index using correlations, chi-square tests, or ANOVAs. Results: We identified 180 contact-tracing apps across 152 countries, states, or territories. We included 85.6% (154/180) of apps with a working Google Play page, most of which (132/154, 85.7%) had a privacy policy document. Most apps were developed by governments (116/154, 75.3%) and totaled 264.5 million installs. The average rating on Google Play was 3.5 (SD 0.7). Across the 154 apps, we identified 94 unique permissions, 18% (17/94) of which were dangerous, and 30 trackers. The average Permission Accumulated Risk Score was 22.7 (SD 17.7; range 4-74, median 16) and the average Privacy Transparency Index was 55.8 (SD 21.7; range 5-95, median 55). Overall, the privacy documents were difficult to read (median grade level 12, range 7-23); 67% (88/132) of these mentioned that the apps collected personal identifiers. The Permission Accumulated Risk Score was negatively associated with the average App Store ratings (r=−0.20; P=.03; 120/154, 77.9%) and Privacy Transparency Index (r=−0.25; P<.001; 132/154, 85.7%), suggesting that the higher the risk to one’s data, the lower the apps’ ratings and transparency index. Conclusions: Many contact-tracing apps were developed covering most of the planet but with a relatively low number of installs. Privacy-preserving apps scored high in transparency and App Store ratings, suggesting that some users appreciate these apps. Nevertheless, privacy policy documents were difficult to read for an average audience. Therefore, we recommend following privacy-preserving and transparency principles to improve contact-tracing uptake while making privacy documents more readable for a wider public. %M 35709334 %R 10.2196/35195 %U https://mhealth.jmir.org/2022/7/e35195 %U https://doi.org/10.2196/35195 %U http://www.ncbi.nlm.nih.gov/pubmed/35709334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e39590 %T Assessing a New Prescreening Score for the Simplified Evaluation of the Clinical Quality and Relevance of eHealth Apps: Instrument Validation Study %A Wagneur,Nicolas %A Callier,Patrick %A Zeitoun,Jean-David %A Silber,Denise %A Sabatier,Remi %A Denis,Fabrice %+ Institut National de la e-Santé, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@ilcgroupe.fr %K scoring %K eHealth %K clinical relevance %K solution %K digital solution %K clinical validation %K prescreening %K eHealth app %K medical digital solution %K scoring tool %K health app %K information quality %D 2022 %7 5.7.2022 %9 Viewpoint %J J Med Internet Res %G English %X Background: In 2020, more than 250 eHealth solutions were added to app stores each day, or 90,000 in the year; however, the vast majority of these solutions have not undergone clinical validation, their quality is unknown, and the user does not know if they are effective and safe. We sought to develop a simple prescreening scoring method that would assess the quality and clinical relevance of each app. We designed this tool with 3 health care stakeholder groups in mind: eHealth solution designers seeking to evaluate a potential competitor or their own tool, investors considering a fundraising candidate, and a hospital clinician or IT department wishing to evaluate a current or potential eHealth solution. Objective: We built and tested a novel prescreening scoring tool (the Medical Digital Solution scoring tool). The tool, which consists of 26 questions that enable the quick assessment and comparison of the clinical relevance and quality of eHealth apps, was tested on 68 eHealth solutions. Methods: The Medical Digital Solution scoring tool is based on the 2021 evaluation criteria of the French National Health Authority, the 2022 European Society of Medical Oncology recommendations, and other provided scores. We built the scoring tool with patient association and eHealth experts and submitted it to eHealth app creators, who evaluated their apps via the web-based form in January 2022. After completing the evaluation criteria, their apps obtained an overall score and 4 categories of subscores. These criteria evaluated the type of solution and domain, the solution’s targeted population size, the level of clinical assessment, and information about the provider. Results: In total, 68 eHealth solutions were evaluated with the scoring tool. Oncology apps (22%, 20/90) and general health solutions (23%, 21/90) were the most represented. Of the 68 apps, 32 (47%) were involved in remote monitoring by health professionals. Regarding clinical outcomes, 5% (9/169) of the apps assessed overall survival. Randomized studies had been conducted for 21% (23/110) of the apps to assess their benefit. Of the 68 providers, 38 (56%) declared the objective of obtaining reimbursement, and 7 (18%) out of the 38 solutions seeking reimbursement were assessed as having a high probability of reimbursement. The median global score was 11.2 (range 4.7-17.4) out of 20 and the distribution of the scores followed a normal distribution pattern (Shapiro-Wilk test: P=.33). Conclusions: This multidomain prescreening scoring tool is simple, fast, and can be deployed on a large scale to initiate an assessment of the clinical relevance and quality of a clinical eHealth app. This simple tool can help a decision-maker determine which aspects of the app require further analysis and improvement. %M 35788102 %R 10.2196/39590 %U https://www.jmir.org/2022/7/e39590 %U https://doi.org/10.2196/39590 %U http://www.ncbi.nlm.nih.gov/pubmed/35788102 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35997 %T Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study %A Sybil,Deborah %A Krishna,Meenakshi %A Shrivastava,Priyanshu Kumar %A Singh,Shradha %A Khan,Imran %+ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Delhi, 110025, India, 91 9958756661, ikhan3@jmi.ac.in %K ExoDont %K mHealth %K mobile health %K Android app %K dental extraction %K postoperative %K oral surgery %K dentistry %K teledentistry %K mobile app %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective: The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods: We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups—verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)—based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results: In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83%) and 28 (93%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions: As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice. %M 35763332 %R 10.2196/35997 %U https://periop.jmir.org/2022/1/e35997 %U https://doi.org/10.2196/35997 %U http://www.ncbi.nlm.nih.gov/pubmed/35763332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36761 %T Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study %A Minen,Mia T %A George,Alexis %A Camacho,Erica %A Yao,Leslie %A Sahu,Ananya %A Campbell,Maya %A Soviero,Mia %A Hossain,Quazi %A Verma,Deepti %A Torous,John %+ Department of Neurology, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, United States, 1 2122637744, minenmd@gmail.com %K headache %K pain %K insomnia %K mobile health %K smartphone apps %K mobile phone %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are thousands of apps for individuals struggling with headache, insomnia, and pain, but it is difficult to establish which of these apps are best suited for patients’ specific needs. If clinicians were to have access to a platform that would allow them to make an informed decision on the efficacy and feasibility of smartphone apps for patient care, they would feel confident in prescribing specific apps. Objective: We sought to evaluate the quality of apps for some of the top common, disabling neurologic conditions (headache, insomnia, and pain) based on principles derived from the American Psychiatric Association’s (APA) app evaluation model. Methods: We used the Mobile Health Index and Navigation database and expanded upon the database’s current supported conditions by adding 177 new app entries. Each app was rated for consistency with the APA’s app evaluation model, which includes 105 objective questions based on the following 5 major classes of consideration: (1) accessibility, (2) privacy and security, (3) clinical foundation, (4) engagement style, and (5) interoperability. These characteristics were evaluated to gain a broader understanding of the significant features of each app category in comparison against a control group. Results: Approximately 90% (187/201) of all apps evaluated were free to download, but only 50% (63/201) of headache- and pain-related apps were truly free. Most (87/106, 81%) sleep apps were not truly free to use. The apps had similar limitations with limited privacy, accessibility, and crisis management resources. For example, only 17% (35/201) of the apps were available in Spanish. The apps offered mostly self-help tools with little tailoring; symptom tracking was the most common feature in headache- (32/48, 67%) and pain-related apps (21/47, 45%), whereas mindfulness was the most common feature in sleep-related apps (73/106, 69%). Conclusions: Although there are many apps for headache, pain, and insomnia, all 3 types of apps have room for improvement around accessibility and privacy. Pain and headache apps share many common features, whereas insomnia apps offer mostly mindfulness-based resources. Given the many available apps to pick from, clinicians and patients should seek apps that offer the highest-quality features, such as complete privacy, remedial features, and the ability to download the app at no cost. These results suggest that there are many opportunities for the improvement of apps centered on headache, insomnia, and pain. %M 35727625 %R 10.2196/36761 %U https://mhealth.jmir.org/2022/6/e36761 %U https://doi.org/10.2196/36761 %U http://www.ncbi.nlm.nih.gov/pubmed/35727625 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e28238 %T Apps for Promoting Children’s Oral Health: Systematic Search in App Stores and Quality Evaluation %A Ho,Teresa C Y %A McGrath,Colman %A Yiu,Cynthia K Y %A Lee,Gillian H M %+ Paediatric Dentistry & Orthodontics, Faculty of Dentistry, University of Hong Kong, Room 2A20A, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, China (Hong Kong), 852 28590255, lee.gillian@gmail.com %K apps %K oral health %K evidence-based %K oral hygiene %K children %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. Objective: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. Methods: A broad search strategy (13 keywords) was developed to identify apps from Apple’s App Store and the Google Play Store in April 2019. After reviewing the apps’ titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). Results: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). Conclusions: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated. %M 35666565 %R 10.2196/28238 %U https://pediatrics.jmir.org/2022/2/e28238 %U https://doi.org/10.2196/28238 %U http://www.ncbi.nlm.nih.gov/pubmed/35666565 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36065 %T Monitoring Symptoms of COVID-19: Review of Mobile Apps %A Schmeelk,Suzanna %A Davis,Alison %A Li,Qiaozheng %A Shippey,Caroline %A Utah,Michelle %A Myers,Annie %A Reading Turchioe,Meghan %A Masterson Creber,Ruth %+ Weill Cornell Medicine, 425 E 61st Street, New York, NY, 10065, United States, 1 9144340731, rmc2009@med.cornell.edu %K COVID-19 %K mobile apps %K mobile health %K mHealth %K symptom assessment %K symptom tracking %K public health %K mobile health application %K surveillance %K digital surveillance %K monitoring system %K digital health %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education. Objective: The aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19. Methods: We systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as “COVID-19,” “Coronavirus,” and “COVID-19 and symptoms.” All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated. Results: A total of 1017 mobile apps were reviewed, and 20 (2%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90%) were designed to track acute COVID-19 symptoms, and only 2 (10%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90%), aches and pains (n=17, 85%), difficulty breathing (n=17, 85%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80%), and diarrhea (n=15, 75%). Only 2 (10%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use. Conclusions: Overall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization. %M 35609313 %R 10.2196/36065 %U https://mhealth.jmir.org/2022/6/e36065 %U https://doi.org/10.2196/36065 %U http://www.ncbi.nlm.nih.gov/pubmed/35609313 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e34017 %T German Mobile Apps for Patients With Psoriasis: Systematic Search and Evaluation %A Lull,Christian %A von Ahnen,Jan Alwin %A Gross,Georg %A Olsavszky,Victor %A Knitza,Johannes %A Leipe,Jan %A Schmieder,Astrid %+ Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Josef-Schneider-Strasse 2, Würzburg, 97080, Germany, 49 0931 201 26351, astrid.schmieder@umm.de %K psoriasis %K eHealth %K mHealth %K telemedicine %K teledermatology %K disease management %K smartphone application %K mental health %K mobile health %K health app %K dermatology %K skin %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psoriasis is a chronic inflammatory skin disease. The visibility of erythematous plaques on the skin as well as the pain and itchiness caused by the skin lesions frequently leads to psychological distress in patients. Smartphone apps are widespread and easily accessible. Earlier studies have shown that apps can effectively complement current management strategies for patients with psoriasis. However, no analysis of such apps has been published to date. Objective: The aim of this study is to systematically identify and objectively assess the quality of current publicly available German apps for patients with psoriasis using the Mobile Application Rating Scale (MARS) and compile brief ready-to-use app descriptions. Methods: We conducted a systematic search and assessment of German apps for patients with psoriasis available in the Google Play Store and Apple App Store. The identified apps were randomly assigned to 1 of 3 reviewers, who independently rated them using the German MARS (MARS-G). The MARS-G includes 15 items from 4 different sections (engagement, functionality, aesthetics, and information) to create an overall mean score for every app. Scores can range from 1 for the lowest-quality apps to 5 for the highest-quality apps. Apps were ranked according to their mean MARS-G rating, and the highest-ranked app was evaluated independently by 2 patients with psoriasis using the user version of the MARS-G (uMARS-G). Furthermore, app information, including origin, main function, and technical aspects, was compiled into a brief overview. Results: In total, we were able to identify 95 unique apps for psoriasis, of which 15 were available in both app stores. Of these apps, 5 were not specifically intended for patients with psoriasis, 1 was designed for clinical trials only, and 1 was no longer available at the time the evaluation process began. Consequently, the remaining 8 apps were included in the final evaluation. The mean MARS-G scores ranged from 3.51 to 4.18. The app with the highest mean MARS-G score was Psoriasis Helferin (4.18/5.00). When rated by patients, however, the app was rated lower in all subcategories, resulting in a mean uMARS-G score of 3.48. Most apps had a commercial background and a focus on symptom tracking. However, only a fraction of the apps assessed used validated instruments to measure the user’s disease activity. Conclusions: App quality was heterogeneous, and only a minority of the identified apps were available in both app stores. When evaluated by patients, app ratings were lower than when evaluated by health care professionals. This discrepancy highlights the importance of involving patients when developing and evaluating health-related apps as the factors that make an app appealing to users may differ between these 2 groups. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://tinyurl.com/ye98an5b %M 35617014 %R 10.2196/34017 %U https://mhealth.jmir.org/2022/5/e34017 %U https://doi.org/10.2196/34017 %U http://www.ncbi.nlm.nih.gov/pubmed/35617014 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e29767 %T Functional and Technical Aspects of Self-management mHealth Apps: Systematic App Search and Literature Review %A Alwakeel,Lyan %A Lano,Kevin %+ Department of Informatics, King’s College London, Strand, London, WC2R 2LS, United Kingdom, 44 02078365454, lyan.alwakeel@kcl.ac.uk %K mHealth %K mobile health apps %K mobile apps %K apps %K systematic literature review %K SLR %K apps %K Mobile App Rating Scale %K MARS %K smartphone %K iOS %K Android %K mobile phone %D 2022 %7 25.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Although the past decade has witnessed the development of many self-management mobile health (mHealth) apps that enable users to monitor their health and activities independently, there is a general lack of empirical evidence on the functional and technical aspects of self-management mHealth apps from a software engineering perspective. Objective: This study aims to systematically identify the characteristics and challenges of self-management mHealth apps, focusing on functionalities, design, development, and evaluation methods, as well as to specify the differences and similarities between published research papers and commercial and open-source apps. Methods: This research was divided into 3 main phases to achieve the expected goal. The first phase involved reviewing peer-reviewed academic research papers from 7 digital libraries, and the second phase involved reviewing and evaluating apps available on Android and iOS app stores using the Mobile Application Rating Scale. Finally, the third phase involved analyzing and evaluating open-source apps from GitHub. Results: In total, 52 research papers, 42 app store apps, and 24 open-source apps were analyzed, synthesized, and reported. We found that the development of self-management mHealth apps requires significant time, effort, and cost because of their complexity and specific requirements, such as the use of machine learning algorithms, external services, and built-in technologies. In general, self-management mHealth apps are similar in their focus, user interface components, navigation and structure, services and technologies, authentication features, and architecture and patterns. However, they differ in terms of the use of machine learning, processing techniques, key functionalities, inference of machine learning knowledge, logging mechanisms, evaluation techniques, and challenges. Conclusions: Self-management mHealth apps may offer an essential means of managing users’ health, expecting to assist users in continuously monitoring their health and encourage them to adopt healthy habits. However, developing an efficient and intelligent self-management mHealth app with the ability to reduce resource consumption and processing time, as well as increase performance, is still under research and development. In addition, there is a need to find an automated process for evaluating and selecting suitable machine learning algorithms for the self-management of mHealth apps. We believe that these issues can be avoided or significantly reduced by using a model-driven engineering approach with a decision support system to accelerate and ameliorate the development process and quality of self-management mHealth apps. %M 35612887 %R 10.2196/29767 %U https://humanfactors.jmir.org/2022/2/e29767 %U https://doi.org/10.2196/29767 %U http://www.ncbi.nlm.nih.gov/pubmed/35612887 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e15719 %T The Quality of Indian Obesity-Related mHealth Apps: PRECEDE-PROCEED Model–Based Content Analysis %A Selvaraj,Shanmuga Nathan %A Sriram,Arulchelvan %+ Department of Media Sciences, College of Engineering, Anna University, No 12 Sardar Patel Rd, Guindy, Chennai, 600025, India, 91 99946 63036, shunmu.nathu@gmail.com %K obesity %K mHealth apps %K PRECEDE-PROCEED Model %K Mobile App Rating Scale %K health communication %K health behavior change techniques %K health information %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of obesity in India is increasing at an alarming rate. Obesity-related mHealth apps have proffered an exciting opportunity to remotely deliver obesity-related information. This opportunity raises the question of whether such apps are truly effective. Objective: The aim of this study was to identify existing obesity-related mHealth apps in India and evaluate the potential of the apps’ contents to promote health behavior change. This study also aimed to discover the general quality of obesity-related mHealth apps. Methods: A systematic search for obesity-related mHealth apps was conducted in both the Google Play Store and the Apple App Store. The features and quality of the sample apps were assessed using the Mobile Application Rating Scale (MARS) and the potential of the sample apps’ contents to promote health behavior change was assessed using the PRECEDE-PROCEED Model (PPM). Results: A total of 13 apps (11 from the Google Play Store and 2 from the Apple App Store) were considered eligible for the study. The general quality of the 13 apps assessed using MARS resulted in mean scores ranging from 1.8 to 3.7. The bivariate Pearson correlation between the MARS rating and app user rating failed to establish statistically significant results. The multivariate regression analysis result indicated that the PPM factors are significant determinants of health behavior change (F3,9=63.186; P<.001) and 95.5% of the variance (R2=0.955; P<.001) in the dependent variable (health behavior change) can be explained by the independent variables (PPM factors). Conclusions: In general, mHealth apps are found to be more effective when they are based on theory. The presence of PPM factors in an mHealth app can greatly influence the likelihood of health behavior change among users. So, we suggest mHealth app developers consider this to develop efficient apps. Also, mHealth app developers should consider providing health information from credible sources and indicating the sources of the information, which will increase the perceived credibility of the apps among the users. We strongly recommend health professionals and health organizations be involved in the development of mHealth apps. Future research should include mHealth app users to understand better the apps’ effectiveness in bringing about health behavior change. %M 35544318 %R 10.2196/15719 %U https://mhealth.jmir.org/2022/5/e15719 %U https://doi.org/10.2196/15719 %U http://www.ncbi.nlm.nih.gov/pubmed/35544318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31810 %T Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation %A Schmieding,Malte L %A Kopka,Marvin %A Schmidt,Konrad %A Schulz-Niethammer,Sven %A Balzer,Felix %A Feufel,Markus A %+ Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450 570425, malte.schmieding@charite.de %K digital health %K triage %K symptom checker %K patient-centered care %K eHealth apps %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. Objective: This study aims to revisit the landmark index study to investigate whether and how symptom checkers’ capabilities have evolved since 2015 and how they currently compare with laypersons’ stand-alone triage appraisal. Methods: In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons’ triage capability. Results: We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Conclusions: Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended. %M 35536633 %R 10.2196/31810 %U https://www.jmir.org/2022/5/e31810 %U https://doi.org/10.2196/31810 %U http://www.ncbi.nlm.nih.gov/pubmed/35536633 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e33735 %T Privacy, Data Sharing, and Data Security Policies of Women’s mHealth Apps: Scoping Review and Content Analysis %A Alfawzan,Najd %A Christen,Markus %A Spitale,Giovanni %A Biller-Andorno,Nikola %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 41 446348370, najd.alfawzan@uzh.ch %K mHealth %K women’s health %K ethics %K privacy policy %K data sharing %K privacy %K data security %K data transparency %K femtech %K mobile apps %K mobile health %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women’s mobile health (mHealth) is a growing phenomenon in the mobile app global market. An increasing number of women worldwide use apps geared to female audiences (female technology). Given the often private and sensitive nature of the data collected by such apps, an ethical assessment from the perspective of data privacy, sharing, and security policies is warranted. Objective: The purpose of this scoping review and content analysis was to assess the privacy policies, data sharing, and security policies of women’s mHealth apps on the current international market (the App Store on the Apple operating system [iOS] and Google Play on the Android system). Methods: We reviewed the 23 most popular women’s mHealth apps on the market by focusing on publicly available apps on the App Store and Google Play. The 23 downloaded apps were assessed manually by 2 independent reviewers against a variety of user data privacy, data sharing, and security assessment criteria. Results: All 23 apps collected personal health-related data. All apps allowed behavioral tracking, and 61% (14/23) of the apps allowed location tracking. Of the 23 apps, only 16 (70%) displayed a privacy policy, 12 (52%) requested consent from users, and 1 (4%) had a pseudoconsent. In addition, 13% (3/23) of the apps collected data before obtaining consent. Most apps (20/23, 87%) shared user data with third parties, and data sharing information could not be obtained for the 13% (3/23) remaining apps. Of the 23 apps, only 13 (57%) provided users with information on data security. Conclusions: Many of the most popular women’s mHealth apps on the market have poor data privacy, sharing, and security standards. Although regulations exist, such as the European Union General Data Protection Regulation, current practices do not follow them. The failure of the assessed women’s mHealth apps to meet basic data privacy, sharing, and security standards is not ethically or legally acceptable. %M 35522465 %R 10.2196/33735 %U https://mhealth.jmir.org/2022/5/e33735 %U https://doi.org/10.2196/33735 %U http://www.ncbi.nlm.nih.gov/pubmed/35522465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e31102 %T 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 %A Gerner,Maximilian %A Vuillerme,Nicolas %A Aubourg,Timothée %A Messner,Eva-Maria %A Terhorst,Yannik %A Hörmann,Verena %A Ganzleben,Ingo %A Schenker,Hannah %A Schett,Georg %A Atreya,Raja %A Neurath,Markus F %A Knitza,Johannes %A Orlemann,Till %+ Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8535000, max_gerner@web.de %K mHealth %K IBD %K ulcerative colitis %K Crohn disease %K inflammatory bowel disease %K telemedicine %K mobile apps %K rating %K rating scale %K quality %K usability %K chronic disease %K IBS %K app store %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients 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. Objective: This study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS). Methods: The 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. Results: In 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. Conclusions: The 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. %M 35503246 %R 10.2196/31102 %U https://mhealth.jmir.org/2022/5/e31102 %U https://doi.org/10.2196/31102 %U http://www.ncbi.nlm.nih.gov/pubmed/35503246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35120 %T Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review %A Amagai,Saki %A Pila,Sarah %A Kaat,Aaron J %A Nowinski,Cindy J %A Gershon,Richard C %+ Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, 2700 suite, Chicago, IL, 60613, United States, 1 312 503 1725, saki.amagai@northwestern.edu %K mobile phone %K mHealth %K retention %K engagement %D 2022 %7 26.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective: This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods: We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results: Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions: Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention. %M 35471414 %R 10.2196/35120 %U https://www.jmir.org/2022/4/e35120 %U https://doi.org/10.2196/35120 %U http://www.ncbi.nlm.nih.gov/pubmed/35471414 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e32702 %T Problems and Barriers Related to the Use of Digital Health Applications: Protocol for a Scoping Review %A Giebel,Godwin Denk %A Speckemeier,Christian %A Abels,Carina %A Börchers,Kirstin %A Wasem,Jürgen %A Blase,Nikola %A Neusser,Silke %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, Essen, 45127, Germany, 49 02011833180, godwin.giebel@medman.uni-due.de %K digital health application %K DHA %K mHealth, problems, barriers, scoping review %K mobile health %K health insurance %K electronic database %K health database %K mHealth app %D 2022 %7 21.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile health (mHealth) apps is increasing rapidly worldwide. More and more institutions and organizations develop regulations and guidelines to enable an evidence-based and safe use. In Germany, mHealth apps fulfilling predefined criteria (Digitale Gesundheitsanwendungen [DiGA]) can be prescribed and are reimbursable by the German statutory health insurance scheme. Due to the increasing distribution of DiGA, problems and barriers should receive special attention. Objective: This study aims to identify the relevant problems and barriers related to the use of mHealth apps fulfilling the criteria of DiGA. Methods: This scoping review will follow published methodological frameworks and the PRISMA-Scr (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) criteria. Electronic databases (MEDLINE, EMBASE, PsycINFO, and JMIR), reference lists of relevant articles, and grey literature sources will be searched. Two reviewers will assess the eligibility of the articles by a two-stage (title and abstract as well as full text) screening process. Only problems and barriers related to mHealth apps fulfilling the criteria of DiGA are included for this research. The identified studies will be categorized and analyzed with MAXQDA. Results: This scoping review gives an overview of the available evidence and identifies research gaps regarding problems and barriers related to DiGA. The results are planned to be submitted to an indexed, peer-reviewed journal in the first quarter of 2022. Conclusions: This is the first review to identify the problems and barriers related to the use of mHealth apps fulfilling the German definition of DiGA. Nevertheless, the findings can be applied to other contexts and health care systems as well. International Registered Report Identifier (IRRID): DERR1-10.2196/32702 %M 35451979 %R 10.2196/32702 %U https://www.researchprotocols.org/2022/4/e32702 %U https://doi.org/10.2196/32702 %U http://www.ncbi.nlm.nih.gov/pubmed/35451979 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e29985 %T Mobile Health Apps Providing Information on Drugs for Adult Emergency Care: Systematic Search on App Stores and Content Analysis %A García-Sánchez,Sebastián %A Somoza-Fernández,Beatriz %A de Lorenzo-Pinto,Ana %A Ortega-Navarro,Cristina %A Herranz-Alonso,Ana %A Sanjurjo,María %+ Pharmacy Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, Madrid, 28007, Spain, 34 91 586 82 45, sebasmur@hotmail.com %K emergency drugs %K emergency medicine %K emergency departments %K emergency professionals %K medication errors %K drug characteristics %K drug management %K apps %K mHealth %K mobile health %K digital health %K smartphone %K mobile phone %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs. Objective: This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost. Results: Overall, 49 apps were identified. Of these 49 apps, 32 (65%) were found on both digital platforms; 11 (22%) were available only for Android, and 6 (12%) were available only for iOS. In total, 41% (20/49) of the apps required payment (ranging from €0.59 [US $0.64] to €179.99 [US $196.10]) and 22% (11/49) of the apps were developed by non–health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45% (22/49) of the apps focused on emergency drugs, and 55% (27/49) focused on emergency medicine. More than half (29/47, 62%) did not include bibliographic references or had not been updated for more than a year (29/49, 59%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55%) and adverse reactions (24/47, 51%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32%), interactions (10/47, 21%), and use during pregnancy and breastfeeding (15/47, 32%). Only 6% (3/47) identified high-alert medications, and 2% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively). Conclusions: We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content. %M 35442212 %R 10.2196/29985 %U https://mhealth.jmir.org/2022/4/e29985 %U https://doi.org/10.2196/29985 %U http://www.ncbi.nlm.nih.gov/pubmed/35442212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31730 %T Toward Research-Informed Design Implications for Interventions Limiting Smartphone Use: Functionalities Review of Digital Well-being Apps %A Almoallim,Sultan %A Sas,Corina %+ School of Computing and Communications, Lancaster University, InfoLab21, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 07453728107, s.almoallim@lancaster.ac.uk %K digital well-being %K smartphone apps %K tracking use %K monitoring against set use limits %K interventions for limiting use %K barriers %K design for friction %K screen time %K attention %K self-regulation %K mobile phone %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Much research in human-computer interaction has focused on well-being and how it can be better supported through a range of technologies, from affective interfaces to mindfulness systems. At the same time, we have seen a growing number of commercial digital well-being apps. However, there has been limited scholarly work reviewing these apps. Objective: This paper aims to report on an autoethnographic study and functionality review of the 39 most popular commercial digital well-being apps on Google Play Store and 17 apps described in academic papers. Methods: From 1250 apps on Google Play Store, we selected 39 (3.12%) digital well-being apps, and from Google Scholar, we identified 17 papers describing academic apps. Both sets of digital well-being apps were analyzed through a review of their functionalities based on their descriptions. The commercial apps were also analyzed through autoethnography, wherein the first author interacted with them to understand how these functionalities work and how they may be experienced by users in their daily lives. Results: Our findings indicate that these apps focus mostly on limiting screen time, and we advanced a richer conversation about such apps, articulating the distinctions among monitoring use, tracking use against set limits, and 4 specific interventions supporting limited use. Conclusions: We conclude with 6 implications for designing digital well-being apps, namely calling to move beyond screen time and support the broader focus of digital well-being; supporting meaningful use rather than limiting meaningless use; leveraging (digital) navigation in design for friction; supporting collaborative interaction to limit phone overuse; supporting explicit, time-based visualizations for monitoring functionality; and supporting the ethical design of digital well-being apps. %M 35188897 %R 10.2196/31730 %U https://formative.jmir.org/2022/4/e31730 %U https://doi.org/10.2196/31730 %U http://www.ncbi.nlm.nih.gov/pubmed/35188897 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e33839 %T The Use of Mobile Apps for Heart Failure Self-management: Systematic Review of Experimental and Qualitative Studies %A Bezerra Giordan,Leticia %A Tong,Huong Ly %A Atherton,John J %A Ronto,Rimante %A Chau,Josephine %A Kaye,David %A Shaw,Tim %A Chow,Clara %A Laranjo,Liliana %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Entrance 10, Westmead Hospital, Hawkesbury Road Westmead, Sydney, 2145, Australia, 61 413461852, liliana.laranjo@sydney.edu.au %K heart failure %K self-management %K mobile health %K mobile app %K secondary prevention %K mobile phone %D 2022 %7 31.3.2022 %9 Review %J JMIR Cardio %G English %X Background: Heart failure self-management is essential to avoid decompensation and readmissions. Mobile apps seem promising in supporting heart failure self-management, and there has been a rapid growth in publications in this area. However, to date, systematic reviews have mostly focused on remote monitoring interventions using nonapp types of mobile technologies to transmit data to health care providers, rarely focusing on supporting patient self-management of heart failure. Objective: This study aims to systematically review the evidence on the effect of heart failure self-management apps on health outcomes, patient-reported outcomes, and patient experience. Methods: Four databases (PubMed, Embase, CINAHL, and PsycINFO) were searched for studies examining interventions that comprised a mobile app targeting heart failure self-management and reported any health-related outcomes or patient-reported outcomes or perspectives published from 2008 to December 2021. The studies were independently screened. The risk of bias was appraised using Cochrane tools. We performed a narrative synthesis of the results. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42020158041). Results: A total of 28 articles (randomized controlled trials [RCTs]: n=10, 36%), assessing 23 apps, and a total of 1397 participants were included. The most common app features were weight monitoring (19/23, 83%), symptom monitoring (18/23, 78%), and vital sign monitoring (15/23, 65%). Only 26% (6/23) of the apps provided all guideline-defined core components of heart failure self-management programs: education, symptom monitoring, medication support, and physical activity support. RCTs were small, involving altogether 717 participants, had ≤6 months of follow-up, and outcomes were predominantly self-reported. Approximately 20% (2/10) of RCTs reported a significant improvement in their primary outcomes: heart failure knowledge (P=.002) and self-care (P=.004). One of the RCTs found a significant reduction in readmissions (P=.02), and 20% (2/10) of RCTs reported higher unplanned clinic visits. Other experimental studies also found significant improvements in knowledge, self-care, and readmissions, among others. Less than half of the studies involved patients and clinicians in the design of apps. Engagement with the intervention was poorly reported, with only 11% (3/28) of studies quantifying app engagement metrics such as frequency of use over the study duration. The most desirable app features were automated self-monitoring and feedback, personalization, communication with clinicians, and data sharing and integration. Conclusions: Mobile apps may improve heart failure self-management; however, more robust evaluation studies are needed to analyze key end points for heart failure. On the basis of the results of this review, we provide a road map for future studies in this area. %M 35357311 %R 10.2196/33839 %U https://cardio.jmir.org/2022/1/e33839 %U https://doi.org/10.2196/33839 %U http://www.ncbi.nlm.nih.gov/pubmed/35357311 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33863 %T Quality of Mobile Apps for Care Partners of People With Alzheimer Disease and Related Dementias: Mobile App Rating Scale Evaluation %A Werner,Nicole E %A Brown,Janetta C %A Loganathar,Priya %A Holden,Richard J %+ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, United States, 1 608 890 2578, nwerner3@wisc.edu %K Alzheimer disease and related dementias %K mobile app %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over 11 million care partners in the United States who provide care to people living with Alzheimer disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to their caregiving role. The proliferation of mobile apps for care partners has the potential to meet care partners’ needs, but the quality of apps is unknown. Objective: This study aims to evaluate the quality of publicly available apps for care partners of people living with ADRD and identify design features of low- and high-quality apps to guide future research and user-centered app development. Methods: We searched the US Apple App and Google Play stores with the criteria that included apps needed to be available in the US Google Play or Apple App stores, accessible to users out of the box, and primarily intended for use by an informal (family or friend) care partner of a person living with ADRD. We classified and tabulated app functionalities. The included apps were then evaluated using the Mobile App Rating Scale (MARS) using 23 items across 5 dimensions: engagement, functionality, aesthetics, information, and subjective quality. We computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on score-driving factors for each MARS rating item and what the app could have done to improve the item score. Results: We evaluated 17 apps. We found that, on average, apps are of minimally acceptable quality. Functionalities supported by apps included education (12/17, 71%), interactive training (3/17, 18%), documentation (3/17, 18%), tracking symptoms (2/17, 12%), care partner community (3/17, 18%), interaction with clinical experts (1/17, 6%), care coordination (2/17, 12%), and activities for the person living with ADRD (2/17, 12%). Of the 17 apps, 8 (47%) had only 1 feature, 6 (35%) had 2 features, and 3 (18%) had 3 features. The MARS quality mean score across apps was 3.08 (SD 0.83) on the 5-point rating scale (1=inadequate to 5=excellent), with apps scoring highest on average on functionality (mean 3.37, SD 0.99) and aesthetics (mean 3.24, SD 0.92) and lowest on average on information (mean 2.95, SD 0.95) and engagement (mean 2.76, SD 0.89). The MARS subjective quality mean score across apps was 2.26 (SD 1.02). Conclusions: We identified apps whose mean scores were more than 1 point below minimally acceptable quality, whereas some were more than 1 point above. Many apps had broken features and were rated as below acceptable for engagement and information. Minimally acceptable quality is likely to be insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for care partner mobile apps. Design features of high-quality apps identified in this study can provide the foundation for benchmarking these standards. %M 35348467 %R 10.2196/33863 %U https://mhealth.jmir.org/2022/3/e33863 %U https://doi.org/10.2196/33863 %U http://www.ncbi.nlm.nih.gov/pubmed/35348467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31309 %T Smartphone Apps for Vaping Cessation: Quality Assessment and Content Analysis %A Sanchez,Sherald %A Kundu,Anasua %A Limanto,Elizabeth %A Selby,Peter %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 535 8501 ext 32005, Sherald.Sanchez@utoronto.ca %K e-cigarettes %K vaping %K cessation %K mHealth interventions %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the prevalence of electronic cigarette (e-cigarette) use, or vaping, continues to grow, particularly among young people, so does the need for research and interventions to address vaping. Objective: This study examines the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Methods: A systematic search of existing apps for vaping cessation was conducted in December 2020. Eligible apps were free, in English, and included features specifically targeting vaping cessation. Each app included in the analysis was used daily for at least seven consecutive days, assessed using the Mobile App Rating Scale, and rated by at least two authors (AK, EL, or SS) based on adherence to evidence-based practices. Intraclass correlation coefficient (ICC) estimates were computed to assess interrater reliability (excellent agreement; ICC 0.92; 95% CI 0.78-0.98). Results: A total of 8 apps were included in the quality assessment and content analysis: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. The mean of app quality total scores was 3.66 out of 5. Existing vaping cessation apps employ similar approaches to smoking cessation apps. However, they are very low in number and have limited features developed specifically for vaping cessation. Conclusions: Given the lack of vaping cessation interventions at a time when they are urgently needed, smartphone apps are potentially valuable tools. Therefore, it is recommended that these apps apply evidence-based practices and undergo rigorous evaluations that can assess their quality, contents and features, and popularity among users. Through this process, we can improve our understanding of how apps can be effective in helping users quit vaping. %M 35343904 %R 10.2196/31309 %U https://mhealth.jmir.org/2022/3/e31309 %U https://doi.org/10.2196/31309 %U http://www.ncbi.nlm.nih.gov/pubmed/35343904 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e28751 %T Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review %A Jaffar,Aida %A Tan,Chai-Eng %A Mohd-Sidik,Sherina %A Admodisastro,Novia %A Goodyear-Smith,Felicity %+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 03 9769 2541, sherina@upm.edu.my %K urinary incontinence %K pelvic floor muscle training %K mHealth app %K persuasive technology %K capability, opportunity, and motivation–behavior model %K mobile phone %D 2022 %7 22.3.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation–Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps. Objective: This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model. Methods: A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias. Results: Of the 169 records from the initial search, 10 (5.9%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The Tät, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as "competition" in its design. The Diário Saúde app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Diário Saúde, Tät, and Pen Yi Kang demonstrated improved PFMT adherence. Conclusions: Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes. %M 35315777 %R 10.2196/28751 %U https://mhealth.jmir.org/2022/3/e28751 %U https://doi.org/10.2196/28751 %U http://www.ncbi.nlm.nih.gov/pubmed/35315777 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e35879 %T Nutrition-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality %A Martinon,Prescilla %A Saliasi,Ina %A Bourgeois,Denis %A Smentek,Colette %A Dussart,Claude %A Fraticelli,Laurie %A Carrouel,Florence %+ Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, 11 Rue Guillaume Paradin, Lyon, 69008, France, 33 478785745, florence.carrouel@univ-lyon1.fr %K mobile apps %K behavior change %K diet %K healthy food %K nutrition %K prevention %K mHealth %K mobile health %K lifestyle %K French %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global burden of disease attributes 20% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed Objective: The aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality. Methods: We screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated. Results: The top scores for overall quality were obtained by Yazio - Régime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores. Conclusions: Although prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users. %M 35285817 %R 10.2196/35879 %U https://mhealth.jmir.org/2022/3/e35879 %U https://doi.org/10.2196/35879 %U http://www.ncbi.nlm.nih.gov/pubmed/35285817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28942 %T Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines %A Martinengo,Laura %A Stona,Anne-Claire %A Tudor Car,Lorainne %A Lee,Jimmy %A Griva,Konstadina %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047017, josip.car@ntu.edu.sg %K health literacy %K mental health literacy %K depression %K mobile apps %K apps %K telemedicine %K mHealth %K self-management %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non–evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user’s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non–evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. %M 35262489 %R 10.2196/28942 %U https://www.jmir.org/2022/3/e28942 %U https://doi.org/10.2196/28942 %U http://www.ncbi.nlm.nih.gov/pubmed/35262489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30468 %T Data Collection Mechanisms in Health and Wellness Apps: Review and Analysis %A Philip,Ben Joseph %A Abdelrazek,Mohamed %A Bonti,Alessio %A Barnett,Scott %A Grundy,John %+ Deakin University, 221 Burwood Highway, Melbourne, 3125, Australia, 61 426824528, benjo@deakin.edu.au %K data collection %K mHealth apps %K app review %K app analysis %K mHealth %K mobile apps %K development %K data sharing %K user experience %K usability %K automation %K data reliability %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a steady rise in the availability of health wearables and built-in smartphone sensors that can be used to collect health data reliably and conveniently from end users. Given the feature overlaps and user tendency to use several apps, these are important factors impacting user experience. However, there is limited work on analyzing the data collection aspect of mobile health (mHealth) apps. Objective: This study aims to analyze what data mHealth apps across different categories usually collect from end users and how these data are collected. This information is important to guide the development of a common data model from current widely adopted apps. This will also inform what built-in sensors and wearables, a comprehensive mHealth platform should support. Methods: In our empirical investigation of mHealth apps, we identified app categories listed in a curated mHealth app library, which was then used to explore the Google Play Store for health and medical apps that were then filtered using our selection criteria. We downloaded these apps from a mirror site hosting Android apps and analyzed them using a script that we developed around the popular AndroGuard tool. We analyzed the use of Bluetooth peripherals and built-in sensors to understand how a given app collects health data. Results: We retrieved 3251 apps meeting our criteria, and our analysis showed that 10.74% (349/3251) of these apps requested Bluetooth access. We found that 50.9% (259/509) of the Bluetooth service universally unique identifiers to be known in these apps, with the remainder being vendor specific. The most common health-related Bluetooth Low Energy services using known universally unique identifiers were Heart Rate, Glucose, and Body Composition. App permissions showed the most used device module or sensor to be the camera (669/3251, 20.57%), closely followed by location (598/3251, 18.39%), with the highest occurrence in the staying healthy app category. Conclusions: We found that not many health apps used built-in sensors or peripherals for collecting health data. The small number of the apps using Bluetooth, with an even smaller number of apps using standard Bluetooth Low Energy services, indicates a wider use of proprietary algorithms and custom services, which restrict the device use. The use of standard profiles could open this ecosystem further and could provide end users more options for apps. The relatively small proportion of apps using built-in sensors along with a high reliance on manual data entry suggests the need for more research into using sensors for data collection in health and fitness apps, which may be more desirable and improve end user experience. %M 35262499 %R 10.2196/30468 %U https://mhealth.jmir.org/2022/3/e30468 %U https://doi.org/10.2196/30468 %U http://www.ncbi.nlm.nih.gov/pubmed/35262499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31016 %T The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search %A Romero-Jimenez,Rosa %A Escudero-Vilaplana,Vicente %A Chamorro-De-Vega,Esther %A Ais-Larisgoitia,Arantza %A Lobato Matilla,Maria Elena %A Herranz-Alonso,Ana %A Sanjurjo,Maria %+ Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, Madrid, 28007, Spain, 34 915868414, rosa.romero@salud.madrid.org %K immune-mediated inflammatory disease %K mobile app %K mHealth %K mobile health %K chronic disease %K disease management %K outcomes %K functionality %K quality %K patient education %K health outcomes %K reliability %D 2022 %7 4.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain. Objective: Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps. Methods: We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities. Results: We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37% (n=90) were on Android, 27.2% (n=66) on iOS, and 35.8% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5%) and medicine (n=82, 37.9%). A total of 211 (82.3%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6% vs 75.8%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6%); specific information about the disease or treatment (n=102, 42%); recording of symptoms or adverse events (n=51, 21%); agenda/calendar (n=44, 18.1%); reminder medication (n=41, 16.9%); and recording of patient-reported outcomes (n=41, 16.9%). A total of 147 (60.5%) apps had more than one functionality. Conclusions: IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year. %M 35254286 %R 10.2196/31016 %U https://www.jmir.org/2022/3/e31016 %U https://doi.org/10.2196/31016 %U http://www.ncbi.nlm.nih.gov/pubmed/35254286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28913 %T The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial %A Sassenberg,Kai %A Roesel,Inka %A Sudeck,Gorden %A Bernecker,Katharina %A Durst,Jennifer %A Krauss,Inga %+ Social Processes Lab, Leibniz-Institut für Wissensmedien, Schleichstrasse 6, Tübingen, 72076, Germany, 49 7071 979 220, k.sassenberg@iwm-tuebingen.de %K mobile app %K exercise %K mastery experience %K self-efficacy %K attitudes toward technology %K osteoarthritis %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise. Objective: This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment. Methods: Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session. Results: In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology. Conclusions: The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments. Trial Registration: German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759 %M 35179500 %R 10.2196/28913 %U https://formative.jmir.org/2022/2/e28913 %U https://doi.org/10.2196/28913 %U http://www.ncbi.nlm.nih.gov/pubmed/35179500 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e17268 %T Classification of Smoking Cessation Apps: Quality Review and Content Analysis %A Seo,Suin %A Cho,Sung-Il %A Yoon,Wonjeong %A Lee,Cheol Min %+ Department of Epidemiology, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 2717, persontime@hotmail.com %K smoking cessation %K app %K type %K content and functions %K MARS %K quality %K score %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people use apps for smoking cessation, and the effectiveness of these apps has been proven in several studies. However, no study has classified these apps and only few studies have analyzed the characteristics of these apps that influence their quality. Objective: The purpose of this study was to analyze the content and the quality of smoking cessation apps by type and identify the characteristics that affect their overall quality. Methods: Two app marketplaces (App Store and Google Play) were searched in January 2018, and the search was completed by May 2020. The search terms used were “stop smoking,” “quit smoking,” and “smoking cessation.” The apps were categorized into 3 types (combined, multifunctional, and informational). The tailored guideline of Clinical Practice Guideline for Treating Tobacco Use and Dependence was utilized for evaluating app content (or functions), and the Mobile App Rating Scale (MARS) was used to evaluate the quality. Chi-square test was performed for the general characteristics, and one-way analysis of variance was performed for MARS analysis. To identify the general features of the apps that could be associated with the MARS and content scores, multiple regression analysis was done. All analyses were performed using SAS software (ver. 9.3). Results: Among 1543 apps, 104 apps met the selection criteria of this study. These 104 apps were categorized as combined type (n=44), functional type (n=31), or informational type (n=29). A large amount of content specified in the guideline was included in the apps, most notably in the combined type, followed by the multifunctional and informational type; the MARS scores followed the same order (3.64, 3.26, and 3.0, respectively). Regression analysis showed that the sector in which the developer was situated and the feedback channel with the developer had a significant impact on both the content and MARS scores. In addition, problematic apps such as those made by unknown developers or copied and single-function apps were shown to have a large market share. Conclusions: This study is the first to evaluate the content and quality of smoking cessation apps by classification. The combined type had higher-quality content and functionality than other app types. The app developer type and feedback channel with the app developer had a significant impact on the overall quality of the apps. In addition, problematic apps and single-function apps were shown to have a large market share. Our results will contribute to the use and development of better smoking cessation apps after considering the problems identified in this study. %M 35175213 %R 10.2196/17268 %U https://mhealth.jmir.org/2022/2/e17268 %U https://doi.org/10.2196/17268 %U http://www.ncbi.nlm.nih.gov/pubmed/35175213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e27337 %T Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review %A Thornton,Louise %A Osman,Bridie %A Champion,Katrina %A Green,Olivia %A Wescott,Annie B %A Gardner,Lauren A %A Stewart,Courtney %A Visontay,Rachel %A Whife,Jesse %A Parmenter,Belinda %A Birrell,Louise %A Bryant,Zachary %A Chapman,Cath %A Lubans,David %A Slade,Tim %A Torous,John %A Teesson,Maree %A Van de Ven,Pepijn %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russel Building, Camperdown, Sydney, 2006, Australia, 61 0403744089, louise.thornton@sydney.edu.au %K smartphone %K app %K alcohol %K smoking %K diet %K measurement %K mobile phone %D 2022 %7 17.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective: The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods: We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results: Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions: This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01375-w %M 35175212 %R 10.2196/27337 %U https://mhealth.jmir.org/2022/2/e27337 %U https://doi.org/10.2196/27337 %U http://www.ncbi.nlm.nih.gov/pubmed/35175212 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e32826 %T Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale %A Narrillos-Moraza,Álvaro %A Gómez-Martínez-Sagrera,Patricia %A Amor-García,Miguel Ángel %A Escudero-Vilaplana,Vicente %A Collado-Borrell,Roberto %A Villanueva-Bueno,Cristina %A Gómez-Centurión,Ignacio %A Herranz-Alonso,Ana %A Sanjurjo-Sáez,María %+ Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 43, Madrid, 28007, Spain, 34 915867714, vicente.escudero@salud.madrid.org %K blood %K hematology %K mHealth %K mobile apps %K quality %K rating tool %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. Objective: The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). Methods: We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen κ coefficient. Results: We identified 2100 apps in the initial search, and 4.19% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61% (54/88) were available on Android, 30% (26/88) were available on iOS, and 9% (8/88) were available on both platforms. Moreover, 7% (6/88) required payment, and 49% (43/88) were updated in the last year. Only 26% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68%), followed by preventive (23/88, 26%) and diagnostic (5/88, 6%). Most of the apps were intended for patients with anemia (23/88, 26%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). Conclusions: There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality. %M 35171109 %R 10.2196/32826 %U https://mhealth.jmir.org/2022/2/e32826 %U https://doi.org/10.2196/32826 %U http://www.ncbi.nlm.nih.gov/pubmed/35171109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31537 %T The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study %A Brown,Jacqueline Marie %A Franco-Arellano,Beatriz %A Froome,Hannah %A Siddiqi,Amina %A Mahmood,Amina %A Arcand,JoAnne %+ Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada, 1 905 721 8668, joanne.arcand@ontariotechu.ca %K mHealth %K children %K app quality %K behavior change techniques %K child nutrition %K mobile apps %K Canada %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. %M 35171100 %R 10.2196/31537 %U https://mhealth.jmir.org/2022/2/e31537 %U https://doi.org/10.2196/31537 %U http://www.ncbi.nlm.nih.gov/pubmed/35171100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30675 %T Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis %A Kouvari,Matina %A Karipidou,Melina %A Tsiampalis,Thomas %A Mamalaki,Eirini %A Poulimeneas,Dimitrios %A Bathrellou,Eirini %A Panagiotakos,Demosthenes %A Yannakoulia,Mary %+ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Athens, 17671, Greece, 30 6944362633, myianna@hua.gr %K childhood obesity %K eHealth %K mHealth %K digital health %K youth %K mobile phone %D 2022 %7 14.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. %M 35156934 %R 10.2196/30675 %U https://www.jmir.org/2022/2/e30675 %U https://doi.org/10.2196/30675 %U http://www.ncbi.nlm.nih.gov/pubmed/35156934 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33103 %T Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Protocol for a Systematic Search and Evaluation of Mobile Apps %A Robinson,Billy %A Gong,Enying %A Oldenburg,Brian %A See,Katharine %+ Department of Respiratory Medicine, Northern Health, 185 Cooper Street, Epping, 3076, Australia, 61 416738886, billymed1994@gmail.com %K asthma %K mHealth %K mobile phone %K applications %K self-management %K chronic disease %K respiratory %K smartphone %K asthma app %D 2022 %7 9.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma is a chronic respiratory disorder that requires long-term pharmacotherapy and patient empowerment to manage the condition and recognize and respond to asthma exacerbations. Mobile health (mHealth) apps represent a potential medium through which patients can improve their ability to self-manage their asthma. Few studies have conducted a systematic evaluation of asthma mobile apps for quality and functionality using a validated tool. None of these reviews have systematically assessed these apps for their content and evaluated them against the available international best practice guidelines. Objective: The objective of this study is to conduct a systematic search and evaluation of adult-targeted asthma mHealth apps. As part of this review, the potential of an mHealth app to improve asthma self-management and the overall quality of the app will be evaluated using the Mobile App Rating Scale framework, and the quality of the information within an app will be evaluated using the current Global Initiative for Asthma guidelines as a reference. Methods: A stepwise methodological approach was taken in creating this review. First, the most recent Global Initiative for Asthma guidelines were independently reviewed by 2 authors to identify key recommendations that could be feasibly incorporated into an mHealth app. A previously developed asthma assessment framework was identified and was modified to suit our research and ensure that all of these identified recommendations were included. In total, 2 popular app stores were reviewed to identify potential mHealth apps. These apps were screened based on predefined inclusion and exclusion criteria. Suitable apps were then evaluated. Technical information was obtained from publicly available information. The next step was to perform an app quality assessment using the validated Mobile App Rating Scale framework to objectively determine the quality of an app. App functionality was assessed using the Intercontinental Medical Statistics Institute for Health Informatics Functionality Scoring System. Finally, the mHealth apps were assessed using our developed checklist. Results: Funding has been received for the project from the Respiratory Department at Northern Health, Victoria. Three reviewers have been recruited to systematically evaluate the apps. The results of this study are expected in 2022. Conclusions: To our knowledge, this review represents the first study to examine all mHealth apps available in Australia that are targeted to adults with asthma for their functionality, quality, and consistency with international best practice guidelines. Although this review will only be conducted on mHealth apps available in Australia, many apps are available worldwide; thus, this study should be largely generalizable to other English-speaking regions and users. The results of this review will help to fill gaps in the literature and assist clinicians in providing evidence-based advice to patients wishing to use mHealth apps as part of their asthma self-management. Trial Registration: PROSPERO 269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894 International Registered Report Identifier (IRRID): PRR1-10.2196/33103 %M 35138257 %R 10.2196/33103 %U https://www.researchprotocols.org/2022/2/e33103 %U https://doi.org/10.2196/33103 %U http://www.ncbi.nlm.nih.gov/pubmed/35138257 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33413 %T Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals %A Pit,Sabrina Winona %A Tan,Aaron J H %A Ramsden,Robyn %A Payne,Kristy %A Freihaut,Winona %A Hayes,Oliver %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary St, Hamilton, 2303, Australia, 61 429455720, spit@nswrdn.com.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to further investigate how persuasive design principles can change rural health professionals’ behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini’s principles of persuasion. These have not been analyzed yet in the field of health workforce capability. Objective: This study aims to determine the persuasive design techniques used in capability building–related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. Methods: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. Results: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6%) and liking (n=48), followed by trustworthiness (n=43, 81.1%), reminders (n=38, 71.7%), and suggestion (n=30, 56.6%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. Conclusions: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce. %M 35129447 %R 10.2196/33413 %U https://mhealth.jmir.org/2022/2/e33413 %U https://doi.org/10.2196/33413 %U http://www.ncbi.nlm.nih.gov/pubmed/35129447 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e35042 %T Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis %A Lewkowicz,Daniel %A Wohlbrandt,Attila M %A Bottinger,Erwin %+ Digital Health Center, Hasso Plattner Institute, University of Potsdam, Prof Dr Helmert Str 2-3, Potsdam, 14482, Germany, 49 (0)331 55094843, daniel.lewkowicz@hpi.de %K cost-utility analysis %K low back pain %K back pain %K cost-effectiveness %K Markov model %K digital therapy %K digital health app %K mHealth %K orthopedic %K eHealth %K mobile health %K digital health %K pain management %K health apps %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital therapeutic care apps provide a new effective and scalable approach for people with nonspecific low back pain (LBP). Digital therapeutic care apps are also driven by personalized decision-support interventions that support the user in self-managing LBP, and may induce prolonged behavior change to reduce the frequency and intensity of pain episodes. However, these therapeutic apps are associated with high attrition rates, and the initial prescription cost is higher than that of face-to-face physiotherapy. In Germany, digital therapeutic care apps are now being reimbursed by statutory health insurance; however, price targets and cost-driving factors for the formation of the reimbursement rate remain unexplored. Objective: The aim of this study was to evaluate the cost-effectiveness of a digital therapeutic care app compared to treatment as usual (TAU) in Germany. We further aimed to explore under which circumstances the reimbursement rate could be modified to consider value-based pricing. Methods: We developed a state-transition Markov model based on a best-practice analysis of prior LBP-related decision-analytic models, and evaluated the cost utility of a digital therapeutic care app compared to TAU in Germany. Based on a 3-year time horizon, we simulated the incremental cost and quality-adjusted life years (QALYs) for people with nonacute LBP from the societal perspective. In the deterministic sensitivity and scenario analyses, we focused on diverging attrition rates and app cost to assess our model’s robustness and conditions for changing the reimbursement rate. All costs are reported in Euro (€1=US $1.12). Results: Our base case results indicated that the digital therapeutic care strategy led to an incremental cost of €121.59, but also generated 0.0221 additional QALYs compared to the TAU strategy, with an estimated incremental cost-effectiveness ratio (ICER) of €5486 per QALY. The sensitivity analysis revealed that the reimbursement rate and the capability of digital therapeutic care to prevent reoccurring LBP episodes have a significant impact on the ICER. At the same time, the other parameters remained unaffected and thus supported the robustness of our model. In the scenario analysis, the different model time horizons and attrition rates strongly influenced the economic outcome. Reducing the cost of the app to €99 per 3 months or decreasing the app’s attrition rate resulted in digital therapeutic care being significantly less costly with more generated QALYs, and is thus considered to be the dominant strategy over TAU. Conclusions: The current reimbursement rate for a digital therapeutic care app in the statutory health insurance can be considered a cost-effective measure compared to TAU. The app’s attrition rate and effect on the patient’s prolonged behavior change essentially influence the settlement of an appropriate reimbursement rate. Future value-based pricing targets should focus on additional outcome parameters besides pain intensity and functional disability by including attrition rates and the app’s long-term effect on quality of life. %M 35129454 %R 10.2196/35042 %U https://mhealth.jmir.org/2022/2/e35042 %U https://doi.org/10.2196/35042 %U http://www.ncbi.nlm.nih.gov/pubmed/35129454 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33168 %T The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play %A Bricca,Alessio %A Pellegrini,Alessandro %A Zangger,Graziella %A Ahler,Jonas %A Jäger,Madalina %A Skou,Søren T %+ Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, 5260, Denmark, 45 65509510, abricca@health.sdu.dk %K app %K self-management %K behavior change %K multimorbidity %K chronic conditions %K health apps %K mHealth %K mobile health %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered. Objective: We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change. Methods: We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change. Results: We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63%), weight and diet (apps: 25/60, 42%), or physical activity (apps: 22/60, 37%) and stress management (apps: 22/60, 37%). Only 8 out of the 60 apps (13%) were completely free. Conclusions: Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change. %M 35119367 %R 10.2196/33168 %U https://mhealth.jmir.org/2022/2/e33168 %U https://doi.org/10.2196/33168 %U http://www.ncbi.nlm.nih.gov/pubmed/35119367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27388 %T Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores %A Leong,Qiao Ying %A Sridhar,Shreya %A Blasiak,Agata %A Tadeo,Xavier %A Yeo,GeckHong %A Remus,Alexandria %A Ho,Dean %+ N.1 Institute for Health, National University of Singapore, 28 Medical Drive, Singapore, 117456, Singapore, 65 86118796, bieamr@nus.edu.sg %K mHealth %K digital medicine %K anxiety %K depression %K systematic review %K mental health conditions %K mobile phone %D 2022 %7 4.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective: The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods: A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results: The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions: A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms. %M 35119370 %R 10.2196/27388 %U https://www.jmir.org/2022/2/e27388 %U https://doi.org/10.2196/27388 %U http://www.ncbi.nlm.nih.gov/pubmed/35119370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30766 %T User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews %A Kaveladze,Benjamin T %A Wasil,Akash R %A Bunyi,John B %A Ramirez,Veronica %A Schueller,Stephen M %+ Department of Psychological Science, University of California, 4201 Social & Behavioral Sciences Gateway, Irvine, CA, 92697-7085, United States, 1 310 984 9318, bkavelad@uci.edu %K mental health apps %K engagement %K user experience %K digital mental health %K user retention %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: User 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. Objective: We aimed to examine the relationship among subjective measures of user experience, objective measures of popularity, and engagement in mental health apps. Methods: We 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. Results: MARS 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. Conclusions: More 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. %M 35099398 %R 10.2196/30766 %U https://humanfactors.jmir.org/2022/1/e30766 %U https://doi.org/10.2196/30766 %U http://www.ncbi.nlm.nih.gov/pubmed/35099398 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30361 %T Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment %A Hendricks-Sturrup,Rachele %+ Future of Privacy Forum, 1400 I St NW, Suite 450, Washington, DC, 20005, United States, 1 202 768 8950, rachele.hendricks.sturrup@duke.edu %K COVID-19 %K pulse oximeters %K mobile apps %K mHealth %K privacy %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19. Objective: The aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation. Methods: During August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy–related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app’s site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards. Results: Six pulse oximeter apps met the inclusion criteria and only 33% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer’s website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app. Conclusions: Pulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic. %M 35084348 %R 10.2196/30361 %U https://mhealth.jmir.org/2022/1/e30361 %U https://doi.org/10.2196/30361 %U http://www.ncbi.nlm.nih.gov/pubmed/35084348 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28621 %T Validity and Reliability of the Korean Version of the Health Information Technology Usability Evaluation Scale: Psychometric Evaluation %A Lee,Jisan %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mobile application %K menstruation %K survey %K questionnaire %K translations %K medical informatics %K app %K validity %K reliability %K usability %K assessment %K mHealth %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Rigorous development of mobile technologies requires the use of validated instruments to evaluate the usability of these tools, which has become more relevant with the expansion of these technologies. Although various usability evaluation tools have been developed, there are relatively few simple evaluation instruments that have been validated across diseases and languages in mobile health (mHealth) information technology for use in multiple diseases. Objective: The purpose of this study is to validate the Korean version of the Health Information Technology Usability Evaluation Scale (Korean Health-ITUES) and assess its applicability for different health conditions. Methods: To develop the Korean Health-ITUES, we used a validation process involving the following 3 steps: (1) customization of the Health-ITUES for menstrual symptoms, (2) translation of the Health-ITUES from English into Korean, and (3) examination of the reliability and validity of the instrument. The translation process adhered to the World Health Organization (WHO) guidelines for translation and back-translation, expert review, and reconciliation. Results: The Korean Health-ITUES showed reliable internal consistency with Cronbach α=.951; meanwhile, factor loadings of the 20 items in the 4 subscales ranged from 0.416 to 0.892. Conclusions: The Health-ITUES demonstrated reliability and validity for its use in assessing mHealth apps’ usability in young Korean women with menstrual discomfort. Given the strong psychometric properties of this tool in Korean and English and across 2 different health conditions, the Health-ITUES is a valid and reliable instrument for assessing the usability of mHealth apps. The Health-ITUES is also a valid instrument for evaluating mHealth technologies, which are widely used by patients to self-manage their health and by providers to improve health care delivery. %M 35072630 %R 10.2196/28621 %U https://medinform.jmir.org/2022/1/e28621 %U https://doi.org/10.2196/28621 %U http://www.ncbi.nlm.nih.gov/pubmed/35072630 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e33944 %T Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review %A Lee,JuHee %A Yeom,Insun %A Chung,Misook L %A Kim,Yielin %A Yoo,Subin %A Kim,Eunyoung %+ Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea, 82 10 2816 2884, key7481@daum.net %K systematic review %K Parkinson disease %K motor symptoms %K nonmotor symptoms %K smartphone %K mobile phone %K mobile health %K mobile apps %K self-care %K symptom %K monitoring %K review %K disability %K app %K care %K quality of life %K self-management %D 2022 %7 21.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app–based self-care in PD is insufficient. Objective: This study aimed to explore the features and characteristics of mobile apps for self-care in people with PD. Methods: This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including ”Parkinson disease” and ”mobile.” Results: A total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management. Conclusions: Mobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267374. %M 35060910 %R 10.2196/33944 %U https://mhealth.jmir.org/2022/1/e33944 %U https://doi.org/10.2196/33944 %U http://www.ncbi.nlm.nih.gov/pubmed/35060910 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e28661 %T Listening to Stakeholders Involved in Speech-Language Therapy for Children With Communication Disorders: Content Analysis of Apple App Store Reviews %A Du,Yao %A Choe,Sarah %A Vega,Jennifer %A Liu,Yusa %A Trujillo,Adrienne %+ Monmouth University, 400 Cedar Ave, West Long Branch, NJ, 07764, United States, 1 7329234616, yadu@monmouth.edu %K eHealth %K mobile health %K mHealth %K mobile app %K communication disorders %K speech therapy %K language therapy %K children %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the plethora of mobile apps available on the Apple App Store, more speech-language pathologists (SLPs) have adopted apps for speech-language therapy services, especially for pediatric clients. App Store reviews are publicly available data sources that can not only create avenues for communication between technology developers and consumers but also enable stakeholders such as parents and clinicians to share their opinions and view opinions about the app content and quality based on user experiences. Objective: This study examines the Apple App Store reviews from multiple key stakeholders (eg, parents, educators, and SLPs) to identify and understand user needs and challenges of using speech-language therapy apps (including augmentative and alternative communication [AAC] apps) for pediatric clients who receive speech-language therapy services. Methods: We selected 16 apps from a prior interview study with SLPs that covered multiple American Speech-Language-Hearing Association Big Nine competencies, including articulation, receptive and expressive language, fluency, voice, social communication, and communication modalities. Using an automatic Python (Python Software Foundation) crawler developed by our research team and a Really Simple Syndication feed generator provided by Apple, we extracted a total of 721 app reviews from 2009 to 2020. Using qualitative coding to identify emerging themes, we conducted a content analysis of 57.9% (418/721) reviews and synthesized user feedback related to app features and content, usability issues, recommendations for improvement, and multiple influential factors related to app design and use. Results: Our analyses revealed that key stakeholders such as family members, educators, and individuals with communication disorders have used App Store reviews as a platform to share their experiences with AAC and speech-language apps. User reviews for AAC apps were primarily written by parents who indicated that AAC apps consistently exhibited more usability issues owing to violations of design guidelines in areas of aesthetics, user errors, controls, and customization. Reviews for speech-language apps were primarily written by SLPs and educators who requested and recommended specific app features (eg, customization of visuals, recorded feedback within the app, and culturally diverse character roles) based on their experiences working with a diverse group of pediatric clients with a variety of communication disorders. Conclusions: To our knowledge, this is the first study to compile and analyze publicly available App Store reviews to identify areas for improvement within mobile apps for pediatric speech-language therapy apps from children with communication disorders and different stakeholders (eg, clinicians, parents, and educators). The findings contribute to the understanding of apps for children with communication disorders regarding content and features, app usability and accessibility issues, and influential factors that impact both AAC apps and speech-language apps for children with communication disorders who need speech therapy. %M 35060912 %R 10.2196/28661 %U https://pediatrics.jmir.org/2022/1/e28661 %U https://doi.org/10.2196/28661 %U http://www.ncbi.nlm.nih.gov/pubmed/35060912 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31607 %T Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie J %A Alfrey,Kristie-Lee %A Waters,Kim %A Cannon,Summer %A Mielke,Gregore I %A Keating,Shelley E %A Mena,Gabriela P %A Mottola,Michelle F %A Evenson,Kelly R %A Davenport,Margie H %A Barlow,S Ariel %A Budzynski-Seymour,Emily %A Comardelle,Natalie %A Dickey,Madison %A Harrison,Cheryce L %A Kebbe,Maryam %A Moholdt,Trine %A Moran,Lisa J %A Nagpal,Taniya S %A Schoeppe,Stephanie %A Alley,Stephanie %A Brown,Wendy J %A Williams,Susan %A Vincze,Lisa %+ Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Building 7/LG.12, North Rockhampton Campus, Rockhampton, 4701, Australia, 61 749306912, m.j.hayman@cqu.edu.au %K apps %K exercise %K mobile health %K mHealth %K mobile phone %K physical activity %K pregnancy %K exercise prescription %K evidence-based guidelines %K app development %K systematic review %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps. %M 35044318 %R 10.2196/31607 %U https://mhealth.jmir.org/2022/1/e31607 %U https://doi.org/10.2196/31607 %U http://www.ncbi.nlm.nih.gov/pubmed/35044318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26453 %T Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation %A Voth,Melissa %A Chisholm,Shannon %A Sollid,Hannah %A Jones,Chelsea %A Smith-MacDonald,Lorraine %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street Edmonton, Edmonton, AB, T6G 2G4, Canada, 1 7804920404, cweiman@ualberta.ca %K occupational stress injury %K trauma %K mHealth %K resilience %K mental health %K military %K veteran %K public safety personnel %K OSI %K PTSD %K mental health intervention %K mobile phone %D 2022 %7 19.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process. %M 35044307 %R 10.2196/26453 %U https://mhealth.jmir.org/2022/1/e26453 %U https://doi.org/10.2196/26453 %U http://www.ncbi.nlm.nih.gov/pubmed/35044307 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30724 %T mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital mental health %K perinatal mental health %K pregnancy %K MIND %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. %M 35037894 %R 10.2196/30724 %U https://mhealth.jmir.org/2022/1/e30724 %U https://doi.org/10.2196/30724 %U http://www.ncbi.nlm.nih.gov/pubmed/35037894 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26563 %T Prioritization of Quality Principles for Health Apps Using the Kano Model: Survey Study %A Malinka,Christin %A von Jan,Ute %A Albrecht,Urs-Vito %+ Peter L Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, 49 511 532 ext 4412, ute.von.jan@plri.de %K Kano %K quality principles %K mobile apps %K physicians %K surveys and questionnaires %K evaluation studies %K mHealth %K health apps %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are often used without adequately taking aspects related to their quality under consideration. This may partially be due to inadequate awareness about necessary criteria and how to prioritize them when evaluating an app. Objective: The aim of this study was to introduce a method for prioritizing quality attributes in the mobile health context. To this end, physicians were asked about their assessment of nine app quality principles relevant in health contexts and their responses were used as a basis for designing a method for app prioritization. Ultimately, the goal was to aid in making better use of limited resources (eg, time) by assisting with the decision as to the specific quality principles that deserve priority in everyday medical practice and those that can be given lower priority, even in cases where the overall principles are rated similarly. Methods: A total of 9503 members of two German professional societies in the field of orthopedics were invited by email to participate in an anonymous online survey over a 1-month period. Participants were asked to rate a set of nine app quality principles using a Kano survey with functional and dysfunctional (ie, positively and negatively worded) questions. The evaluation was based on the work of Kano (baseline), supplemented by a self-designed approach. Results: Among the 9503 invited members, 382 completed relevant parts of the survey (return rate of 4.02%). These participants were equally and randomly assigned to two groups (test group and validation group, n=191 each). Demographic characteristics did not significantly differ between groups (all P>.05). Participants were predominantly male (328/382, 85.9%) and older than 40 years (290/382, 75.9%). Given similar ratings, common evaluation strategies for Kano surveys did not allow for conclusive prioritization of the principles, and the same was true when using the more elaborate approach of satisfaction and dissatisfaction indices following the work of Timko. Therefore, an extended, so-called “in-line-of-sight” method was developed and applied for this evaluation. Modified from the Timko method, this approach is based on a “point of view” (POV) metric, which generates a ranking coefficient. Although the principles were previously almost exclusively rated as must-be (with the exception of resource efficiency), which was not conducive to their prioritization, the new method applied from the must-be POV resulted in identical rankings for the test and validation groups: (1) legal conformity, (2) content validity, (3) risk adequacy, (4) practicality, (5) ethical soundness, (6) usability, (7) transparency, (8) technical adequacy, and (9) resource efficiency. Conclusions: Established survey methodologies based on the work of Kano predominantly seek to categorize the attributes to be evaluated. The methodology presented here is an interesting option for prioritization, and enables focusing on the most important criteria, thus saving valuable time when reviewing apps for use in the medical field, even with otherwise largely similar categorization results. The extent to which this approach is applicable beyond the scenario presented herein requires further investigation. %M 35014965 %R 10.2196/26563 %U https://mhealth.jmir.org/2022/1/e26563 %U https://doi.org/10.2196/26563 %U http://www.ncbi.nlm.nih.gov/pubmed/35014965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31058 %T Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation %A Bunova,Anna %A Wiemker,Veronika %A Gornyi,Boris %A Ferreira-Borges,Carina %A Neufeld,Maria %+ National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow, 101990, Russian Federation, 7 9151416154, asbunova@gmail.com %K alcohol %K mHealth %K mobile applications %K screening and brief intervention %K Mobile Application Rating Scale %K App Behavior Change Scale %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized 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. Objective: This 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. Methods: A 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). Results: We 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. Conclusions: Russian-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 Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458 %M 35006083 %R 10.2196/31058 %U https://mhealth.jmir.org/2022/1/e31058 %U https://doi.org/10.2196/31058 %U http://www.ncbi.nlm.nih.gov/pubmed/35006083 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33348 %T Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis %A Keller,Roman %A Hartmann,Sven %A Teepe,Gisbert Wilhelm %A Lohse,Kim-Morgaine %A Alattas,Aishah %A Tudor Car,Lorainne %A Müller-Riemenschneider,Falk %A von Wangenheim,Florian %A Mair,Jacqueline Louise %A Kowatsch,Tobias %+ Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore, 65 82645302, roman.keller@sec.ethz.ch %K digital health companies %K health care %K type 2 diabetes %K prevention %K management %K conversational agent %K digital behavior change intervention %K investment %K just-in-time adaptive intervention %K digital health %K diabetes %K agent %K behavior %D 2022 %7 7.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Advancements in technology offer new opportunities for the prevention and management of type 2 diabetes. Venture capital companies have been investing in digital diabetes companies that offer digital behavior change interventions (DBCIs). However, little is known about the scientific evidence underpinning such interventions or the degree to which these interventions leverage novel technology-driven automated developments such as conversational agents (CAs) or just-in-time adaptive intervention (JITAI) approaches. Objective: Our objectives were to identify the top-funded companies offering DBCIs for type 2 diabetes management and prevention, review the level of scientific evidence underpinning the DBCIs, identify which DBCIs are recognized as evidence-based programs by quality assurance authorities, and examine the degree to which these DBCIs include novel automated approaches such as CAs and JITAI mechanisms. Methods: A systematic search was conducted using 2 venture capital databases (Crunchbase Pro and Pitchbook) to identify the top-funded companies offering interventions for type 2 diabetes prevention and management. Scientific publications relating to the identified DBCIs were identified via PubMed, Google Scholar, and the DBCIs’ websites, and data regarding intervention effectiveness were extracted. The Diabetes Prevention Recognition Program (DPRP) of the Center for Disease Control and Prevention in the United States was used to identify the recognition status. The DBCIs’ publications, websites, and mobile apps were reviewed with regard to the intervention characteristics. Results: The 16 top-funded companies offering DBCIs for type 2 diabetes received a total funding of US $2.4 billion as of June 15, 2021. Only 4 out of the 50 identified publications associated with these DBCIs were fully powered randomized controlled trials (RCTs). Further, 1 of those 4 RCTs showed a significant difference in glycated hemoglobin A1c (HbA1c) outcomes between the intervention and control groups. However, all the studies reported HbA1c improvements ranging from 0.2% to 1.9% over the course of 12 months. In addition, 6 interventions were fully recognized by the DPRP to deliver evidence-based programs, and 2 interventions had a pending recognition status. Health professionals were included in the majority of DBCIs (13/16, 81%,), whereas only 10% (1/10) of accessible apps involved a CA as part of the intervention delivery. Self-reports represented most of the data sources (74/119, 62%) that could be used to tailor JITAIs. Conclusions: Our findings suggest that the level of funding received by companies offering DBCIs for type 2 diabetes prevention and management does not coincide with the level of evidence on the intervention effectiveness. There is considerable variation in the level of evidence underpinning the different DBCIs and an overall need for more rigorous effectiveness trials and transparent reporting by quality assurance authorities. Currently, very few DBCIs use automated approaches such as CAs and JITAIs, limiting the scalability and reach of these solutions. %M 34994693 %R 10.2196/33348 %U https://www.jmir.org/2022/1/e33348 %U https://doi.org/10.2196/33348 %U http://www.ncbi.nlm.nih.gov/pubmed/34994693 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e18083 %T A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis %A Ayyoubzadeh,Seyed Mohammad %A Shirkhoda,Mohammad %A R Niakan Kalhori,Sharareh %A Mohammadzadeh,Niloofar %A Zakerabasali,Somayyeh %+ Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Mühlenpfordtstraße 23, Braunschweig, 38106, Germany, 49 531 391 2125, sharareh.niakankalhori@plri.de %K eHealth %K app %K colorectal cancer %K survivors %K requirements analysis %K MoSCoW %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors’ and clinical experts’ views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won’t have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (–0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors’ perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients’ and health care providers’ communication and interaction. %M 34989685 %R 10.2196/18083 %U https://cancer.jmir.org/2022/1/e18083 %U https://doi.org/10.2196/18083 %U http://www.ncbi.nlm.nih.gov/pubmed/34989685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e34054 %T Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation %A Wu,Xiaoqian %A Xu,Lin %A Li,PengFei %A Tang,TingTing %A Huang,Cheng %+ College of Medical Informatics, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K mobile apps %K app %K mental health %K mHealth %K content analysis %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental 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. Objective: This 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. Methods: A 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. Results: A 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). Conclusions: The 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. %M 34982717 %R 10.2196/34054 %U https://mhealth.jmir.org/2022/1/e34054 %U https://doi.org/10.2196/34054 %U http://www.ncbi.nlm.nih.gov/pubmed/34982717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25330 %T Active Usage of Mobile Health Applications: Cross-sectional Study %A Wang,Yang %A Wu,Tailai %A Chen,Zhuo %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13477072665, lncle2012@yahoo.com %K active usage %K mobile health %K 3-factor theory %K consumer satisfaction %K consumer dissatisfaction %K medical informatics %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health applications are being increasingly used for people’s health management. The different uses of mobile health applications lead to different health outcomes. Although active usage of mobile health applications is shown to be linked to the effectiveness of mobile health services, the factors that influence people’s active usage of mobile health applications are not well studied. Objective: This paper aims to examine the antecedents of active usage of mobile health applications. Methods: Grounded on the 3-factor theory, we proposed 10 attributes of mobile health applications that influence the active usage of mobile health applications through consumers’ satisfaction and dissatisfaction. We classified these 10 attributes into 3 categories (ie, excitement attributes, performance attributes, and basic attributes). Using the survey method, 494 valid responses were collected and analyzed using structural equation modeling. Results: Our analysis results revealed that both consumer satisfaction (β=0.351, t=6.299, P<.001) and dissatisfaction (β=–0.251, t=5.119, P<.001) significantly influenced active usage. With regard to the effect of attributes, excitement attributes (β=0.525, t=12.861, P<.001) and performance attributes (β=0.297, t=6.508, P<.001) positively influenced consumer satisfaction, while performance attributes (β=–0.231, t=3.729, P<.001) and basic attributes (β=–0.412, t=7.132, P<.001) negatively influenced consumer dissatisfaction. The results of the analysis confirmed our proposed hypotheses. Conclusions: Our study provides a novel perspective to study the active usage of mobile health applications. By categorizing the attributes of mobile health applications into 3 categories, the differential effects of different attributes can be tested. Meanwhile, consumer satisfaction and dissatisfaction are confirmed to be independent from each other. %M 34941545 %R 10.2196/25330 %U https://www.jmir.org/2021/12/e25330 %U https://doi.org/10.2196/25330 %U http://www.ncbi.nlm.nih.gov/pubmed/34941545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31737 %T Improving User Experience of Virtual Health Assistants: Scoping Review %A Curtis,Rachel G %A Bartel,Bethany %A Ferguson,Ty %A Blake,Henry T %A Northcott,Celine %A Virgara,Rosa %A Maher,Carol A %+ UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 8 8302 2455, Rachel.Curtis@unisa.edu.au %K virtual assistant %K conversational agent %K chatbot %K eHealth %K digital health %K design %K user experience %K mobile phone %D 2021 %7 21.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Virtual assistants can be used to deliver innovative health programs that provide appealing, personalized, and convenient health advice and support at scale and low cost. Design characteristics that influence the look and feel of the virtual assistant, such as visual appearance or language features, may significantly influence users’ experience and engagement with the assistant. Objective: This scoping review aims to provide an overview of the experimental research examining how design characteristics of virtual health assistants affect user experience, summarize research findings of experimental research examining how design characteristics of virtual health assistants affect user experience, and provide recommendations for the design of virtual health assistants if sufficient evidence exists. Methods: We searched 5 electronic databases (Web of Science, MEDLINE, Embase, PsycINFO, and ACM Digital Library) to identify the studies that used an experimental design to compare the effects of design characteristics between 2 or more versions of an interactive virtual health assistant on user experience among adults. Data were synthesized descriptively. Health domains, design characteristics, and outcomes were categorized, and descriptive statistics were used to summarize the body of research. Results for each study were categorized as positive, negative, or no effect, and a matrix of the design characteristics and outcome categories was constructed to summarize the findings. Results: The database searches identified 6879 articles after the removal of duplicates. We included 48 articles representing 45 unique studies in the review. The most common health domains were mental health and physical activity. Studies most commonly examined design characteristics in the categories of visual design or conversational style and relational behavior and assessed outcomes in the categories of personality, satisfaction, relationship, or use intention. Over half of the design characteristics were examined by only 1 study. Results suggest that empathy and relational behavior and self-disclosure are related to more positive user experience. Results also suggest that if a human-like avatar is used, realistic rendering and medical attire may potentially be related to more positive user experience; however, more research is needed to confirm this. Conclusions: There is a growing body of scientific evidence examining the impact of virtual health assistants’ design characteristics on user experience. Taken together, data suggest that the look and feel of a virtual health assistant does affect user experience. Virtual health assistants that show empathy, display nonverbal relational behaviors, and disclose personal information about themselves achieve better user experience. At present, the evidence base is broad, and the studies are typically small in scale and highly heterogeneous. Further research, particularly using longitudinal research designs with repeated user interactions, is needed to inform the optimal design of virtual health assistants. %M 34931997 %R 10.2196/31737 %U https://www.jmir.org/2021/12/e31737 %U https://doi.org/10.2196/31737 %U http://www.ncbi.nlm.nih.gov/pubmed/34931997 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29098 %T Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K COM-B %K TDF %K user engagement %K motivation %K usability %K engagement %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. %M 34927597 %R 10.2196/29098 %U https://mhealth.jmir.org/2021/12/e29098 %U https://doi.org/10.2196/29098 %U http://www.ncbi.nlm.nih.gov/pubmed/34927597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e17062 %T User Reviews of Depression App Features: Sentiment Analysis %A Meyer,Julien %A Okuboyejo,Senanu %+ School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria Street, Office: TRS 3-081, Toronto, ON, M4T 1G6, Canada, 1 4169795000 ext 6296, julien.meyer@ryerson.ca %K mHealth %K depression %K app reviews %K natural language processing %K app features %K emotions %K use %K linguistic inquiry word count %K mobile phone %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health in general, and depression in particular, remain undertreated conditions. Mobile health (mHealth) apps offer tremendous potential to overcome the barriers to accessing mental health care and millions of depression apps have been installed and used. However, little is known about the effect of these apps on a potentially vulnerable user population and the emotional reactions that they generate, even though emotions are a key component of mental health. App reviews, spontaneously posted by the users on app stores, offer up-to-date insights into the experiences and emotions of this population and are increasingly decisive in influencing mHealth app adoption. Objective: This study aims to investigate the emotional reactions of depression app users to different app features by systematically analyzing the sentiments expressed in app reviews. Methods: We extracted 3261 user reviews of depression apps. The 61 corresponding apps were categorized by the features they offered (psychoeducation, medical assessment, therapeutic treatment, supportive resources, and entertainment). We then produced word clouds by features and analyzed the reviews using the Linguistic Inquiry Word Count 2015 (Pennebaker Conglomerates, Inc), a lexicon-based natural language analytical tool that analyzes the lexicons used and the valence of a text in 4 dimensions (authenticity, clout, analytic, and tone). We compared the language patterns associated with the different features of the underlying apps. Results: The analysis highlighted significant differences in the sentiments expressed for the different features offered. Psychoeducation apps exhibited more clout but less authenticity (ie, personal disclosure). Medical assessment apps stood out for the strong negative emotions and the relatively negative ratings that they generated. Therapeutic treatment app features generated more positive emotions, even though user feedback tended to be less authentic but more analytical (ie, more factual). Supportive resources (connecting users to physical services and people) and entertainment apps also generated fewer negative emotions and less anxiety. Conclusions: Developers should be careful in selecting the features they offer in their depression apps. Medical assessment features may be riskier as users receive potentially disturbing feedback on their condition and may react with strong negative emotions. In contrast, offering information, contacts, or even games may be safer starting points to engage people with depression at a distance. We highlight the necessity to differentiate how mHealth apps are assessed and vetted based on the features they offer. Methodologically, this study points to novel ways to investigate the impact of mHealth apps and app features on people with mental health issues. mHealth apps exist in a rapidly changing ecosystem that is driven by user satisfaction and adoption decisions. As such, user perceptions are essential and must be monitored to ensure adoption and avoid harm to a fragile population that may not benefit from traditional health care resources. %M 34904955 %R 10.2196/17062 %U https://formative.jmir.org/2021/12/e17062 %U https://doi.org/10.2196/17062 %U http://www.ncbi.nlm.nih.gov/pubmed/34904955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31333 %T CE Accreditation and Barriers to CE Marking of Pediatric Drug Calculators for Mobile Devices: Scoping Review and Qualitative Analysis %A Koldeweij,Charlotte %A Clarke,Jonathan %A Nijman,Joppe %A Feather,Calandra %A de Wildt,Saskia N %A Appelbaum,Nicholas %+ Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 21, Nijmegen, 6525 EZ, Netherlands, 31 243616192, charlotte.koldeweij@radboudumc.nl %K pediatric %K drug dosage calculator %K European regulations %K safety %K medical devices %K medical errors %K app %K application %K mobile health %K pharmacy %D 2021 %7 13.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Pediatric drug calculators (PDCs) intended for clinical use qualify as medical devices under the Medical Device Directive and the Medical Device Regulation. The extent to which they comply with European standards on quality and safety is unknown. Objective: This study determines the number of PDCs available as mobile apps for use in the Netherlands that bear a CE mark, and explore the factors influencing the CE marking of such devices among app developers. Methods: A scoping review of Google Play Store and Apple App Store was conducted to identify PDCs available for download in the Netherlands. CE accreditation of the sampled apps was determined by consulting the app landing pages on app stores, by screening the United Kingdom Medicines and Healthcare products Regulatory Agency’s online registry of medical devices, and by surveying app developers. The barriers to CE accreditation were also explored through a survey of app developers. Results: Of 632 screened apps, 74 were eligible, including 60 pediatric drug dosage calculators and 14 infusion rate calculators. One app was CE marked. Of the 20 (34%) respondents to the survey, 8 considered their apps not to be medical devices based on their intent of use or functionality. Three developers had not aimed to make their app available for use in Europe. Other barriers that may explain the limited CE accreditation of sampled PDC apps included poor awareness of European regulations among developers and a lack of restrictions when placing PDCs in app stores. Conclusions: The compliance of PDCs with European standards on medical devices is poor. This puts clinicians and their patients at risk of medical errors resulting from the largely unrestricted use of these apps. %M 34898456 %R 10.2196/31333 %U https://www.jmir.org/2021/12/e31333 %U https://doi.org/10.2196/31333 %U http://www.ncbi.nlm.nih.gov/pubmed/34898456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29047 %T Patient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores %A Merolli,Mark %A Francis,Jill J %A Vallance,Patrick %A Bennell,Kim L %A Malliaras,Peter %A Hinman,Rana S %+ Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Melbourne, 3053, Australia, 61 408513984, merollim@unimelb.edu.au %K physiotherapy %K physical therapy %K digital health intervention %K mobile app %K eHealth %K behavior change technique %K behavior change %K exercise %K digital health %K mHealth %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Care delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors. Objective: The primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps. Methods: A systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS). Results: App store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent paper in 2022. Conclusions: Knowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care. International Registered Report Identifier (IRRID): PRR1-10.2196/29047 %M 34889767 %R 10.2196/29047 %U https://www.researchprotocols.org/2021/12/e29047 %U https://doi.org/10.2196/29047 %U http://www.ncbi.nlm.nih.gov/pubmed/34889767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31271 %T Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis %A Janvrin,Miranda Lynn %A Korona-Bailey,Jessica %A Koehlmoos,Tracey Pérez %+ The Henry M Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Dr, Suite 100, Bethesda, MD, 20817, United States, 1 6035403059, miranda.janvrin@gmail.com %K COVID-19 %K coronavirus %K framework analysis %K information resources %K monitoring %K patient-reported outcome measures %K self-reported %K surveillance %K symptom tracking %K synthesis %K digital health %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the “best-fit” framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. %M 34792469 %R 10.2196/31271 %U https://formative.jmir.org/2021/12/e31271 %U https://doi.org/10.2196/31271 %U http://www.ncbi.nlm.nih.gov/pubmed/34792469 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27533 %T Selecting and Evaluating Mobile Health Apps for the Healthy Life Trajectories Initiative: Development of the eHealth Resource Checklist %A Vanderloo,Leigh M %A Carsley,Sarah %A Agarwal,Payal %A Marini,Flavia %A Dennis,Cindy-Lee %A Birken,Catherine %+ Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada, 1 5194956306, lvande32@uwo.ca %K eHealth resources %K applications %K quality assessment %K preconception health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ubiquity of smartphones and mobile devices in the general population presents an unprecedented opportunity for preventative health. Not surprisingly, the use of electronic health (eHealth) resources accessed through mobile devices in clinical trials is becoming more prevalent; the selection, screening, and collation of quality eHealth resources is necessary to clinical trials using these technologies. However, the constant creation and turnover of new eHealth resources can make this task difficult. Although syntheses of eHealth resources are becoming more common, their methodological and reporting quality require improvement so as to be more accessible to nonexperts. Further, there continues to be significant variation in quality criteria employed for assessment, with no clear method for developing the included criteria. There is currently no single existing framework that addresses all six dimensions of mobile health app quality identified in Agarwal et al’s recent scoping review (ie, basic descriptions of the design and usage of the resource; technical features and accessibility; health information quality; usability; evidence of impact; and user engagement and behavior change). In instances where highly systematic tactics are not possible (due to time constraints, cost, or lack of expertise), there may be value in adopting practical and pragmatic approaches to helping researchers and clinicians identify and disseminate e-resources. Objective: The study aimed to create a set of guidelines (ie, a checklist) to aid the members of the Healthy Life Trajectories Initiative (HeLTI) Canada trial—a preconception randomized controlled clinical trial to prevent child obesity—to assist their efforts in searching, identifying, screening, and including selected eHealth resources for participant use in the study intervention. Methods: A framework for searching, screening, and selecting eHealth resources was adapted from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist for systematic and scoping reviews to optimize the rigor, clarity, and transparency of the process. Details regarding searching, selecting, extracting, and assessing quality of eHealth resources are described. Results: This study resulted in the systematic development of a checklist consisting of 12 guiding principles, organized in a chronological versus priority sequence to aid researchers in searching, screening, and assessing the quality of various eHealth resources. Conclusions: The eHealth Resource Checklist will assist researchers in navigating the eHealth resource space by providing a mechanism to detail their process of developing inclusion criteria, identifying search location, selecting and reviewing evidence, extracting information, evaluating the quality of the evidence, and synthesizing the extracted evidence. The overarching goal of this checklist is to provide researchers or generalists new to the eHealth field with a tool that balances pragmatism with rigor and that helps standardize the process of searching and critiquing digital material—a particularly important aspect given the recent explosion of and reliance on eHealth resources. Moreover, this checklist may be useful to other researchers and practitioners developing similar health interventions. %M 34860681 %R 10.2196/27533 %U https://mhealth.jmir.org/2021/12/e27533 %U https://doi.org/10.2196/27533 %U http://www.ncbi.nlm.nih.gov/pubmed/34860681 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e15433 %T 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 %A Muro-Culebras,Antonio %A Escriche-Escuder,Adrian %A Martin-Martin,Jaime %A Roldán-Jiménez,Cristina %A De-Torres,Irene %A Ruiz-Muñoz,Maria %A Gonzalez-Sanchez,Manuel %A Mayoral-Cleries,Fermin %A Biró,Attila %A Tang,Wen %A Nikolova,Borjanka %A Salvatore,Alfredo %A Cuesta-Vargas,Antonio Ignacio %+ Grupo Clinimetría (F-14), University of Málaga, C/ Arquitecto Francisco Peñalosa 3, Málaga, 29071, Spain, 34 951952852, acuesta@uma.es %K mobile health %K mHealth %K eHealth %K mobile apps %K assessment %K rating %K smartphone %K questionnaire design %K mobile phone %D 2021 %7 1.12.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There 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. Objective: This 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. Methods: From 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. Results: The 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. Conclusions: The 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. %M 34855618 %R 10.2196/15433 %U https://mhealth.jmir.org/2021/12/e15433 %U https://doi.org/10.2196/15433 %U http://www.ncbi.nlm.nih.gov/pubmed/34855618 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e31985 %T Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis %A Cruz-Martínez,Roberto Rafael %A Wentzel,Jobke %A Bente,Britt Elise %A Sanderman,Robbert %A van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Cubicus Bldg, 10, De Zul, Enschede, 7522 NJ, Netherlands, 31 683186149, r.cruzmartinez@utwente.nl %K eHealth %K self-management %K self-care %K cardiovascular diseases %K value sensitive design %K values %K content analysis %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients’ fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients’ values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients’ values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. %M 34855608 %R 10.2196/31985 %U https://cardio.jmir.org/2021/2/e31985 %U https://doi.org/10.2196/31985 %U http://www.ncbi.nlm.nih.gov/pubmed/34855608 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e27037 %T Mobile Health Apps That Act as Surgical Preparatory Guides: App Store Search and Quality Evaluation %A Gadde,Naga Sindhura %A Yap,Kevin Yi-Lwern %+ Department of Pharmacy, Singapore General Hospital, SingHealth Tower, 10 Hospital Boulevard, Lobby A, Level 9, Singapore, 168582, Singapore, 65 63214366, kevin.yap.y.l@sgh.com.sg %K mHealth apps %K surgical apps %K surgery preparation %K operating room personnel %K quality assessment %K quality evaluation %K perioperative %K operative %K mobile health %K surgery %K post-operative %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Mobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides. Objective: The aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool. Methods: The quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: “surgical apps”, “surgical preferences”, “surgeon preferences”, “operating room”, and “perioperative procedures”. The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages. Results: A total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%). Conclusions: ScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices. %M 34851296 %R 10.2196/27037 %U https://periop.jmir.org/2021/2/e27037 %U https://doi.org/10.2196/27037 %U http://www.ncbi.nlm.nih.gov/pubmed/34851296 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27995 %T Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores %A Muñoz-Mancisidor,Aranzazu %A Martin-Payo,Ruben %A Gonzalez-Mendez,Xana %A Fernández-Álvarez,María Del Mar %+ Universidad de Oviedo, Calle Julián Clavería s/n, Campus del Cristo, Oviedo, 33006, Spain, 34 985 103 147, martinruben@uniovi.es %K pregnancy %K mobile apps %K behavior %K technology assessment, biomedical %K telemedicine %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women 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. Objective: The 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. Methods: A 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. Results: A 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). Conclusions: The 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. %M 34787587 %R 10.2196/27995 %U https://mhealth.jmir.org/2021/11/e27995 %U https://doi.org/10.2196/27995 %U http://www.ncbi.nlm.nih.gov/pubmed/34787587 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29207 %T Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study %A Alessa,Tourkiah %A Hawley,Mark %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 1726, talessa@KSU.EDU.SA %K app %K hypertension %K self-management %K mHealth %K blood pressure %K support %K Saudi Arabia %K cardiology %K heart %K effective %K security %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants’ attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users’ data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients’ and doctors’ discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. %M 34787586 %R 10.2196/29207 %U https://mhealth.jmir.org/2021/11/e29207 %U https://doi.org/10.2196/29207 %U http://www.ncbi.nlm.nih.gov/pubmed/34787586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28185 %T Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis %A Ang,Siew Min %A Chen,Juliana %A Liew,Jia Huan %A Johal,Jolyn %A Dan,Yock Young %A Allman-Farinelli,Margaret %A Lim,Su Lin %+ Department of Dietetics, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore, 65 67725166, siew_min_ang@nuhs.edu.sg %K systematic review %K meta-analysis %K mobile app %K obesity %K weight loss %K Asian %K diet %K physical activity %K adults %K mobile phone %D 2021 %7 16.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective: This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods: A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results: A total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=–0.26; 95% CI –0.41 to –0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=–0.28; 95% CI –0.47 to –0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions: More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration: PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6 %M 34783674 %R 10.2196/28185 %U https://www.jmir.org/2021/11/e28185 %U https://doi.org/10.2196/28185 %U http://www.ncbi.nlm.nih.gov/pubmed/34783674 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32093 %T Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis %A Lee,Bohee %A Ibrahim,Siti Aishah %A Zhang,Tiying %+ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 1316503034, bohee.lee@ed.ac.uk %K mobile apps %K applications %K eHealth %K mHealth %K mobile health %K digital health %K telemedicine %K telehealth %K COVID-19 %K coronavirus %K pandemic %K public health %K health policy %D 2021 %7 11.11.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. %M 34748515 %R 10.2196/32093 %U https://mhealth.jmir.org/2021/11/e32093 %U https://doi.org/10.2196/32093 %U http://www.ncbi.nlm.nih.gov/pubmed/34748515 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31170 %T Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis %A Eisenstadt,Mia %A Liverpool,Shaun %A Infanti,Elisa %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 7989165986, mia.eisenstadt@annafreud.org %K systematic review %K MHapp, mHealth %K mental health %K well-being %K emotion regulation %K mobile apps %K effectiveness %K monitoring %K management %K mental health app %D 2021 %7 8.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. %M 34747713 %R 10.2196/31170 %U https://mental.jmir.org/2021/11/e31170 %U https://doi.org/10.2196/31170 %U http://www.ncbi.nlm.nih.gov/pubmed/34747713 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e30674 %T 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 %A Diaz-Skeete,Yohanca Maria %A McQuaid,David %A Akinosun,Adewale Samuel %A Ekerete,Idongesit %A Carragher,Natacha %A Carragher,Lucia %+ NetwellCASALA Advanced Research Centre, Dundalk Institute of Technology, Dublin Road, Marshes Upper, Dundalk, A91 K584, Ireland, 353 429370497 ext 2592, yohanca.diaz@dkit.ie %K mobile app %K mHealth %K medication app %K heart failure %K Mobile App Rating Scale %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Managing 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. Objective: The 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. Methods: A 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. Results: Google 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. Conclusions: The 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. %M 34726613 %R 10.2196/30674 %U https://mhealth.jmir.org/2021/11/e30674 %U https://doi.org/10.2196/30674 %U http://www.ncbi.nlm.nih.gov/pubmed/34726613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29441 %T Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan %A Benoit,James %A Hartling,Lisa %A Chan,Michelle %A Scott,Shannon %+ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K internet %K mHealth %K mobile health %K digital health %K ehealth %K app %K mobile application %K Android %K Apple %K marketplace %K environmental scan %K review %K acute childhood illness %K knowledge translation %K child %K parent %K caregiver %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing 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.  Objective: The 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. Methods: We 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. Results: Overall, 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. Conclusions: There 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. %M 34665144 %R 10.2196/29441 %U https://www.jmir.org/2021/10/e29441 %U https://doi.org/10.2196/29441 %U http://www.ncbi.nlm.nih.gov/pubmed/34665144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25667 %T Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features %A Frid,Gabriela %A Bogaert,Kelly %A Chen,Katherine T %+ Icahn School of Medicine at Mount Sinai, 1 Gustace L. Levy Pl, New York, NY, 10029, United States, 1 3478664514, gabriela.frid@icahn.mssm.edu %K app %K app store %K mHealth %K mobile health %K prenatal %K pregnancy %K women's health %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women’s health–related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women’s satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term “pregnancy app.” After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps. %M 34524100 %R 10.2196/25667 %U https://www.jmir.org/2021/10/e25667 %U https://doi.org/10.2196/25667 %U http://www.ncbi.nlm.nih.gov/pubmed/34524100 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30404 %T Characteristics and Quality of Mobile Apps Containing Prenatal Genetic Testing Information: Systematic App Store Search and Assessment %A Wu,Ko-Lin %A Alegria,Rebeca %A Gonzalez,Jazzlyn %A Hu,Harrison %A Wang,Haocen %A Page,Robin %A Robbins-Furman,Patricia %A Ma,Ping %A Tseng,Tung-Sung %A Chen,Lei-Shih %+ Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77840, United States, 1 979 862 2912, lacechen@tamu.edu %K mobile applications %K prenatal genetic testing %K pregnancy %K review %K evaluation %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward. %M 34647898 %R 10.2196/30404 %U https://mhealth.jmir.org/2021/10/e30404 %U https://doi.org/10.2196/30404 %U http://www.ncbi.nlm.nih.gov/pubmed/34647898 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26712 %T The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features %A Balaskas,Andreas %A Schueller,Stephen M %A Cox,Anna L %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin, Ireland, 353 01 8963858, Gavin.Doherty@tcd.ie %K mental health %K cognitive behavioral therapy %K mobile apps %K anxiety %K stress %K mHealth %K mobile phone %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. Objective: The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. Methods: A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. Results: Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. Conclusions: Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content. %M 34612833 %R 10.2196/26712 %U https://mhealth.jmir.org/2021/10/e26712 %U https://doi.org/10.2196/26712 %U http://www.ncbi.nlm.nih.gov/pubmed/34612833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27093 %T Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study %A Marengo,Davide %A Sariyska,Rayna %A Schmitt,Helena Sophia %A Messner,Eva-Maria %A Baumeister,Harald %A Brand,Matthias %A Kannen,Christopher %A Montag,Christian %+ Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, Ulm, 89081, Germany, 49 07315026550, christian.montag@uni-ulm.de %K smartphone use disorder %K smartphone use %K social media %K objective measures %K mediation model %K smartphone %K web-based communication %K social networking %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. %M 34591025 %R 10.2196/27093 %U https://www.jmir.org/2021/9/e27093 %U https://doi.org/10.2196/27093 %U http://www.ncbi.nlm.nih.gov/pubmed/34591025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29412 %T Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review %A Teepe,Gisbert W %A Da Fonseca,Ashish %A Kleim,Birgit %A Jacobson,Nicholas C %A Salamanca Sanabria,Alicia %A Tudor Car,Lorainne %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 76 419 09 91, gteepe@ethz.ch %K depression %K digital mental health %K smartphone applications %K just-in-time adaptive interventions %K effectiveness %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual’s burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. Objective: The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. Methods: We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app’s website, information on the app’s website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. Results: None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. Conclusions: Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps. %M 34309569 %R 10.2196/29412 %U https://www.jmir.org/2021/9/e29412 %U https://doi.org/10.2196/29412 %U http://www.ncbi.nlm.nih.gov/pubmed/34309569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26603 %T Psychoeducational Social Anxiety Mobile Apps: Systematic Search in App Stores, Content Analysis, and Evaluation %A Hammond,Trent Ernest %A Lampe,Lisa %A Campbell,Andrew %A Perisic,Steve %A Brakoulias,Vlasios %+ Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, 62 Derby Street, Kingswood, New South Wales, 2747, Australia, 61 431931448, trent.hammond@sydney.edu.au %K anxiety %K app %K cell phone %K mobile app %K mobile phone %K SAD %K smartphone %K social anxiety %K social phobia %K tablet %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps. %M 34546179 %R 10.2196/26603 %U https://mhealth.jmir.org/2021/9/e26603 %U https://doi.org/10.2196/26603 %U http://www.ncbi.nlm.nih.gov/pubmed/34546179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27162 %T Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial %A Schwaninger,Philipp %A Berli,Corina %A Scholz,Urte %A Lüscher,Janina %+ Applied Social and Health Psychology, Department of Psychology, University of Zurich, Binzmühlestrasse 14/14, Zurich, 8050, Switzerland, 41 44 635 72 25, philipp.schwaninger@psychologie.uzh.ch %K mHealth %K smartphone app %K smoking cessation %K buddy %K social support %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective: The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods: A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results: A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions: Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration: ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7723-z %M 34499045 %R 10.2196/27162 %U https://www.jmir.org/2021/9/e27162 %U https://doi.org/10.2196/27162 %U http://www.ncbi.nlm.nih.gov/pubmed/34499045 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 3 %P e17431 %T Health Internet Technology for Chronic Conditions: Review of Diabetes Management Apps %A Sneha,Sweta %A Thalla,Srivarun %A Rischie,Ishaan %A Shahriar,Hossain %+ Kennesaw State University, 560 Parliament Garden Way, Kennesaw, GA, 30144, United States, 1 770 853 0661, ssneha@kennesaw.edu %K chronic disease %K diabetes %K blood glucose %K diabetes management %K mHealth disease apps %K diabetes apps %K best Apple diabetes apps %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Mobile health (mHealth) smartphone apps have shown promise in the self-management of chronic disease. In today’s oversaturated health app market, selection criteria that consumers are employing to choose mHealth apps for disease self-management are of paramount importance. App quality is critical in monitoring disease controls but is often linked to consumer popularity rather than clinical recommendations of effectiveness in disease management. Management of key disease variances can be performed through these apps to increase patient engagement in disease self-management. This paper provides a comprehensive review of features found in mHealth apps frequently used in the self- management of diabetes. Objective: The purpose of this study was to review features of frequently used and high consumer-rated mHealth apps used in the self-management of diabetes. This study aimed to highlight key features of consumer-favored mHealth apps used in the self-management of diabetes. Methods: A 2-fold approach was adopted involving the Apple iOS store and the Google search engine. The primary search was conducted on the Apple iOS store using the term “diabetes apps” (device used: Apple iPad). The top 5 most frequently used mHealth apps were identified and rated by the number of consumer reviews, app ratings, and the presence of key diabetes management features, such as dietary blood glucose, A1C, insulin, physical activity, and prescription medication. A subsequent Google search was conducted using the search term “best Apple diabetes apps.” The top 3 search results—“Healthline,” “Everyday Health,” and “Diabetes Apps–American Diabetes Association”—were explored. Results: In total, 12 mHealth apps were reviewed due to their appearing across 4 evaluated sources. Only 1 health app—Glucose Buddy Diabetes Tracker—appeared as the most frequently used within the Apple iOS store and across the other 3 sources. The OneTouch Reveal app ranked first on the list in the iOS store with 39,000 consumer reviews and a rating of 4.7 out of 5.0 stars but only appeared in 1 of the other 3 sources. Blood glucose tracking was present across all apps, but other disease management features varied in type with at least 3 of the 5 key features being present across the 12 reviewed apps. Subscription cost and integration needs were present in the apps which could impact consumers’ decision to select apps. Although mobile app preference was assessed and defined by the number of consumer reviews and star ratings, there were no scientific standards used in the selection and ranking of the health apps within this study. Conclusions: mHealth apps have shown promise in chronic disease management, but a surge in development of these nonregulated health solutions points to a need for regulation, standardization, and quality control. A governing body of health IT professionals, clinicians, policymakers, payors, and patients could be beneficial in defining health app standards for effective chronic disease management. Variabilities in features, cost, and other aspects of management could be reduced by regulatory uniformity, which would increase patient engagement and improve disease outcomes. %M 34463627 %R 10.2196/17431 %U https://diabetes.jmir.org/2021/3/e17431 %U https://doi.org/10.2196/17431 %U http://www.ncbi.nlm.nih.gov/pubmed/34463627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29151 %T Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores %A Brunelli,Laura %A De Vita,Chiara %A Cenedese,Fabrizio %A Cinello,Michela %A Paris,Marta %A Samogizio,Francesca %A Starec,Anja %A Bava,Michele %A Dal Cin,Margherita %A Zanchiello,Sara %A Stampalija,Tamara %+ Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria, 65, Trieste, 34137, Italy, 39 0432554768, laura.brunelli@phd.units.it %K pregnancy %K postnatal care %K app %K mHealth %K mobile health %K newborn %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children’s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health–related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. %M 34383668 %R 10.2196/29151 %U https://www.jmir.org/2021/8/e29151 %U https://doi.org/10.2196/29151 %U http://www.ncbi.nlm.nih.gov/pubmed/34383668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27619 %T Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence %A Martinengo,Laura %A Stona,Anne-Claire %A Griva,Konstadina %A Dazzan,Paola %A Pariante,Carmine Maria %A von Wangenheim,Florian %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, Singapore, 65 6904 7005, josip.car@ntu.edu.sg %K cognitive behavioral therapy %K CBT %K depression %K mobile applications %K apps %K telemedicine %K mHealth %K self-guided CBT-based apps %K self-management %K mobile phone %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. Objective: This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. Methods: We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. Results: The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19–related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. Conclusions: Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users’ data security. %M 34328431 %R 10.2196/27619 %U https://www.jmir.org/2021/7/e27619 %U https://doi.org/10.2196/27619 %U http://www.ncbi.nlm.nih.gov/pubmed/34328431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25437 %T Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis %A Fijačko,Nino %A Masterson Creber,Ruth %A Gosak,Lucija %A Štiglic,Gregor %A Egan,Dominic %A Chaka,Brian %A Debeljak,Nika %A Strnad,Matej %A Skok,Pavel %+ Faculty of Health Sciences, University of Maribor, Žitna 15, Maribor, 2000, Slovenia, 386 23004764, nino.fijacko@um.si %K cardiopulmonary resuscitation %K basic life support %K mobile learning %K mobile phone %K gamification %K schoolchildren %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable. Objective: This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children. Methods: We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps’ BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy. Results: Of the 1207 potentially relevant apps, only 6 (0.49%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95% CI 3.0-3.4) and 47.1/100 points (95% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs. Conclusions: Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills. %M 34283034 %R 10.2196/25437 %U https://mhealth.jmir.org/2021/7/e25437 %U https://doi.org/10.2196/25437 %U http://www.ncbi.nlm.nih.gov/pubmed/34283034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e29689 %T Popular Evidence-Based Commercial Mental Health Apps: Analysis of Engagement, Functionality, Aesthetics, and Information Quality %A Lau,Nancy %A O'Daffer,Alison %A Yi-Frazier,Joyce P %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mobile health %K mental health %K behavioral health %K user-centered design %K evidence-based health management %K smartphones %K mobile phones %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There 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. Objective: The 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. Methods: We 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. Results: The 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). Conclusions: In 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. %M 34259639 %R 10.2196/29689 %U https://mhealth.jmir.org/2021/7/e29689 %U https://doi.org/10.2196/29689 %U http://www.ncbi.nlm.nih.gov/pubmed/34259639 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27234 %T Evaluating Chinese Mobile Health Apps for Ankylosing Spondylitis Management: Systematic App Search %A Song,Yuqing %A Chen,Hong %+ West China School of Nursing/West China Hospital, Sichuan University, No 37, Guoxuexiang, Wuhou District, Chengdu, 610041, China, 86 18980601733, 1366109878@qq.com %K ankylosing spondylitis %K app %K eHealth %K mHealth %K smartphone %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with ankylosing spondylitis (AS), a chronic systematic inflammatory disease, require long-term treatment and management. Mobile health (mHealth) apps can deliver health services through mobile devices, facilitate long-term disease management, support patient–health care provider communication, and enable patients to engage in disease management. There are some apps targeted at patients with AS, but the feature and quality of these apps have not been systematically examined. Objective: The aim of this study was to identify existing, publicly available Chinese mHealth apps for AS management and to evaluate their features and quality. Methods: We systematically searched potential apps for AS management on the Apple and Huawei App Stores, using 4 search terms: ankylosing spondylitis, spondyloarthritis, rheumatic disease, and arthritis. Apps were included if they were in the Chinese language, targeted at patients with AS, could be downloaded and run on Android and/or iOS operating systems, and incorporated elements of disease management and/or patient education. We excluded apps that were not for patient use, not relevant to AS, or had not been updated since 2018. Apps that met the inclusion criteria were downloaded for final analysis. We formulated a list of app quality measures from and consistent with international guidelines for mHealth apps and AS management to evaluate the features and quality of the included app. The user version of the Mobile App Rating Scale (uMARS) was also used to rate the apps’ quality. Results: Of the 354 apps screened, 5 met the inclusion criteria and were included in our analysis. All apps were free, and most apps (4/5, 80%) had a privacy policy. Of the 5 apps, 1 (20%) involved medical professionals in the development process, 2 (40%) were developed by companies, and 2 (40%) were developed by medical institutions. All apps provided educational information about AS. Around half of the apps had functions like a basic information record (ie, users can input gender, age, disease history, etc) (n=3, 60%), patient–health care provider (and patient-patient) communication (n=2, 40%), symptom tracking (n=2, 40%), and information sharing (n=3, 60%). Only 1 (20%) app provided comprehensive functions that adhered to international guidelines for AS management and mHealth apps. The overall uMARS scores ranged from 2.7 to 4.2; only 1 app, with an overall uMARS score of 4.2, was considered as a high-quality app. Conclusions: Most apps lacked comprehensive functions for AS management. One high-quality app provided comprehensive functions to help patients manage their conditions. This study assessed and summarized the features and quality of the apps but did not evaluate their efficacy. Future studies should evaluate the feasibility and efficacy of these apps. International guidelines and regulations for the design, development, validation, and implementation of mHealth apps are needed in the future. Meanwhile, health care providers, patients with AS, and app developers should collaborate to develop high-quality, evidence-based apps that take into account patients’ needs and health care professionals’ perspectives. %M 34259644 %R 10.2196/27234 %U https://mhealth.jmir.org/2021/7/e27234 %U https://doi.org/10.2196/27234 %U http://www.ncbi.nlm.nih.gov/pubmed/34259644 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27018 %T User Engagement and Usability of Suicide Prevention Apps: Systematic Search in App Stores and Content Analysis %A Wilks,Chelsey R %A Chu,Carol %A Sim,DongGun %A Lovell,Josh %A Gutierrez,Peter %A Joiner,Thomas %A Kessler,Ronald C %A Nock,Matthew K %+ Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Way, St Louis, MO, 63121, United States, 1 (314) 516 5383, chelseywilks@umsl.edu %K suicide %K mHealth %K usability %K engagement %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: People with suicidal thoughts are more inclined to seek technology-delivered interventions than in-person forms of treatment, making mobile apps for suicide prevention an ideal platform for treatment delivery. This review examines apps designed for suicide prevention, with a specific focus on user engagement. Objective: This study aims to update the literature and broadly evaluate the landscape of mobile health apps for suicide prevention; examine apps with key features and primary approaches to suicide prevention; and systematically evaluate the engagement, functionality, aesthetics, and information of the apps. Methods: All apps related to suicidal thoughts and behaviors were identified in the Google Play and iOS app stores and were systematically reviewed for their content and quality. The mobile app rating scale (MARS) was used to evaluate app usability and engagement. Results: Of the 66 apps identified, 42 (64%) were specifically designed for people with suicidal ideation, and 59 (89%) had at least one best practice feature for suicide risk reduction. The mean overall MARS score of all apps was 3.5 (range 2.1-4.5), with 83% (55/66) of apps having a minimum acceptability score of 3. The total MARS score was not associated with the user app rating (r=−0.001; P=.99) or the number of features (r=0.24; P=.09). Conclusions: This study identified many usable and engaging apps in app stores designed for suicide prevention. However, there are only limited apps for clinicians. Thus, mobile apps for suicide prevention should be carefully developed and clinically evaluated. %M 34259163 %R 10.2196/27018 %U https://formative.jmir.org/2021/7/e27018 %U https://doi.org/10.2196/27018 %U http://www.ncbi.nlm.nih.gov/pubmed/34259163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25151 %T Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study %A Maharaj,Alita %A Lim,David %A Murphy,Rinki %A Serlachius,Anna %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 3073, a.serlachius@auckland.ac.nz %K type 2 diabetes %K mobile apps %K diabetes %K self-management %K user engagement %K app %K mHealth %K randomized controlled trial %K intervention %K efficacy %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. Objective: We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. Methods: Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. Results: In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. Conclusions: Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671 %M 34132640 %R 10.2196/25151 %U https://formative.jmir.org/2021/6/e25151 %U https://doi.org/10.2196/25151 %U http://www.ncbi.nlm.nih.gov/pubmed/34132640 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e26262 %T Mobile Apps for Drug–Drug Interaction Checks in Chinese App Stores: Systematic Review and Content Analysis %A Shen,Chunying %A Jiang,Bin %A Yang,Qilian %A Wang,Chengnan %A Lu,Kevin Z %A Gu,Meng %A Yuan,Jing %+ Department of Pharmacy, Minhang Hospital, Fudan University, 826 Zhangheng Rd, Shanghai, 201203, China, 86 215 1980025, jyuan@fudan.edu.cn %K drug interaction %K MARS %K app %K drug safety %K drugs %K mHealth %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As a computerized drug–drug interaction (DDI) alert system has not been widely implemented in China, health care providers are relying on mobile health (mHealth) apps as references for checking drug information, including DDIs. Objective: The main objective of this study was to evaluate the quality and content of mHealth apps supporting DDI checking in Chinese app stores. Methods: A systematic review was carried out in November 2020 to identify mHealth apps providing DDI checking in both Chinese iOS and Android platforms. We extracted the apps’ general information (including the developer, operating system, costs, release date, size, number of downloads, and average rating), scientific or clinical basis, and accountability, based on a multidimensional framework for evaluation of apps. The quality of mHealth apps was evaluated by using the Mobile App Rating Scale (MARS). Descriptive statistics, including numbers and percentages, were calculated to describe the characteristics of the apps. For each app selected for evaluation, the section-specific MARS scores were calculated by taking the arithmetic mean, while the overall MARS score was described as the arithmetic mean of the section scores. In addition, the Cohen kappa (κ) statistic was used to evaluate the interrater agreement. Results: A total of 7 apps met the selection criteria, and only 3 included citations. The average rating score for Android apps was 3.5, with a minimum of 1.0 and a maximum of 4.9, while the average rating score for iOS apps was 4.7, with a minimum of 4.2 and a maximum of 4.9. The mean MARS score was 3.69 out of 5 (95% CI 3.34-4.04), with the lowest score of 1.96 for Medication Guidelines and the highest score of 4.27 for MCDEX mobile. The greatest variation was observed in the information section, which ranged from 1.41 to 4.60. The functionality section showed the highest mean score of 4.05 (95% CI 3.71-4.40), whereas the engagement section resulted in the lowest average score of 3.16 (95% CI 2.81-3.51). For the information quality section, which was the focus of this analysis, the average score was 3.42, with the MCDEX mobile app having the highest score of 4.6 and the Medication Guidelines app having the lowest score of 1.9. For the overall MARS score, the Cohen interrater κ was 0.354 (95% CI 0.236-0.473), the Fleiss κ was 0.353 (95% CI, 0.234-0.472), and the Krippendorff α was 0.356 (95% CI 0.237-0.475). Conclusions: This study systematically reviewed the mHealth apps in China with a DDI check feature. The majority of investigated apps demonstrated high quality with accurate and comprehensive information on DDIs. However, a few of the apps that had a massive number of downloads in the Chinese market provided incorrect information. Given these apps might be used by health care providers for checking potential DDIs, this creates a substantial threat to patient safety. %M 33962910 %R 10.2196/26262 %U https://mhealth.jmir.org/2021/6/e26262 %U https://doi.org/10.2196/26262 %U http://www.ncbi.nlm.nih.gov/pubmed/33962910 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e23250 %T State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review %A Kolasa,Katarzyna %A Mazzi,Francesca %A Leszczuk-Czubkowska,Ewa %A Zrubka,Zsombor %A Péntek,Márta %+ Division of Health Economics and Healthcare Management, Kozminski University, 57/59 Jagiellonska St, Warsaw, 03-301, Poland, 48 22 519 21 00, kkolasa@kozminski.edu.pl %K COVID-19 %K contact tracing app %K data accessibility %K data privacy %K mobile app %K digital health %K digital contact tracing %D 2021 %7 10.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. Objective: The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. Methods: A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps’ compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. Results: Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. Conclusions: Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized. %M 34033581 %R 10.2196/23250 %U https://mhealth.jmir.org/2021/6/e23250 %U https://doi.org/10.2196/23250 %U http://www.ncbi.nlm.nih.gov/pubmed/34033581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27102 %T Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review %A Osmanlliu,Esli %A Rafie,Edmond %A Bédard,Sylvain %A Paquette,Jesseca %A Gore,Genevieve %A Pomey,Marie-Pascale %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, MUHC Glen Site, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 514 412 4499, esli.osmanlliu@mcgill.ca %K COVID-19 %K contact tracing %K exposure notification %K app %K design %K implementation %K participatory %K eHealth %K surveillance %K monitoring %K review %D 2021 %7 9.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps. %M 34038376 %R 10.2196/27102 %U https://mhealth.jmir.org/2021/6/e27102 %U https://doi.org/10.2196/27102 %U http://www.ncbi.nlm.nih.gov/pubmed/34038376 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e22587 %T Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis %A Paganini,Sarah %A Terhorst,Yannik %A Sander,Lasse Bosse %A Catic,Selma %A Balci,Sümeyye %A Küchler,Ann-Marie %A Schultchen,Dana %A Plaumann,Katrin %A Sturmbauer,Sarah %A Krämer,Lena Violetta %A Lin,Jiaxi %A Wurst,Ramona %A Pryss,Rüdiger %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str 16, Ulm, 89081, Germany, 49 7315032802, eva-maria.messner@uni-ulm.de %K sports %K exercise %K mobile apps %K mHealth %K quality indicators %K systematic review %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers. Objective: This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed. Methods: A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps. Results: Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not. Conclusions: Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers. %M 34106073 %R 10.2196/22587 %U https://mhealth.jmir.org/2021/6/e22587 %U https://doi.org/10.2196/22587 %U http://www.ncbi.nlm.nih.gov/pubmed/34106073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27105 %T Goldilocks and the Three Bears: A Just-Right Hybrid Model to Synthesize the Growing Landscape of Publicly Available Health-Related Mobile Apps %A Lau,Nancy %A O'Daffer,Alison %A Yi-Frazier,Joyce %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 0569, nancy.lau@seattlechildrens.org %K telemedicine %K smartphone %K mobile phones %K mHealth %K mobile apps %K health services %D 2021 %7 7.6.2021 %9 Viewpoint %J J Med Internet Res %G English %X Mobile health (mHealth) technologies have provided an innovative platform for the deployment of health care diagnostics, symptom monitoring, and prevention and intervention programs. Such health-related smartphone apps are universally accepted by patients and providers with over 50 million users worldwide. Despite the rise in popularity and accessibility among consumers, the evidence base in support of health-related apps has fallen well behind the rapid pace of industry development. To bridge this evidence gap, researchers are beginning to consider how to best apply evidence-based research standards to the systematic synthesis of the mHealth consumer market. In this viewpoint, we argue for the adoption of a “hybrid model” that combines a traditional systematic review with a systematic search of mobile app download platforms for health sciences researchers interested in synthesizing the state of the science of consumer apps. This approach, which we have successfully executed in a recent review, maximizes the benefits of traditional and novel approaches to address the essential question of whether popular consumer mHealth apps work. %M 34096868 %R 10.2196/27105 %U https://www.jmir.org/2021/6/e27105 %U https://doi.org/10.2196/27105 %U http://www.ncbi.nlm.nih.gov/pubmed/34096868 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22489 %T Self-Management Apps for People With Epilepsy: Systematic Analysis %A Alzamanan,Mohsen Zaied %A Lim,Kheng-Seang %A Akmar Ismail,Maizatul %A Abdul Ghani,Norjihan %+ Department of Information Systems, Faculty of Computer Science and Information Technology, University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia, 60 133476676, maizatul@um.edu.my %K mobile health %K epilepsy %K self-management %K smartphone %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with epilepsy (PWEs) are motivated to manage and cope with their disorder themselves (ie, self-management [SM] is encouraged). Mobile health (mHealth) apps have multiple features that have a huge potential to improve SM of individuals with chronic disorders such as epilepsy. Objective: This study aimed to review all freely available apps related to the SM of PWEs and to determine the SM domains covered in these apps. Methods: We performed a search of apps on Google Play and App Store using the keywords “epilepsy” or “seizures” from May to August 2018. Apps were included if they were free and in English language. We excluded apps with installation-related issues and not related to epilepsy self-management (eSM). Results: A total of 22 eSM apps were identified in our search: 6 of these run only on iOS, 7 only on Android, and 9 run on both operating systems. Of the 11 domains of SM, seizure tracking and seizure response features were covered by most apps (n=22 and n=19, respectively), followed by treatment management (n=17) and medication adherence (n=15). Three apps (Epilepsy Journal, Epilepsy Tool Kit, and EpiDiary) were installed more than 10,000 times, with features focused specifically on a few domains (treatment management, medication adherence, health care communication, and seizure tracking). Two apps (Young Epilepsy and E-Epilepsy Inclusion) covered more than 6 SM domains but both had lower installation rates (5000+ and 100+, respectively). Conclusions: Both Android and iOS mHealth apps are available to improve SM in epilepsy, but the installation rate of most apps remains low. The SM features of these apps were different from one another, making it difficult to recommend a single app that completely fulfills the needs of PWEs. The common features of the apps evaluated included seizure tracking and seizure response. To improve the efficacy and availability of these apps, we propose the following: (1) involve the stakeholders, such as physicians, pharmacists, and PWEs, during the development of mHealth apps; (2) assess the efficacy and acceptance of the apps objectively by performing a usability analysis; and (3) promote the apps so that they benefit more PWEs. %M 34047709 %R 10.2196/22489 %U https://mhealth.jmir.org/2021/5/e22489 %U https://doi.org/10.2196/22489 %U http://www.ncbi.nlm.nih.gov/pubmed/34047709 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e24907 %T Effective German and English Language mHealth Apps for Self-management of Bronchial Asthma in Children and Adolescents: Comparison Study %A Franzmair,Julian %A Diesner-Treiber,Susanne C %A Voitl,Julian J M %A Voitl,Peter %+ First Vienna Pediatric Medical Center, Donau-City-Strasse 1, Vienna, 1220, Austria, 43 1 263 7979, peter.voitl@kinderarzt.at %K asthma %K apps %K mobile health %K self-management %K recommended apps %K German %K English %K mobile phone %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps hold great potential for asthma self-management. Data on the suitability of asthma apps intended for children are insufficient, and the availability of German language apps is still inadequate compared with English language apps. Objective: This study aims to identify functional asthma apps for children in German and to compare them with English language apps. In line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Google Play Store and Apple App Store are systematically searched to preselect the most efficient apps, which are then compared according to a self-compiled criteria catalog. Methods: Both app stores were screened for the term asthma. Following a PRISMA preselection process, the apps that met the inclusion criteria (ie, available free of charge, German or English language, and suitable for children) were rated by 3 independent persons following a criteria catalog consisting of 9 categories, some conceived for this purpose (availability, child-friendly, learning factor, and range of functions) and some adopted from existing validated catalogs (functionality and design, ease of use, potential for improving asthma self-management, fun factor and incentives, and information management and medical accuracy). The highest rated apps in German and English were compared. Results: A total of 403 apps were identified on the Google Play Store and the Apple App Store. Finally, 24 apps that met the inclusion criteria were analyzed. In the first step of the quality assessment, only 4 available German language asthma apps were compared with 20 English language asthma apps. The 4 German language apps were then compared with the 4 highest rated English language apps. All selected apps, independent of the language, were comparable in the following categories: availability, functionality and design, ease of use, and information management and medical accuracy. The English language apps scored significantly higher in the following categories: potential for improving self-management, child-friendly, fun factor, learning factor, and range of function. English language apps (mean total points 34.164, SD 1.09) performed significantly better than German language asthma apps (mean total points 22.91, SD 2.898; P=.003). The best rated English language app was Kiss my asthma (36/42 points), whereas the best rated German language app Kata achieved only 27.33 points. Conclusions: The recommended English language apps are Kiss my asthma, AsthmaXcel, AsthmaAustralia, and Ask Me, AsthMe!, whereas the only recommended German language app is Kata. The use of apps plays an increasingly important role in patients’ lives and in the medical field, making mHealth a staple in the future of asthma treatment plans. Although validated recommendations on rating mHealth apps have been published, it remains a challenging task for physicians and patients to choose a suitable app for each case, especially in non–English-speaking countries. %M 34009134 %R 10.2196/24907 %U https://mhealth.jmir.org/2021/5/e24907 %U https://doi.org/10.2196/24907 %U http://www.ncbi.nlm.nih.gov/pubmed/34009134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26082 %T Behavior Change Techniques in Popular Mobile Apps for Smoking Cessation in France: Content Analysis %A Bustamante,Luz Adriana %A Gill Ménard,Cédric %A Julien,Sabrina %A Romo,Lucia %+ Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, 200, Avenue de la Republique, Nanterre, Ile-de-France, 92000, France, 33 783192547, adriana.bustamante93@gmail.com %K smartphone app %K smoking cessation %K mHealth %K app quality %K user engagement %K behavior change technique taxonomy %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The mobile app market differs from country to country, and to date, no previous review of the content quality of smoking cessation apps has been conducted in France. Objective: This study aimed to examine the general quality of the most popular smoking cessation apps in France and also determine the degree to which apps adhere to established behavioral and cognitive techniques (BCTs) proven effective in clinical practice. Methods: A systematic research of smoking cessation apps was conducted in both the Google Play Store and Apple Store in the French market. The general quality of popular apps was rated with the Mobile App Rating Scale (MARS), and the therapeutic quality was assessed with the ratio of adherence of the behavior change technique taxonomy for smoking cessation treatment. Results: A total of 14 mobile apps met all the inclusion criteria of the content analysis. The interrater reliability varied from “substantial” (0.79) to “almost perfect” (0.9) for the two measures. The mean MARS score was 3.5 out of 5 (median 3.6, IQR 0.6 [3.2-3.8]). The findings suggest that popular apps focus primarily on the functionality dimension of the MARS scale (4.2/5). The mean number of BCTs was 22, with a large difference between apps (minimum 4, maximum 38). At least half of the apps addressed motivation (8.8/14, 63%) and advised on using behavioral skills in order to quit smoking or stay a nonsmoker (8.7/14, 62%). However, only a handful of apps gathered important information (5.9/14, 42%) in order to deliver proper advice regarding the use of approved medication or the implementation of behavioral techniques (4.3/14, 31%). The mean MARS score was positively correlated with the price (r=0.70, P=.007) and the number of BCTs used (r=0.67, P=.01). User rating was not correlated with any quality scale (P=.67). Conclusions: The content quality of popular smoking cessation apps in France varied by app type and price. Most popular apps propose in general good quality content but lack implementation of evidence-based BCTs associated with effectiveness on smoking cessation treatment. Further research is needed to evaluate the improvement in the content quality of smoking cessation apps in France. %M 33983130 %R 10.2196/26082 %U https://mhealth.jmir.org/2021/5/e26082 %U https://doi.org/10.2196/26082 %U http://www.ncbi.nlm.nih.gov/pubmed/33983130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22990 %T Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement %A Mauch,Chelsea E %A Laws,Rachel A %A Prichard,Ivanka %A Maeder,Anthony J %A Wycherley,Thomas P %A Golley,Rebecca K %+ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 8 83038988, chelsea.mauch@csiro.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. %M 33960951 %R 10.2196/22990 %U https://mhealth.jmir.org/2021/5/e22990 %U https://doi.org/10.2196/22990 %U http://www.ncbi.nlm.nih.gov/pubmed/33960951 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25377 %T Measuring the Quality of Clinical Skills Mobile Apps for Student Learning: Systematic Search, Analysis, and Comparison of Two Measurement Scales %A Gladman,Tehmina %A Tylee,Grace %A Gallagher,Steve %A Mair,Jonathan %A Grainger,Rebecca %+ Education Unit, University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand, 64 04 918 6749, tehmina.gladman@otago.ac.nz %K mobile apps %K MARS %K MARuL %K medical education %K app review %K mobile phone %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are widely used in health professions, which increases the need for simple methods to determine the quality of apps. In particular, teachers need the ability to curate high-quality mobile apps for student learning. Objective: This study aims to systematically search for and evaluate the quality of clinical skills mobile apps as learning tools. The quality of apps meeting the specified criteria was evaluated using two measures—the widely used Mobile App Rating Scale (MARS), which measures general app quality, and the Mobile App Rubric for Learning (MARuL), a recently developed instrument that measures the value of apps for student learning—to assess whether MARuL is more effective than MARS in identifying high-quality apps for learning. Methods: Two mobile app stores were systematically searched using clinical skills terms commonly found in medical education and apps meeting the criteria identified using an approach based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 9 apps were identified during the screening process. The apps were rated independently by 2 reviewers using MARS and MARuL. Results: The intraclass correlation coefficients (ICCs) for the 2 raters using MARS and MARuL were the same (MARS ICC [two-way]=0.68; P<.001 and MARuL ICC [two-way]=0.68; P<.001). Of the 9 apps, Geeky Medics-OSCE revision (MARS Android=3.74; MARS iOS=3.68; MARuL Android=75; and MARuL iOS=73) and OSCE PASS: Medical Revision (MARS Android=3.79; MARS iOS=3.71; MARuL Android=69; and MARuL iOS=73) scored highly on both measures of app quality and for both Android and iOS. Both measures also showed agreement for the lowest rated app, Patient Education Institute (MARS Android=2.21; MARS iOS=2.11; MARuL Android=18; and MARuL iOS=21.5), which had the lowest scores in all categories except information (MARS) and professional (MARuL) in both operating systems. MARS and MARuL were both able to differentiate between the highest and lowest quality apps; however, MARuL was better able to differentiate apps based on teaching and learning quality. Conclusions: This systematic search and rating of clinical skills apps for learning found that the quality of apps was highly variable. However, 2 apps—Geeky Medics-OSCE revision and OSCE PASS: Medical Revision—rated highly for both versions and with both quality measures. MARS and MARuL showed similar abilities to differentiate the quality of the 9 apps. However, MARuL’s incorporation of teaching and learning elements as part of a multidimensional measure of quality may make it more appropriate for use with apps focused on teaching and learning, whereas MARS’s more general rating of quality may be more appropriate for health apps targeting a general health audience. Ratings of the 9 apps by both measures also highlighted the variable quality of clinical skills mobile apps for learning. %M 33890859 %R 10.2196/25377 %U https://mhealth.jmir.org/2021/4/e25377 %U https://doi.org/10.2196/25377 %U http://www.ncbi.nlm.nih.gov/pubmed/33890859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25160 %T User Perspectives of Diet-Tracking Apps: Reviews Content Analysis and Topic Modeling %A Zečević,Mila %A Mijatović,Dejan %A Kos Koklič,Mateja %A Žabkar,Vesna %A Gidaković,Petar %+ School of Economics and Business, University of Ljubljana, Kardeljeva ploscad 17, Ljubljana, 1000, Slovenia, 386 15892429, mila.zecevic@ef.uni-lj.si %K diet-tracking apps %K mobile apps %K user reviews %K topic modeling %K n-grams %K mHealth %K nutrition %K diet %K well-being %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability and use of mobile apps in health and nutrition management are increasing. Ease of access and user friendliness make diet-tracking apps an important ally in their users’ efforts to lose and manage weight. To foster motivation for long-term use and to achieve goals, it is necessary to better understand users’ opinions and needs for dietary self-monitoring. Objective: The aim of this study was to identify the key topics and issues that users highlight in their reviews of diet-tracking apps on Google Play Store. Identifying the topics that users frequently mention in their reviews of these apps, along with the user ratings for each of these apps, allowed us to identify areas where further improvement of the apps could facilitate app use, and support users’ weight loss and intake management efforts. Methods: We collected 72,084 user reviews from Google Play Store for 15 diet-tracking apps that allow users to track and count calories. After a series of text processing operations, two text-mining techniques (topic modeling and topical n-grams) were applied to the corpus of user reviews of diet-tracking apps. Results: Using the topic modeling technique, 11 separate topics were extracted from the pool of user reviews. Most of the users providing feedback were generally satisfied with the apps they use (average rating of 4.4 out of 5 for the 15 apps). Most topics referred to the positive evaluation of the apps and their functions. Negatively rated topics mostly referred to app charges and technical difficulties encountered. We identified the positive and negative topic trigrams (3-word combinations) among the most frequently mentioned topics. Usability and functionality (tracking options) of apps were rated positively on average. Negative ratings were associated with trigrams related to adding new foods, technical issues, and app charges. Conclusions: Motivating users to use an app over time could help them better achieve their nutrition goals. Although user reviews generally showed positive opinions and ratings of the apps, developers should pay more attention to users’ technical problems and inform users about expected payments, along with their refund and cancellation policies, to increase user loyalty. %M 33885375 %R 10.2196/25160 %U https://www.jmir.org/2021/4/e25160 %U https://doi.org/10.2196/25160 %U http://www.ncbi.nlm.nih.gov/pubmed/33885375 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e26471 %T Assessing the Quality of Mobile Health-Related Apps: Interrater Reliability Study of Two Guides %A Miró,Jordi %A Llorens-Vernet,Pere %+ Universitat Rovira i Virgili; Department of Psychology, Centre de Recerca en Avaluació i Mesura de la Conducta, Institut d'Investigació Sanitària Pere Virgili, Dept de Psicologia, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977558179, jordi.miro@urv.cat %K mHealth %K mobile health %K mobile apps %K evaluation studies, rating %K interrater reliability %K MARS %K MAG %D 2021 %7 19.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a huge number of health-related apps available, and the numbers are growing fast. However, many of them have been developed without any kind of quality control. In an attempt to contribute to the development of high-quality apps and enable existing apps to be assessed, several guides have been developed. Objective: The main aim of this study was to study the interrater reliability of a new guide — the Mobile App Development and Assessment Guide (MAG) — and compare it with one of the most used guides in the field, the Mobile App Rating Scale (MARS). Moreover, we also focused on whether the interrater reliability of the measures is consistent across multiple types of apps and stakeholders. Methods: In order to study the interrater reliability of the MAG and MARS, we evaluated the 4 most downloaded health apps for chronic health conditions in the medical category of IOS and Android devices (ie, App Store and Google Play). A group of 8 reviewers, representative of individuals that would be most knowledgeable and interested in the use and development of health-related apps and including different types of stakeholders such as clinical researchers, engineers, health care professionals, and end users as potential patients, independently evaluated the quality of the apps using the MAG and MARS. We calculated the Krippendorff alpha for every category in the 2 guides, for each type of reviewer and every app, separately and combined, to study the interrater reliability. Results: Only a few categories of the MAG and MARS demonstrated a high interrater reliability. Although the MAG was found to be superior, there was considerable variation in the scores between the different types of reviewers. The categories with the highest interrater reliability in MAG were “Security” (α=0.78) and “Privacy” (α=0.73). In addition, 2 other categories, “Usability” and “Safety,” were very close to compliance (health care professionals: α=0.62 and 0.61, respectively). The total interrater reliability of the MAG (ie, for all categories) was 0.45, whereas the total interrater reliability of the MARS was 0.29. Conclusions: This study shows that some categories of MAG have significant interrater reliability. Importantly, the data show that the MAG scores are better than the ones provided by the MARS, which is the most commonly used guide in the area. However, there is great variability in the responses, which seems to be associated with subjective interpretation by the reviewers. %M 33871376 %R 10.2196/26471 %U https://mhealth.jmir.org/2021/4/e26471 %U https://doi.org/10.2196/26471 %U http://www.ncbi.nlm.nih.gov/pubmed/33871376 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e21808 %T Mobile Apps to Support Family Caregivers of People With Alzheimer Disease and Related Dementias in Managing Disruptive Behaviors: Qualitative Study With Users Embedded in a Scoping Review %A Désormeaux-Moreau,Marjorie %A Michel,Charlie-Maude %A Vallières,Mélanie %A Racine,Maryse %A Poulin-Paquet,Myriame %A Lacasse,Delphine %A Gionet,Pascale %A Genereux,Melissa %A Lachiheb,Wael %A Provencher,Véronique %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12 Avenue N, Sherbrooke, QC, Canada, 1 819 791 7904 ext 70525, veronique.provencher@usherbrooke.ca %K disruptive behaviors management %K dementia %K caregivers %K mobile phone %K app %K scoping review %K focus group %K mHealth %K neurocognitive disorder %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: People with Alzheimer disease and related dementias often display disruptive behaviors (eg, aggression, wandering, and restlessness), which increase family caregivers’ burden of care. However, there are few tools currently available to help these caregivers manage disruptive behaviors. Mobile apps could meet this need, but to date little is known about them. Objective: The aims of our study were to identify existing mobile apps designed to support family caregivers of people with Alzheimer disease and related dementias in managing disruptive behaviors; explore whether family caregivers view these mobile apps as relevant to meeting their needs and as useful in managing disruptive behaviors; and document the types of mobile apps that are of interest and appeal to most family caregivers (with regard to format, ergonomics, and clarity). Methods: A review of mobile apps initially conducted in February 2018 was updated in March 2019 with 2 platforms (App Store [Apple Inc.] and Google Play [Google]). The selected apps were first analyzed independently by 3 raters (2 students and 1 researcher) for each of the platforms. A focus group discussion was then held with 4 family caregivers to explore their perceptions of the apps according to their needs and interests. The content of the discussion was analyzed. Results: Initially, 7 of 118 apps identified met the inclusion criteria. An eighth app, recommended by one of the knowledge users, was added later. Four family caregivers (women aged between 58 and 78 years) participated in the discussion. Participants expressed a preference for easy-to-understand apps that provide concrete intervention strategies. They reported being most inclined to use two apps, Dementia Advisor and DTA Behaviours. Conclusions: Few mobile apps on the market meet the needs of family caregivers in terms of content and usability. Our results could help to address this gap by identifying what family caregivers deem relevant in a mobile app to help them manage disruptive behaviors. %M 33861207 %R 10.2196/21808 %U https://aging.jmir.org/2021/2/e21808 %U https://doi.org/10.2196/21808 %U http://www.ncbi.nlm.nih.gov/pubmed/33861207 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e23822 %T Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review %A Demers,Marika %A Fung,Karen %A Subramanian,Sandeep K %A Lemay,Martin %A Robert,Maxime T %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Department of Rehabilitation, Faculty of Medicine, Université Laval, 525 boul Hamel, Quebec, QC, G1M 2S8, Canada, 1 418 529 9141 ext 6121, maxime.robert@fmed.ulaval.ca %K virtual rehabilitation %K upper limb %K brain damage %K feedback %K active video games %K learning %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality. Objective: The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist. Results: The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as “fair” according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games. Conclusions: Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982 %M 33825690 %R 10.2196/23822 %U https://games.jmir.org/2021/2/e23822 %U https://doi.org/10.2196/23822 %U http://www.ncbi.nlm.nih.gov/pubmed/33825690 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23649 %T Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie %A Alfrey,Kristie-Lee %A Cannon,Summer %A Alley,Stephanie %A Rebar,Amanda L %A Williams,Susan %A Short,Camille E %A Altazan,Abby %A Comardelle,Natalie %A Currie,Sinead %A Denton,Caitlin %A Harrison,Cheryce L %A Lamerton,Tayla %A Mena,Gabriela P %A Moran,Lisa %A Mottola,Michelle %A Nagpal,Taniya S %A Vincze,Lisa %A Schoeppe,Stephanie %+ School of Health, Medical and Applied Sciences, CQUniversity, Bruce Highway, Rockhampton, 4701, Australia, 61 49306912 ext 56912, m.j.hayman@cqu.edu.au %K pregnancy %K exercise %K physical activity %K mobile health (mHealth) %K applications %K MARS %K behavior change techniques %K mobile phone %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. %M 33825693 %R 10.2196/23649 %U https://mhealth.jmir.org/2021/4/e23649 %U https://doi.org/10.2196/23649 %U http://www.ncbi.nlm.nih.gov/pubmed/33825693 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e27232 %T Analyzing the Essential Attributes of Nationally Issued COVID-19 Contact Tracing Apps: Open-Source Intelligence Approach and Content Analysis %A Weiß,Jan-Patrick %A Esdar,Moritz %A Hübner,Ursula %+ Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Caprivistraße 30a, Osnabrück, , Germany, 49 5419692012, u.huebner@hs-osnabrueck.de %K COVID-19 %K contact tracing %K app %K protocol %K privacy %K assessment %K review %K surveillance %K monitoring %K design %K framework %K feature %K usage %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide. Objective: Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information. Methods: We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach. Results: Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup. Conclusions: We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries. %M 33724920 %R 10.2196/27232 %U https://mhealth.jmir.org/2021/3/e27232 %U https://doi.org/10.2196/27232 %U http://www.ncbi.nlm.nih.gov/pubmed/33724920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e27406 %T Comparing Smartphone Apps for Traditional Chinese Medicine and Modern Medicine in China: Systematic Search and Content Analysis %A Liu,Xiao Hang %A Jin,Fan %A Hsu,Jeffrey %A Li,Di Nan %A Chen,Wei %+ Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, East District, Beijing, 100730, China, 86 13716941630, chenweipumch@126.com %K mHealth %K traditional Chinese medicine %K modern medicine %K mobile apps %K app %K comparison %K content analysis %K China %K health care %K development %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional Chinese medicine (TCM) is an integral part of mainstream medicine in China, with theories and practices that are completely different from modern medicine. TCM should not be ignored or confused with modern medicine in the analysis of the Chinese health care system, including the analysis of mobile health (mHealth) apps. To date, differences between TCM apps and modern medicine apps have not be systematically investigated. Objective: The aim of this study was to systematically compare the quality of apps for TCM and modern medicine in China. Methods: In December 2020, we searched iOS (iTunes) and Android (Tencent, Oppo, and Huawei app stores) platforms for all mHealth apps and then categorized them as TCM or modern medicine apps if they were included in the final analysis. The included apps were downloaded on smartphones and assessed by 2 reviewers on the following 4 aspects: (1) data in the app stores, including user ratings, download counts, cost, target users, and year of last update; (2) functionality; (3) quality of the app content as determined by the Mobile App Rating Scale (MARS); and (4) analysis of the app privacy and security. Results: In total, 658 apps were analyzed, including 261 TCM medicine apps and 397 modern medicine apps. The average download count of modern medicine apps (approximately 5 million) was more than 10 times that of TCM apps (approximately 400,000). Regarding functionalities, 64.7% (257/397) of modern medicine apps provided telemedicine (74/261, 28.4% in TCM apps), 62.7% (249/397) provided registration (70/261, 26.8% in TCM apps), and 45.6% (181/397) provided communication (38/261, 14.6% in TCM apps). A larger proportion of TCM apps provided prescription and medication management (144/261, 55.2% in TCM apps versus 168/397, 42.3% in modern medicine apps). The majority of modern medicine apps (329/397, 82.9%) combined ≥3 functionalities compared with one-third of TCM apps (93/261, 34.6%). We then selected 81 top apps for quality and safety assessment (41 TCM apps and 40 modern medicine apps). Of these, the mean overall MARS score of TCM apps (2.7, SD 0.5) was significantly lower than modern medicine apps (3.6, SD 0.4). Almost all modern medicine apps (38/40, 95%) addressed privacy and security by providing a privacy policy and describing how to protect personal data, but less than half of the TCM apps (18/41, 44%) described this information (P<.001). Conclusions: The different functionalities reflect the distinct innate characteristics of these two medical systems. Although great progress has been made and the Chinese mHealth market size is large, there still exist many opportunities for future development, especially for TCM. %M 33759786 %R 10.2196/27406 %U https://mhealth.jmir.org/2021/3/e27406 %U https://doi.org/10.2196/27406 %U http://www.ncbi.nlm.nih.gov/pubmed/33759786 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24202 %T Mobile Apps for Foot Measurement in Pedorthic Practice: Scoping Review %A Kabir,Muhammad Ashad %A Rahman,Sheikh Sowmen %A Islam,Mohammad Mainul %A Ahmed,Sayed %A Laird,Craig %+ School of Computing and Mathematics, Charles Sturt University, Panorama Ave, Bathurst, NSW, 2795, Australia, 61 263386259, akabir@csu.edu.au %K foot measurement %K foot scanning %K mobile app %K custom shoes making %K apps review %K diabetic foot %K pedorthics %K footcare %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the use of smartphones increases globally across various fields of research and technology, significant contributions to the sectors related to health, specifically foot health, can be observed. Numerous smartphone apps are now being used for providing accurate information about various foot-related properties. Corresponding to this abundance of foot scanning and measuring apps available in app stores, there is a need for evaluating these apps, as limited information regarding their evidence-based quality is available. Objective: The aim of this review was to assess the measurement techniques and essential software quality characteristics of mobile foot measurement apps, and to determine their potential as commercial tools used by foot care health professionals, to assist in measuring feet for custom shoes, and for individuals to enhance their awareness of foot health and hygiene to ultimately prevent foot-related problems. Methods: An electronic search across Android and iOS app stores was performed between July and August 2020 to identify apps related to foot measurement and general foot health. The selected apps were rated by three independent raters, and all discrepancies were resolved by discussion among raters and other investigators. Based on previous work on app rating tools, a modified rating scale tool was devised to rate the selected apps. The internal consistency of the rating tool was tested with a group of three people who rated the selected apps over 2-3 weeks. This scale was then used to produce evaluation scores for the selected foot measurement apps and to assess the interrater reliability. Results: Evaluation inferences showed that all apps failed to meet even half of the measurement-specific criteria required for the proper manufacturing of custom-made footwear. Only 23% (6/26) of the apps reportedly used external scanners or advanced algorithms to reconstruct 3D models of a user’s foot that could possibly be used for ordering custom-made footwear (shoes, insoles/orthoses), and medical casts to fit irregular foot sizes and shapes. The apps had varying levels of performance and usability, although the overall measurement functionality was subpar with a mean of 1.93 out of 5. Apps linked to online shops and stores (shoe recommendation) were assessed to be more usable than other apps but lacked some features (eg, custom shoe sizes and shapes). Overall, the current apps available for foot measurement do not follow any specific guidelines for measurement purposes. Conclusions: Most commercial apps currently available in app stores are not viable for use as tools in assisting foot care health professionals or individuals to measure their feet for custom-made footwear. Current apps lack software quality characteristics and need significant improvements to facilitate proper measurement, enhance awareness of foot health, and induce motivation to prevent and cure foot-related problems. Guidelines similar to the essential criteria items introduced in this study need to be developed for future apps aimed at foot measurement for custom-made or individually fitted footwear and to create awareness of foot health. %M 33661124 %R 10.2196/24202 %U https://mhealth.jmir.org/2021/3/e24202 %U https://doi.org/10.2196/24202 %U http://www.ncbi.nlm.nih.gov/pubmed/33661124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24322 %T Health Apps for Combating COVID-19: Descriptive Review and Taxonomy %A Almalki,Manal %A Giannicchi,Anna %+ Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Gizan, Jazan, 82726, Saudi Arabia, 966 597636563, manal_almalki@hotmail.com %K app %K COVID-19 %K corona %K self-care %K personal tracking %K review %K mHealth %K track %K surveillance %K awareness %K exposure %K consumer health informatics %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies’ characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps’ designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps’ web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27%), managing exposure to COVID-19 (6/29, 20%), monitoring health by health care professionals (5/29, 17%), and conducting research studies (1/29, 3.5%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps’ effectiveness and from governmental organizations to increase public awareness of these digital solutions. %M 33626017 %R 10.2196/24322 %U https://mhealth.jmir.org/2021/3/e24322 %U https://doi.org/10.2196/24322 %U http://www.ncbi.nlm.nih.gov/pubmed/33626017 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e23313 %T Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores %A Portenhauser,Alexandra A %A Terhorst,Yannik %A Schultchen,Dana %A Sander,Lasse B %A Denkinger,Michael D %A Stach,Michael %A Waldherr,Natalie %A Dallmeier,Dhayana %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Lise-Meitner-Str. 16, Ulm, Germany, 49 73150 32802, eva-maria.messner@uni-ulm.de %K mHealth %K MARS %K MARS-G %K older adults %K mobile apps %K apps %K aging %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective: This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods: In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results: In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions: There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps. %M 33605884 %R 10.2196/23313 %U https://aging.jmir.org/2021/1/e23313 %U https://doi.org/10.2196/23313 %U http://www.ncbi.nlm.nih.gov/pubmed/33605884 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23912 %T mHealth Strategies Related to HIV Postexposure Prophylaxis Knowledge and Access: Systematic Literature Review, Technology Prospecting of Patent Databases, and Systematic Search on App Stores %A Queiroz,Artur Acelino Francisco Luz Nunes %A Mendes,Isabel Amélia Costa %A de Godoy,Simone %A Velez Lapão,Luís %A Dias,Sónia %+ Department of General and Specialized Nursing, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, R Prof Hélio Lourenço, 3900 - Vila Monte Alegre, Ribeirão Preto, 14040-902, Brazil, 55 16 3315 4321, arturqueiroz@usp.br %K HIV %K eHealth %K mHealth %K postexposure prophylaxis %K PEP %K prevention %K mobile phone %D 2021 %7 16.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Globally, the number of HIV cases continue to increase, despite the development of multiple prevention strategies. New cases of HIV have been reported disproportionately more in men who have sex with men and other vulnerable populations. Issues such as internalized and structural homophobia prevent these men from accessing prevention strategies such as postexposure prophylaxis (PEP). Mobile health (mHealth) interventions are known to be one of the newest and preferred options to enhance PEP knowledge and access. Objective: The aim of this study was to identify and analyze the mobile apps addressing PEP for HIV infections. Methods: We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis, and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines adapted for an integrative review in the databases of PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure, and CINAHL. The patent analysis was performed by exploring the databases of the Brazilian National Institute of Industrial Property, the United States Patent and Trademark Office, and the European Patent Office. For the systematic search, we analyzed mHealth apps related to HIV in 2 major app libraries, that is, Google Play Store and App Store. The apps were evaluated by name, characteristics, functions, and availability in iPhone operating system/Android phones. Results: We analyzed 22 studies, of which 2 were selected for the final stage. Both studies present the use of apps as mHealth strategies aimed at improving the sexual health of men who have sex with men, and they were classified as decision support systems. The search in the patent databases showed only 1 result, which was not related to the topic since it was a drug intervention. In the app libraries, 25 apps were found and analyzed, with 15 (60%) apps available for Android systems but only 3 (12%) addressing PEP. In general, the apps inform about HIV and HIV prevention and treatment, with the focus users being health care providers, people with HIV, or the general population, but they have only limited features available, that is, mainly text, images, and videos. The 3 apps exclusively focusing on PEP were created by researchers from Brazilian universities. Conclusions: Our review found no connection between the scientific studies, registered patents, and the available apps related to PEP; this finding indicates that these available apps do not have a theoretical or a methodological background in their creation. Thus, since the scientific knowledge on HIV is not translated into technological products, preventing the emergence of new infections, especially in the more vulnerable groups, is difficult. In the future, researchers and the community must work in synergy to create more mHealth tools aimed at PEP. %M 33591289 %R 10.2196/23912 %U http://mhealth.jmir.org/2021/2/e23912/ %U https://doi.org/10.2196/23912 %U http://www.ncbi.nlm.nih.gov/pubmed/33591289 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23921 %T Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability %A Furlong,Lisa %A Serry,Tanya %A Erickson,Shane %A Morris,Meg E %+ School of Education, College of Arts, Social Sciences and Commerce, La Trobe University, Plenty Road and Kingsbury Drive, Bundoora, Melbourne, 3086, Australia, 61 457645539, l.furlong@latrobe.edu.au %K app %K appraisal %K characteristics %K COVID-19 %K health management %K mHealth %K mobile apps %K phonics %K phonological awareness %K quality %K reading %K usability %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores. Objective: This protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple’s App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools. Methods: This protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist. Results: This method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021. Conclusions: This protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use. International Registered Report Identifier (IRRID): PRR1-10.2196/23921 %M 33523827 %R 10.2196/23921 %U http://www.researchprotocols.org/2021/2/e23921/ %U https://doi.org/10.2196/23921 %U http://www.ncbi.nlm.nih.gov/pubmed/33523827 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26155 %T Feasibility of a Web-Based Platform (Trial My App) to Efficiently Conduct Randomized Controlled Trials of mHealth Apps For Patients With Cardiovascular Risk Factors: Protocol For Evaluating an mHealth App for Hypertension %A Lokker,Cynthia %A Jezrawi,Rita %A Gabizon,Itzhak %A Varughese,Jobin %A Brown,Michael %A Trottier,Dan %A Alvarez,Elizabeth %A Schwalm,Jon-David %A McGillion,Michael %A Ma,Jinhui %A Bhagirath,Vinai %+ Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL 125, Hamilton, ON, L8S4L8, Canada, 1 905259140 ext 22208, LOKKERC@MCMASTER.CA %K mHealth %K mobile health %K hypertension %K app %K patient-oriented %K feasibility %K cardiovascular disease %K internet-administered %K randomized controlled trial %D 2021 %7 1.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) interventions can improve health by improving cardiovascular risk factors, but their adoption in care by physicians and patients is untapped. Few mHealth apps have been evaluated in clinical trials, and due to the fast pace of technological development, those previously evaluated are often outdated by the time trial results are available. Given the rapid pace of change in this field, it is not feasible to rigorously evaluate mHealth apps with current methodologies. Objective: The overall aim of this pilot study was to test the feasibility of using a web research platform called Trial My App to conduct efficient and rigorous web-based randomized controlled trials (RCTs) of mHealth apps relevant to patients with cardiovascular risk factors by evaluating an app that targets hypertension. Methods: For this study, 200 participants with suboptimally controlled hypertension will be recruited through advertisements in newsletters, media, and the internet, as well as through referrals from their health care providers. Screening, consent, randomization, and collection of patient-important health confidence and self-management ability outcomes will be conducted online through the Trial My App research platform. Participants will be randomized into 2 groups: 100 that will use an mHealth app for tracking hypertension and 100 that will be considered as an educational control. All participants will complete questionnaires at 0, 1, 3 and 6 months after enrolment. A substudy to validate the method of blood pressure readings and the consistency of data entered through Trial My App will be conducted with 40 participants. Results: The development of the Trial My App web platform has been completed. The creation of survey instruments has been completed in collaboration with our patient partners and advisory board. Recruitment is expected to begin in the first quarter of 2021; data collection and analysis are expected to be completed approximately 1 year after study commencement. Results will be disseminated through conferences and publications. The primary outcomes of this study include the feasibility of conducting an RCT using the Trial My App platform by reporting recruitment, retention, and completion statistics. We will validate app-entered data with a standard 7-day home blood pressure measurement method. Lastly, the pilot, nonblinded RCT will assess the effectiveness of the mHealth app in improving the control of hypertension compared with the control of hypertension in the educational control group. Conclusions: This study will determine if it is feasible to use the Trial My App web-based platform to evaluate the effectiveness of mHealth apps for patients with cardiovascular risk factors. As more mHealth apps are evaluated in RCTs, patients will be able to select apps that meet their needs and physicians will be able to make evidence-based recommendations to their patients for apps aimed at improving cardiovascular health. Trial Registration: ClinicalTrials.gov NCT04528654; https://clinicaltrials.gov/ct2/show/NCT04528654 International Registered Report Identifier (IRRID): PRR1-10.2196/26155 %M 33522978 %R 10.2196/26155 %U https://www.researchprotocols.org/2021/2/e26155 %U https://doi.org/10.2196/26155 %U http://www.ncbi.nlm.nih.gov/pubmed/33522978 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e23409 %T Privacy Policy Compliance of Chronic Disease Management Apps in China: Scale Development and Content Evaluation %A Ni,Zhenni %A Wang,Yiying %A Qian,Yuxing %+ School of Information Management, Wuhan University, LuoJiaShan, WuChang district, Wuhan, China, 86 13667195159, Jennie_N@whu.edu.cn %K mHealth %K noncommunicable diseases %K content analysis %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the development of mobile health (mHealth), chronic disease management apps have brought not only the possibility of reducing the burden of chronic diseases but also huge privacy risks to patients’ health data. Objective: The purpose of the study was to analyze the extent to which chronic disease management apps in China comply with the Personal Information Security Specification (PI Specification). Methods: The compliance of 45 popular chronic disease management apps was evaluated from the perspective of the information life cycle. To conduct a fine-grained evaluation, a scale based on the PI Specification was developed. Finally, 6 level 1 indicators, 22 level 2 indicators, and 61 level 3 indicators were defined. Results: There were 33/45 apps (73%) with a privacy policy, and the average score of these apps was 40.4 out of 100. Items of level 1 indicators with high scores included general characteristics (mean 51.9% [SD 28.1%]), information collection and use (mean 51.1% [SD 36.7%]), and information sharing and transfer (mean 50.3% [SD 33.5%]). Information storage and protection had the lowest compliance with PI Specification (mean 29.4% [SD 32.4%]). Few personal information (PI) controllers have stated how to handle security incidents, including security incident reporting (7/33, 21%), security incident notification (10/33, 30%), and commitment to bear corresponding legal responsibility for PI security incidents (1/33, 3%). The performance of apps in the stage of information destruction (mean 31.8% [SD 40.0%]) was poor, and only 21% (7/33) apps would notify third parties to promptly delete PI after individuals cancelled their accounts. Moreover, the scoring rate for rights of PI subjects is generally low (mean 31.2% [SD 35.5%]), especially for obtaining copies of PI (15%) and responding to requests (25%). Conclusions: Although most chronic disease management apps had a privacy policy, the total compliance rate of the policy content was low, especially in the stage of information storage and protection. Thus, the field has a long way to go with regard to compliance around personal privacy protection in China. %M 33507159 %R 10.2196/23409 %U http://mhealth.jmir.org/2021/1/e23409/ %U https://doi.org/10.2196/23409 %U http://www.ncbi.nlm.nih.gov/pubmed/33507159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19958 %T Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation %A Chen,Rebecca %A Santo,Karla %A Wong,Grace %A Sohn,Woosung %A Spallek,Heiko %A Chow,Clara %A Irving,Michelle %+ Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, REN Building, Darcy Road, Westmead, 2145, Australia, 61 8890 3125, rebecca.chen@sydney.edu.au %K dental caries %K oral hygiene %K self-management %K mobile applications %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental caries is the most common multifactorial oral disease; it affects 60% to 90% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps. Objective: This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality. Methods: We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis. Results: Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1% (40/562) of the apps fit our eligibility criteria, of which 55% (22/40) targeted adults, 93% (37/40) were free to download, and 65% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93% (37/40) of the apps, while dietary intake was addressed in 45% (18/40) of the apps and fluoride usage was addressed in 42% (17/40) of the apps. Overall, 50% (20/40) of the apps addressed only 1 behavior, and 38% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children. Conclusions: Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended. %M 33439141 %R 10.2196/19958 %U http://mhealth.jmir.org/2021/1/e19958/ %U https://doi.org/10.2196/19958 %U http://www.ncbi.nlm.nih.gov/pubmed/33439141 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 1 %P e16146 %T Analysis of Diabetes Apps to Assess Privacy-Related Permissions: Systematic Search of Apps %A Flors-Sidro,José Javier %A Househ,Mowafa %A Abd-Alrazaq,Alaa %A Vidal-Alaball,Josep %A Fernandez-Luque,Luis %A Sanchez-Bocanegra,Carlos Luis %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Doha, , Qatar, 974 55708549, aabdalrazaq@hbku.edu.qa %K diabetes mellitus %K privacy %K mobile apps %K dangerous permissions %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Mobile health has become a major vehicle of support for people living with diabetes. Accordingly, the availability of mobile apps for diabetes has been steadily increasing. Most of the previous reviews of diabetes apps have focused on the apps’ features and their alignment with clinical guidelines. However, there is a lack of knowledge on the actual compliance of diabetes apps with privacy and data security guidelines. Objective: The aim of this study was to assess the levels of privacy of mobile apps for diabetes to contribute to the raising of awareness of privacy issues for app users, developers, and governmental data protection regulators. Methods: We developed a semiautomatic app search module capable of retrieving Android apps’ privacy-related information, particularly the dangerous permissions required by apps, with the aim of analyzing privacy aspects related to diabetes apps. Following the research selection criteria, the original 882 apps were narrowed down to 497 apps that were included in the analysis. Results: Approximately 60% of the analyzed diabetes apps requested potentially dangerous permissions, which pose a significant risk to users’ data privacy. In addition, 28.4% (141/497) of the apps did not provide a website for their privacy policy. Moreover, it was found that 40.0% (199/497) of the apps contained advertising, and some apps that claimed not to contain advertisements actually did. Ninety-five percent of the apps were free, and those belonging to the “medical” and “health and fitness” categories were the most popular. However, app users do not always realize that the free apps’ business model is largely based on advertising and, consequently, on sharing or selling their private data, either directly or indirectly, to unknown third parties. Conclusions: The aforementioned findings confirm the necessity of educating patients and health care providers and raising their awareness regarding the privacy aspects of diabetes apps. Therefore, this research recommends properly and comprehensively training users, ensuring that governments and regulatory bodies enforce strict data protection laws, devising much tougher security policies and protocols in Android and in the Google Play Store, and implicating and supervising all stakeholders in the apps’ development process. %M 33439129 %R 10.2196/16146 %U http://diabetes.jmir.org/2021/1/e16146/ %U https://doi.org/10.2196/16146 %U http://www.ncbi.nlm.nih.gov/pubmed/33439129 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e18513 %T Mobile Health Apps for Medical Emergencies: Systematic Review %A Plaza Roncero,Alejandro %A Marques,Gonçalo %A Sainz-De-Abajo,Beatriz %A Martín-Rodríguez,Francisco %A del Pozo Vegas,Carlos %A Garcia-Zapirain,Begonya %A de la Torre-Díez,Isabel %+ eVIDA Research Group, University of Deusto, Avda/ Universidades 24, Bilbao, 48007, Spain, 34 619967223, mbgarciazapi@deusto.es %K mobile health %K mHealth %K eHealth %K Android %K iOS %K medical emergencies %K mobile apps %D 2020 %7 11.12.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are used to improve the quality of health care. These apps are changing the current scenario in health care, and their numbers are increasing. Objective: We wanted to perform an analysis of the current status of mobile health technologies and apps for medical emergencies. We aimed to synthesize the existing body of knowledge to provide relevant insights for this topic. Moreover, we wanted to identify common threads and gaps to support new challenging, interesting, and relevant research directions. Methods: We reviewed the main relevant papers and apps available in the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used in this review. The search criteria were adopted using systematic methods to select papers and apps. On one hand, a bibliographic review was carried out in different search databases to collect papers related to each application in the health emergency field using defined criteria. On the other hand, a review of mobile apps in two virtual storage platforms (Google Play Store and Apple App Store) was carried out. The Google Play Store and Apple App Store are related to the Android and iOS operating systems, respectively. Results: In the literature review, 28 papers in the field of medical emergency were included. These studies were collected and selected according to established criteria. Moreover, we proposed a taxonomy using six groups of applications. In total, 324 mobile apps were found, with 192 identified in the Google Play Store and 132 identified in the Apple App Store. Conclusions: We found that all apps in the Google Play Store were free, and 73 apps in the Apple App Store were paid, with the price ranging from US $0.89 to US $5.99. Moreover, 39% (11/28) of the included studies were related to warning systems for emergency services and 21% (6/28) were associated with disaster management apps. %M 33306037 %R 10.2196/18513 %U http://mhealth.jmir.org/2020/12/e18513/ %U https://doi.org/10.2196/18513 %U http://www.ncbi.nlm.nih.gov/pubmed/33306037 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e17139 %T Availability of Spanish-Language Medical Apps in Google Play and the App Store: Retrospective Descriptive Analysis Using Google Tools %A Grau-Corral,Inmaculada %A Gascon,Pau %A Grajales III,Francisco J %A Kostov,Belchin %A Sisó Almirall,Antoni %+ Fundación iSYS, C/Mallorca 140, 2-4, Barcelona, 08036, Spain, 34 692241233, Imma.grau.corral@gmail.com %K apps %K mobile health %K mHealth assessment %K evaluation studies %K health apps %K ratings %K mobile apps, Spanish apps %K patient apps %K Google Advanced Search %K mobile phone %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of medical and health apps in the App Store and Google Play repositories has been increasing in the recent years, and most of these apps are in English. However, little is known about the domain of Spanish health apps and their evolution. Objective: The aim of this study was to perform a retrospective descriptive analysis of medical apps for patients in the Spanish language by using Google search tools over a 5-year period and to compare the results by using a reproducible methodology to obtain a better knowledge of the medical apps available in the Spanish Language. Methods: Over a 5-year period, medical apps were catalogued using a Google-based methodology. Keywords of the first 14 categories of the International Classification of Diseases, Tenth Revision, were selected, and in December of each year, searches of the URLs of Google Play and the App Store were conducted using Google Advanced Search. The first 10 results were taken, and apps meeting the inclusion criteria were selected and rated with the iSYScore method. Results: Out of a sample of 1358 apps, 136 met the inclusion criteria. The 3 main categories of the medical apps were in the fields of endocrinology (diabetes), respiratory (chronic obstructive pulmonary disease, asthma, and allergies), and neurology (multiple sclerosis, Parkinson disease, and Alzheimer disease). Few apps were maintained over the 5 years. Only 10 of the 136 apps were maintained for 3 years or more. There was a large number of original apps in other languages that were translated into Spanish (56/136, 41.2%). In the last year of the study, the main reason (73/280, 26.1%) for discarding an app was the date of the last update. Conclusions: The market of Spanish apps is poor; only few apps have appeared repeatedly over 5 years. Differences were found with the international market in terms of apps related to mental health, heart and circulatory system, and cancer, and coincidences were found in the relevance of apps for diabetes control. %M 33270031 %R 10.2196/17139 %U https://mhealth.jmir.org/2020/12/e17139 %U https://doi.org/10.2196/17139 %U http://www.ncbi.nlm.nih.gov/pubmed/33270031 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e22340 %T Mobile Phone Apps in Australia for Improving Pregnancy Outcomes: Systematic Search on App Stores %A Musgrave,Loretta M %A Kizirian,Nathalie V %A Homer,Caroline S E %A Gordon,Adrienne %+ Centre for Midwifery, Child and Family Health, University of Technology Sydney, Building 10, Level 11, 235 Jones St, Ultimo NSW, Australia, 61 421633406, loretta.musgrave@uts.edu.au %K smartphone apps %K mobile phone %K pregnancy %K health behavior change %K MARS tool %K CALO-RE taxonomy %K pregnancy outcomes %K quality assessment methods %D 2020 %7 16.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women are increasingly turning to mobile health platforms to receive health information and support in pregnancy, yet the content of these platforms vary. Although there is great potential to influence health behaviors, little research has assessed the quality of these platforms or their ability to change behavior. In recent years, validated tools to assess app quality have become available. Objective: To identify and assess the quality and ongoing popularity of the top 10 freely available pregnancy apps in Australia using validated tools. Methods: A systematic search on app stores to identify apps was performed. A Google Play search used subject terms pregnancy, parenting, and childbirth; the iTunes search used alternative categories medical and health and fitness. The top 250 apps from each store were cross-referenced, and the top 100 found in both Google Play and iTunes were screened for eligibility. Apps that provided health information or advice for pregnancy were included. Excluded apps focused on nonhealth information (eg, baby names). The top 10 pregnancy apps were assessed using the Mobile App Rating Scale (MARS). A comparative analysis was conducted at 2 time points over 2 years to assess the ongoing popularity of the apps. The MARS score was compared to the download and star rating data collected from iTunes and Google Play in 2017 and 2019. Health behaviors including breastfeeding, healthy pregnancy weight, and maternal awareness of fetal movements were reviewed for apparent impact on the user’s knowledge, attitudes, and behavior change intentions using the MARS perceived impact section and the Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy. Results: A total of 2052 free apps were screened for eligibility, 1397 were excluded, and 655 were reviewed and scored. The top 10 apps were selected using download numbers and star ratings. All 10 apps were suboptimal in quality, practicality, and functionality. It was not possible to identify a primary purpose for all apps, and there was overlap in purpose for many. The mean overall MARS app quality score across all 10 apps was 3.01 (range 1.97-4.40) in 2017 and 3.40 (range 2.27-4.44) in 2019. A minority of apps scored well for perceived impact on health behavior using the MARS tool. Using the CALO-RE 40 item taxonomy, the number of behavior change techniques used was low. The mean number of behavior change techniques for breastfeeding was 5 (range 2-11), for pregnancy weight was 4 (range 2-12), and for maternal awareness of fetal movements was 5 (range 2-8). Conclusions: This review provides valuable information to clinicians and consumers about the quality of apps currently available for pregnancy in Australia. Consideration is needed regarding the regulation of information and the potential opportunity to incorporate behavior change techniques to improve maternal and fetal outcomes. %M 33196454 %R 10.2196/22340 %U http://mhealth.jmir.org/2020/11/e22340/ %U https://doi.org/10.2196/22340 %U http://www.ncbi.nlm.nih.gov/pubmed/33196454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20009 %T Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review %A Meacham,Meredith C %A Vogel,Erin A %A Thrul,Johannes %+ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 206 4253, Meredith.Meacham@ucsf.edu %K vaping %K mobile apps %K nicotine %K cannabis %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely. Objective: Understanding the types of nicotine and cannabis vaping–related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers. Methods: In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app’s purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale. Results: Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping. Conclusions: The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple’s ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps. %M 33185565 %R 10.2196/20009 %U http://www.jmir.org/2020/11/e20009/ %U https://doi.org/10.2196/20009 %U http://www.ncbi.nlm.nih.gov/pubmed/33185565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14988 %T Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis %A Bowie-DaBreo,Dionne %A Sünram-Lea,Sandra I %A Sas,Corina %A Iles-Smith,Heather %+ Research and Innovation Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom, 44 113 206 0469, dionne.bowie@nhs.net %K mobile mental health %K mHealth %K mobile apps %K depression %K clinical guidance %K NICE guidelines %K NHS %K safety %K ethics %K content analysis %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety. Objective: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression. Methods: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults. Results: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression. Conclusions: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design. %M 33185566 %R 10.2196/14988 %U http://formative.jmir.org/2020/11/e14988/ %U https://doi.org/10.2196/14988 %U http://www.ncbi.nlm.nih.gov/pubmed/33185566 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18858 %T Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality %A Vaezipour,Atiyeh %A Campbell,Jessica %A Theodoros,Deborah %A Russell,Trevor %+ RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, 288 Herston Road, Brisbane, 4006, Australia, 61 7 3365 5560, a.vaezipour@uq.edu.au %K communication disorders %K speech therapy %K language therapy %K ergonomics %K rehabilitation %K mobile health %K mHealth %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective: The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods: Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results: From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions: To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use. %M 33118953 %R 10.2196/18858 %U http://mhealth.jmir.org/2020/10/e18858/ %U https://doi.org/10.2196/18858 %U http://www.ncbi.nlm.nih.gov/pubmed/33118953 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15076 %T Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps %A Camacho-Rivera,Marlene %A Vo,Huy %A Huang,Xueqi %A Lau,Julia %A Lawal,Adeola %A Kawaguchi,Akira %+ Department of Community Health Sciences, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 43, Brooklyn, NY, 11203, United States, 1 7182704386, marlene.camacho-rivera@downstate.edu %K mHealth %K asthma apps %K sentiment analysis %K user ratings %K smartphone %K mobile phone %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. %M 33118944 %R 10.2196/15076 %U http://mhealth.jmir.org/2020/10/e15076/ %U https://doi.org/10.2196/15076 %U http://www.ncbi.nlm.nih.gov/pubmed/33118944 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19844 %T Weight Management Apps in Saudi Arabia: Evaluation of Features and Quality %A Alshathri,Dalal M %A Alhumaimeedy,Abeer S %A Al-Hudhud,Ghada %A Alsaleh,Aseel %A Al-Musharaf,Sara %A Aljuraiban,Ghadeer S %+ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Turki Alawwal, Riyadh , Saudi Arabia, 966 50 301 2345, galjuraiban@ksu.edu.sa %K mHealth %K eHealth %K smartphone %K obesity %K weight management %K mobile apps %K MARS %K six sigma %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Weight management apps may provide support and management options for individuals with overweight and obesity. Research on the quality of weight management mHealth apps among the Saudi population is insufficient despite frequent use. Objective: The aims of this study were to explore user perceptions of weight management apps, explore reasons for starting and stopping app use, appraise the quality of weight management apps available in the App Store, and compare the features currently available within the app market and those that are most desirable to weight management app users. Methods: A web-based survey consisted of 31 open and closed questions about sociodemographic information, general health questions, app use, app user perceptions, and discontinuation of app use. The quality of the weight management apps available on the App Store was assessed using the Mobile App Rating Scale and evidence-based strategies. We also used six sigma evaluations to ensure that the quality measured by the tools consistently meets customer expectations. Results: Data from the survey were analyzed. Of the respondents, 30.17% (324/1074) had used a weight management app, 18.16% (195/1074) used the apps and stopped, and 51.68% (555/1074) had never used a weight management app. Of apps mentioned, 23 met the inclusion criteria. The overall average Mobile App Rating Scale quality of apps was acceptable; 30% (7/23) received a quality mean score of 4 or higher (out of 5), and 30% (7/23) did not meet the acceptability score of 3 or higher. Evidence-based strategy results showed that feedback was not observed in any of the apps, and motivation strategy was observed in only 1 app. The sigma results of evidence-based strategies reflect that most of the apps fail to pass the mean. Conclusions: App users desired a feature that allows them to communicate with a specialist, which is a missing in the available free apps. Despite the large number and accessibility of weight management apps, the quality and features of most are variable. It can be concluded from six sigma results that passing the mean does not ensure that the quality is consistently distributed through all app quality properties and Mobile App Rating Scale and evidence-based strategies do not give developers an indication of the acceptance of their apps by mobile users. This finding stresses the importance of reevaluating the passing criterion, which is ≥50% for designing an effective app. %M 33104013 %R 10.2196/19844 %U http://mhealth.jmir.org/2020/10/e19844/ %U https://doi.org/10.2196/19844 %U http://www.ncbi.nlm.nih.gov/pubmed/33104013 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19280 %T Archetypes of Gamification: Analysis of mHealth Apps %A Schmidt-Kraepelin,Manuel %A Toussaint,Philipp A %A Thiebes,Scott %A Hamari,Juho %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160846037, sunyaev@kit.edu %K mHealth %K smartphones %K mobile phones %K gamification %K quantified-self %K exergames, persuasive technology %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. %M 33074155 %R 10.2196/19280 %U https://mhealth.jmir.org/2020/10/e19280 %U https://doi.org/10.2196/19280 %U http://www.ncbi.nlm.nih.gov/pubmed/33074155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18140 %T User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis %A Widnall,Emily %A Grant,Claire Ellen %A Wang,Tao %A Cross,Lauren %A Velupillai,Sumithra %A Roberts,Angus %A Stewart,Robert %A Simonoff,Emily %A Downs,Johnny %+ Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, United Kingdom, 44 7730683269, emily.widnall@kcl.ac.uk %K mood monitoring %K engagement %K mobile applications %K mHealth %K mental health %K smartphone %K qualitative research %K mobile phone %D 2020 %7 10.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are increasingly available and used in a clinical context to monitor young people’s mood and mental health. Despite the benefits of accessibility and cost-effectiveness, consumer engagement remains a hurdle for uptake and continued use. Hundreds of mood-monitoring apps are publicly available to young people on app stores; however, few studies have examined consumer perspectives. App store reviews held on Google and Apple platforms provide a large, rich source of naturally generated, publicly available user reviews. Although commercial developers use these data to modify and improve their apps, to date, there has been very little in-depth evaluation of app store user reviews within scientific research, and our current understanding of what makes apps engaging and valuable to young people is limited. Objective: This study aims to gain a better understanding of what app users consider useful to encourage frequent and prolonged use of mood-monitoring apps appropriate for young people. Methods: A systematic approach was applied to the selection of apps and reviews. We identified mood-monitoring apps (n=53) by a combination of automated application programming interface (API) methods. We only included apps appropriate for young people based on app store age categories (apps available to those younger than 18 years). We subsequently downloaded all available user reviews via API data scraping methods and selected a representative subsample of reviews (n=1803) for manual qualitative content analysis. Results: The qualitative content analysis revealed 8 main themes: accessibility (34%), flexibility (21%), recording and representation of mood (18%), user requests (17%), reflecting on mood (16%), technical features (16%), design (13%), and health promotion (11%). A total of 6 minor themes were also identified: notification and reminders; recommendation; privacy, security, and transparency; developer; adverts; and social/community. Conclusions: Users value mood-monitoring apps that can be personalized to their needs, have a simple and intuitive design, and allow accurate representation and review of complex and fluctuating moods. App store reviews are a valuable repository of user engagement feedback and provide a wealth of information about what users value in an app and what user needs are not being met. Users perceive mood-monitoring apps positively, but over 20% of reviews identified the need for improvement. %M 33037875 %R 10.2196/18140 %U http://mhealth.jmir.org/2020/10/e18140/ %U https://doi.org/10.2196/18140 %U http://www.ncbi.nlm.nih.gov/pubmed/33037875 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18339 %T Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS) %A Mandracchia,Floriana %A Llauradó,Elisabet %A Tarro,Lucia %A Valls,Rosa Maria %A Solà,Rosa %+ Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç, 21, Reus, Spain, 34 977758920, lucia.tarro@urv.cat %K food allergy %K food hypersensitivity %K food intolerance %K allergens %K mobile applications %K mobile health %K mHealth %K eHealth. %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues. Objective: This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements. Methods: This systematic search identified apps through the keywords “food allergy,” “food intolerance,” and “allergens” in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ≥3 (of 5 stars) to limit the selection to the most highly rated apps; ≥1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free “food products,” “restaurants,” or recipes in “meal planners”) and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated. Results: Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ≥3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps. Conclusions: In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps. %M 32936078 %R 10.2196/18339 %U http://mhealth.jmir.org/2020/9/e18339/ %U https://doi.org/10.2196/18339 %U http://www.ncbi.nlm.nih.gov/pubmed/32936078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18346 %T Technology Evaluation and Assessment Criteria for Health Apps (TEACH-Apps): Pilot Study %A Camacho,Erica %A Hoffman,Liza %A Lagan,Sarah %A Rodriguez-Villa,Elena %A Rauseo-Ricupero,Natali %A Wisniewski,Hannah %A Henson,Philip %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, United States, 1 7143359858, jtorous@bidmc.harvard.edu %K app %K mobile phones %K smartphones %K app evaluation %K technology %D 2020 %7 27.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the emergence of app evaluation tools, there remains no well-defined process receptive to diverse local needs, rigorous standards, and current content. The need for such a process to assist in the implementation of app evaluation across all medical fields is evident. Such a process has the potential to increase stakeholder engagement and catalyze interest and engagement with present-day app evaluation models. Objective: This study aimed to develop and pilot test the Technology Evaluation and Assessment Criteria for Health apps (TEACH-apps). Methods: Tailoring a well-known implementation framework, Replicating Effective Programs, we present a new process to approach the challenges faced in implementing app evaluation tools today. As a culmination of our experience implementing this process and feedback from stakeholders, we present the four-part process to aid the implementation of mobile health technology. This paper outlines the theory, evidence, and initial versions of the process. Results: The TEACH-apps process is designed to be broadly usable and widely applicable across all fields of health. The process comprises four parts: (1) preconditions (eg, gathering apps and considering local needs), (2) preimplementation (eg, customizing criteria and offering digital skills training), (3) implementation (eg, evaluating apps and creating educational handouts), and (4) maintenance and evolution (eg, repeating the process every 90 days and updating content). TEACH-apps has been tested internally at our hospital, and there is growing interest in partnering health care facilities to test the system at their sites. Conclusions: This implementation framework introduces a process that equips stakeholders, clinicians, and users with the foundational tools to make informed decisions around app use and increase app evaluation engagement. The application of this process may lead to the selection of more culturally appropriate and clinically relevant tools in health care. %M 32535548 %R 10.2196/18346 %U https://www.jmir.org/2020/8/e18346 %U https://doi.org/10.2196/18346 %U http://www.ncbi.nlm.nih.gov/pubmed/32535548 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20334 %T Features and Functionalities of Smartphone Apps Related to COVID-19: Systematic Search in App Stores and Content Analysis %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Villanueva-Bueno,Cristina %A Herranz-Alonso,Ana %A Sanjurjo-Saez,Maria %+ Hospital General Universitario Gregorio Marañón, C/del Dr. Esquerdo, 46, Madrid, 28007, Spain, 34 678239017, vicente.escudero@salud.madrid.org %K COVID-19 %K mobile apps %K contact tracing %K monitoring %K telemedicine %K smartphone %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Knowledge of the quantity and quality of apps related to coronavirus disease (COVID-19) is lacking. In addition, no directory has been established listing all the apps developed to address the COVID-19 pandemic. Objective: The aim of this study was to identify smartphone apps designed to address the COVID-19 pandemic and to analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of all smartphone apps associated with COVID-19. Between April 27 and May 2, 2020, we searched the App Store (iOS) and Google Play Store (Android) for COVID-19 apps. The search terms used were coronavirus, COVID-19, and SARS-COV-2. The apps were downloaded and evaluated. The variables analyzed were name, platform, country, language, category, cost, update date, size, version, number of downloads, developer, and purpose. Purpose was further classified into the following categories: news, general information, self-diagnosis, contact tracing, notices to contacts, notification of close cases, awareness, helplines, monitoring of clinical parameters, recording of symptoms and treatment, and messaging with health care professionals. Results: We identified 114 apps on the investigated platforms. Of these, 62/114 (54.4%) were on Android and 52/114 (45.6%) were on iOS. Of the 114 apps, 37 (32.5%) were developed in Europe, 32 (28.1%) in Asia, and 30 (26.3%) in North America. The most frequent languages were English (65/114, 57.0%), Spanish (34/114, 29.8%), and Chinese (14/114, 12.3%). The most common categories were health and well-being/fitness apps (41/114, 41.2%) and medicine apps (43/114, 37.7%). Of the 114 apps, 113 (99.1%) were free. The mean time between the date of the analysis and the date of the last update was 11.1 days (SD 11.0). Overall, 95 of the 114 apps (83.3%) were intended for the general population, 99 apps (7.9%) were intended for health professionals, and 3 apps (2.6%) were intended for both. Regarding the type of developer, 64/114 apps (56.1%) were developed by governments; 42/114 (64.1%) were developed by national governments, and 23/114 (35.9%) were developed by regional governments. The apps with the highest number of downloads (100,000+) were developed by governments (P=.13), except for the World Health Organization app (500,000+). The purposes of the apps available in Western languages (107/114, 93.9%) were determined; the most common purposes were general information about COVID-19 (66, 64.0%), COVID-19 news (53, 51.0%), recording of symptoms (53, 51.0%), and contact tracing (51, 47.7%). More than one purpose was identified for 99/107 apps (92.5%). Conclusions: This paper offers a comprehensive and unique review of all available COVID-19 apps. Governments have adopted these tools during the pandemic, and more than half of the apps were developed by government agencies. The most common purposes of the apps are providing information on the numbers of infected, recovered, and deceased patients, recording of symptoms, and contact tracing. %M 32614777 %R 10.2196/20334 %U https://www.jmir.org/2020/8/e20334 %U https://doi.org/10.2196/20334 %U http://www.ncbi.nlm.nih.gov/pubmed/32614777 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e21767 %T Smartphone and Mobile Health Apps for Tinnitus: Systematic Identification, Analysis, and Assessment %A Mehdi,Muntazir %A Stach,Michael %A Riha,Constanze %A Neff,Patrick %A Dode,Albi %A Pryss,Rüdiger %A Schlee,Winfried %A Reichert,Manfred %A Hauck,Franz J %+ Institute of Distributed Systems, Ulm University, Albert-Einstein-Allee 11, Ulm, 89081, Germany, 49 731 50 24140, franz.hauck@uni-ulm.de %K Health care %K Mobile Health %K Smartphone Apps %K Mobile Apps %K Tinnitus %K App Quality Assessment and Evaluation %K MARS %D 2020 %7 18.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern smartphones contain sophisticated high-end hardware features, offering high computational capabilities at extremely manageable costs and have undoubtedly become an integral part in users' daily life. Additionally, smartphones offer a well-established ecosystem that is easily discoverable and accessible via the marketplaces of differing mobile platforms, thus encouraging the development of many smartphone apps. Such apps are not exclusively used for entertainment purposes but are also commonplace in health care and medical use. A variety of those health and medical apps exist within the context of tinnitus, a phantom sound perception in the absence of any physical external source. Objective: In this paper, we shed light on existing smartphone apps addressing tinnitus by providing an up-to-date overview. Methods: Based on PRISMA guidelines, we systematically searched and identified existing smartphone apps on the most prominent app markets, namely Google Play Store and Apple App Store. In addition, we applied the Mobile App Rating Scale (MARS) to evaluate and assess the apps in terms of their general quality and in-depth user experience. Results: Our systematic search and screening of smartphone apps yielded a total of 34 apps (34 Android apps, 26 iOS apps). The mean MARS scores (out of 5) ranged between 2.65-4.60. The Tinnitus Peace smartphone app had the lowest score (mean 2.65, SD 0.20), and Sanvello—Stress and Anxiety Help had the highest MARS score (mean 4.60, SD 0.10). The interrater agreement was substantial (Fleiss κ=0.74), the internal consistency was excellent (Cronbach α=.95), and the interrater reliability was found to be both high and excellent—Guttman λ6=0.94 and intraclass correlation, ICC(2,k) 0.94 (95% CI 0.91-0.97), respectively. Conclusions: This work demonstrated that there exists a plethora of smartphone apps for tinnitus. All of the apps received MARS scores higher than 2, suggesting that they all have some technical functional value. However, nearly all identified apps were lacking in terms of scientific evidence, suggesting the need for stringent clinical validation of smartphone apps in future. To the best of our knowledge, this work is the first to systematically identify and evaluate smartphone apps within the context of tinnitus. %M 32808939 %R 10.2196/21767 %U http://mhealth.jmir.org/2020/8/e21767/ %U https://doi.org/10.2196/21767 %U http://www.ncbi.nlm.nih.gov/pubmed/32808939 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19807 %T Quality of Psychoeducational Apps for Military Members With Mild Traumatic Brain Injury: An Evaluation Utilizing the Mobile Application Rating Scale %A Jones,Chelsea %A O'Toole,Kaitlin %A Jones,Kevin %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, 8205 - 114 Street NW, Edmonton, AB, T6G 2G4, Canada, 1 780 492 0404, cweiman@ualberta.ca %K psychoeducation %K mTBI %K military %K app %K smartphone %K mHealth, concussion %K Mobile App Rating Scale %K MARS %K mobile phone %D 2020 %7 18.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and postconcussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and access to health care resources. Objective: This study aims to (1) use the Mobile Application Rating Scale (MARS) to evaluate smartphone apps purporting to provide psychoeducation for those who have sustained an mTBI or a PCS; (2) explore the relevance, utility, and effectiveness of these apps in facilitating symptom management and overall recovery from mTBI and PCS among military personnel; and (3) discuss considerations pertinent to health care professionals and patients with mTBI when considering the use of mobile health (mHealth), including apps for mTBI psychoeducation. Methods: A five-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January 31, 2020. Cost-free apps meeting the inclusion criteria were evaluated using the MARS and compared with evidence-based best practice management protocols for mTBI and PCS. Results: The search yielded a total of 347 smartphone apps. After applying the inclusion and exclusion criteria, 13 apps were subjected to evaluation. Two apps were endorsed by the US Department of Veterans Affairs and the US Department of Defense; all the others (n=11) were developed for civilians. When compared with evidence-based best practice resources, the apps provided various levels of psychoeducational content. There are multiple considerations that health care professionals and those who sustain an mTBI or a PCS have to consider when choosing to use mHealth and selecting a specific app for mTBI psychoeducation. These may include factors such as the app platform, developer, internet requirement, cost, frequency of updates, language, additional features, acknowledgment of mental health, accessibility, military specificity, and privacy and security of data. Conclusions: Psychoeducational interventions have a good evidence base as a treatment for mTBI and PCS. The use of apps for this purpose may be clinically effective, cost-effective, confidential, user friendly, and accessible. However, more research is needed to explore the effectiveness, usability, safety, security, and accessibility of apps designed for mTBI management. %M 32808937 %R 10.2196/19807 %U http://mhealth.jmir.org/2020/8/e19807/ %U https://doi.org/10.2196/19807 %U http://www.ncbi.nlm.nih.gov/pubmed/32808937 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20596 %T Mobile Health Apps That Help With COVID-19 Management: Scoping Review %A John Leon Singh,Hanson %A Couch,Danielle %A Yap,Kevin %+ Department of Public Health, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Building, Melbourne, 3086, Australia, 61 3 9479 6068, kevinyap.ehealth@gmail.com %K COVID-19 %K mobile apps %K mHealth %K contact tracing %K symptom monitoring %K information provision %K mobile health %D 2020 %7 6.8.2020 %9 Review %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country’s name as keywords and “coronavirus,” “COVID-19,” “nCOV19,” “contact tracing,” “information providing apps,” “symptom tracking,” “mobile apps,” “mobile applications,” “smartphone,” “mobile phone,” and “mHealth.” Countries most affected by COVID-19 and those that first rolled out COVID-19–related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. %M 32897271 %R 10.2196/20596 %U https://nursing.jmir.org/2020/1/e20596/ %U https://doi.org/10.2196/20596 %U http://www.ncbi.nlm.nih.gov/pubmed/32897271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18392 %T The Association Between App-Administered Depression Assessments and Suicidal Ideation in User Comments: Retrospective Observational Study %A DeForte,Shelly %A Huang,Yungui %A Bourgeois,Tran %A Hussain,Syed-Amad %A Lin,Simon %+ Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43215, United States, 1 202 318 1627, simon.lin@nationwidechildrens.org %K mobile health %K mHealth %K depression %K qualitative research %K mental health %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people use apps to help understand and manage their depression symptoms. App-administered questionnaires for the symptoms of depression, such as the Patient Health Questionnaire-9, are easy to score and implement in an app, but may not be accompanied by essential resources and access needed to provide proper support and avoid potential harm. Objective: Our primary goal was to evaluate the differences in risks and helpfulness associated with using an app to self-diagnose depression, comparing assessment-only apps with multifeatured apps. We also investigated whether, what, and how additional app features may mitigate potential risks. Methods: In this retrospective observational study, we identified apps in the Google Play store that provided a depression assessment as a feature and had at least five user comments. We separated apps into two categories based on those having only a depression assessment versus those that offered additional supportive features. We conducted theoretical thematic analyses over the user reviews, with thematic coding indicating the helpfulness of the app, the presence of suicidal ideation, and how and why the apps were used. We compared the results across the two categories of apps and analyzed the differences using chi-square statistical tests. Results: We evaluated 6 apps; 3 provided only a depression assessment (assessment only), and 3 provided features in addition to self-assessment (multifeatured). User comments for assessment-only apps indicated significantly more suicidal ideation or self-harm (n=31, 9.4%) compared to comments for multifeatured apps (n=48, 2.3%; X21=43.88, P<.001). Users of multifeatured apps were over three times more likely than assessment-only app users to comment in favor of the app’s helpfulness, likely due to features like mood tracking, journaling, and informational resources (n=56, 17% vs n=1223, 59% respectively; X21=200.36, P<.001). The number of users under the age of 18 years was significantly higher among assessment-only app users (n=40, 12%) than multifeatured app users (n=9, 0.04%; X21=189.09, P<.001). Conclusions: Apps that diagnose depression by self-assessment without context or other supportive features are more likely to be used by those under 18 years of age and more likely to be associated with increased user distress and potential harm. Depression self-assessments in apps should be implemented with caution and accompanied by evidence-based capabilities that establish proper context, increase self-empowerment, and encourage users to seek clinical diagnostics and outside help. %M 32663158 %R 10.2196/18392 %U https://mhealth.jmir.org/2020/8/e18392 %U https://doi.org/10.2196/18392 %U http://www.ncbi.nlm.nih.gov/pubmed/32663158 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18015 %T A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study %A Gladman,Tehmina %A Tylee,Grace %A Gallagher,Steve %A Mair,Jonathan %A Rennie,Sarah C %A Grainger,Rebecca %+ Education Unit, University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand, 64 04 918 6749, tehmina.gladman@otago.ac.nz %K questionnaire design %K medical education %K health occupations students %K just-in-time learning %K self-directed learning %K mobile phone %K rubric %K mobile learning %K mobile apps %K mhealth %K digital learning %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. Objective: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. Methods: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. Results: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (α=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). Conclusions: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning. %M 32735228 %R 10.2196/18015 %U https://mhealth.jmir.org/2020/7/e18015 %U https://doi.org/10.2196/18015 %U http://www.ncbi.nlm.nih.gov/pubmed/32735228 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17760 %T The Mobile App Development and Assessment Guide (MAG): Delphi-Based Validity Study %A Llorens-Vernet,Pere %A Miró,Jordi %+ Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 +34649298921, jordi.miro@urv.cat %K assessment %K Delphi method %K MAG %K mobile apps %K mobile health %K validity %K guide %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, there has been an exponential growth of mobile health (mHealth)–related apps. This has occurred in a somewhat unsupervised manner. Therefore, having a set of criteria that could be used by all stakeholders to guide the development process and the assessment of the quality of the apps is of most importance. Objective: The aim of this paper is to study the validity of the Mobile App Development and Assessment Guide (MAG), a guide recently created to help stakeholders develop and assess mobile health apps. Methods: To conduct a validation process of the MAG, we used the Delphi method to reach a consensus among participating stakeholders. We identified 158 potential participants: 45 patients as potential end users, 41 health care professionals, and 72 developers. We sent participants an online survey and asked them to rate how important they considered each item in the guide to be on a scale from 0 to 10. Two rounds were enough to reach consensus. Results: In the first round, almost one-third (n=42) of those invited participated, and half of those (n=24) also participated in the second round. Most items in the guide were found to be important to a quality mHealth-related app; a total of 48 criteria were established as important. “Privacy,” “security,” and “usability” were the categories that included most of the important criteria. Conclusions: The data supports the validity of the MAG. In addition, the findings identified the criteria that stakeholders consider to be most important. The MAG will help advance the field by providing developers, health care professionals, and end users with a valid guide so that they can develop and identify mHealth-related apps that are of quality. %M 32735226 %R 10.2196/17760 %U http://mhealth.jmir.org/2020/7/e17760/ %U https://doi.org/10.2196/17760 %U http://www.ncbi.nlm.nih.gov/pubmed/32735226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14915 %T Mobile Mental Health Apps in China: Systematic App Store Search %A Yin,Huifang %A Wardenaar,Klaas J %A Wang,Yuhao %A Wang,Nan %A Chen,Wenjin %A Zhang,Yan %A Xu,Guangming %A Schoevers,Robert A %+ Tianjin Anding Hospital, No 13, Liulin Road, Hexi district, Tianjin, China, 86 15122997716, xugm@ymail.com %K smartphone %K app %K mobile mental health %K mental illness %K mental health problem %K China %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health. Objective: The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018. Methods: A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app’s affiliation, cost, target users, information security, and evidence-based nature were evaluated. Results: Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps. Conclusions: Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed. %M 32716301 %R 10.2196/14915 %U https://www.jmir.org/2020/7/e14915 %U https://doi.org/10.2196/14915 %U http://www.ncbi.nlm.nih.gov/pubmed/32716301 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17609 %T Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis %A Amor-García,Miguel Ángel %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Melgarejo-Ortuño,Alejandra %A Herranz-Alonso,Ana %A Arranz Arija,José Ángel %A Sanjurjo-Sáez,María %+ Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid, 28007, Spain, 34 915867714, vicente.escudero@salud.madrid.org %K genitourinary cancer %K mobile apps %K eHealth %K mHealth %K rating tool %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: 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. Objective: 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. Methods: 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. Results: 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 (P<.001 and P=.01, respectively), but not for cost (P=.62). Conclusions: 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. %M 32706737 %R 10.2196/17609 %U http://mhealth.jmir.org/2020/7/e17609/ %U https://doi.org/10.2196/17609 %U http://www.ncbi.nlm.nih.gov/pubmed/32706737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18495 %T Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis %A Bearne,Lindsay M %A Sekhon,Mandeep %A Grainger,Rebecca %A La,Anthony %A Shamali,Mehrdad %A Amirova,Aliya %A Godfrey,Emma L %A White,Claire M %+ Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, 2nd Floor, Addison House, Guy's Campus, London, SE1 1UL, United Kingdom, 44 02078486283, lindsay.bearne@kcl.ac.uk %K rheumatoid arthritis %K physical activity %K exercise %K mobile applications %K behavior change techniques %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA. Objective: This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise. Methods: A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14). Results: A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified. Conclusions: This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation. %M 32706727 %R 10.2196/18495 %U http://mhealth.jmir.org/2020/7/e18495/ %U https://doi.org/10.2196/18495 %U http://www.ncbi.nlm.nih.gov/pubmed/32706727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16136 %T Adherence to Established Treatment Guidelines Among Unguided Digital Interventions for Depression: Quality Evaluation of 28 Web-Based Programs and Mobile Apps %A Bubolz,Stefan %A Mayer,Gwendolyn %A Gronewold,Nadine %A Hilbel,Thomas %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 38176, nadine.gronewold@med.uni-heidelberg.de %K web-based interventions %K depression %K mHealth %K mental health %K telemedicine %K mobile phone %K eHealth %K electronic mental health %K online therapy %D 2020 %7 13.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed. Objective: The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals. Methods: A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression. Results: Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46). Conclusions: Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression. %M 32673221 %R 10.2196/16136 %U https://www.jmir.org/2020/7/e16136 %U https://doi.org/10.2196/16136 %U http://www.ncbi.nlm.nih.gov/pubmed/32673221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16753 %T Need for the Development of a Specific Regulatory Framework for Evaluation of Mobile Health Apps in Peru: Systematic Search on App Stores and Content Analysis %A Rojas Mezarina,Leonardo %A Silva-Valencia,Javier %A Escobar-Agreda,Stefan %A Espinoza Herrera,Daniel Hector %A Egoavil,Miguel S %A Maceda Kuljich,Mirko %A Inga-Berrospi,Fiorella %A Ronceros,Sergio %+ Unidad de Telesalud, School of Medicine, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, Lima, Peru, 51 978978368, javier.silva@unmsm.edu.pe %K mhealth apps %K mHealth %K regulatory framework %K Peru, eHealth %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Peru, there is an increase in the creation of mobile health (mHealth) apps; however, this situation could present problems related to the quality of information these apps share, data security and privacy, usability, and effectiveness, as there is no specific local regulation about their creation and use. Objective: The objective of this study was to review mHealth apps created, uploaded, or used in Peru, and perform an analysis of the national regulatory framework that could be applied to evaluate whether there is a need to develop and implement a specific regulation to these apps. Methods: A total of 3 reviews were performed. First, we reviewed information about Peruvian mHealth apps created up to May 2019 from scientific publications, news, government communications, and virtual stores, and evaluated their purpose, creator, and the available evidence of their usability and effectiveness. The second review was carried out by taking a sample of the 10 most commonly used mHealth apps in Peru (regardless of the country of creation), to evaluate the information they collect and classify them according to the possible risks that they could present in terms of security and privacy. In addition, we evaluated whether they refer to or endorse the information they provided. Finally, in the third review, we searched for Peruvian standards related to electronic health (eHealth) that involve information technology that can be applied to regulate these apps. Results: A total of 66 apps meeting our inclusion criteria were identified; of these, 47% (n=31) belonged to government agencies and 47% (n=31) were designed for administrative purposes (private and government agencies). There was no evidence about the usability or effectiveness of any of these apps. Concerning the 10 most commonly used mHealth apps in Peru, about the half of them gathered user information that could be leaked, changed, or lost, thus posing a great harm to their users or to their related patients. In addition, 6/10 (60%) of these apps did not mention the source of the information they provided. Among the Peruvian norms, the Law on the Protection of Personal Data, Law on Medical Devices, and administrative directives on standards and criteria for health information systems have some regulations that could be applied to these apps; however, these do not fully cover all aspects concerning the evaluation of security and privacy of data, quality of provided information, and evidence of an app’s usability and effectiveness. Conclusions: Because many Peruvian mHealth apps have issues related to security and privacy of data, quality of information provided, and lack of available evidence of their usability and effectiveness, there is an urgent need to develop a regulatory framework based on existing medical device and health information system norms in order to promote the evaluation and regulation of all the aforesaid aspects, including the creation of a national repository for these apps that describes all these characteristics. %M 32352926 %R 10.2196/16753 %U https://mhealth.jmir.org/2020/7/e16753 %U https://doi.org/10.2196/16753 %U http://www.ncbi.nlm.nih.gov/pubmed/32352926 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16365 %T The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps %A Fijačko,Nino %A Gosak,Lucija %A Cilar,Leona %A Novšak,Alenka %A Creber,Ruth Masterson %A Skok,Pavel %A Štiglic,Gregor %+ Faculty of Health Sciences, University of Maribor, Žitna 15, Maribor, Slovenia, 386 23004764, nino.fijacko@um.si %K mobile health %K oral health care %K gamification %K mobile store %K evidence-based dentistry %K behavior change technique %K Mobile Application Rating Scale user version %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches. Objective: The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene. Methods: We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change. Results: Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app. Conclusions: The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement. %M 32673235 %R 10.2196/16365 %U https://mhealth.jmir.org/2020/7/e16365 %U https://doi.org/10.2196/16365 %U http://www.ncbi.nlm.nih.gov/pubmed/32673235 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e16525 %T Apps With Maps—Anxiety and Depression Mobile Apps With Evidence-Based Frameworks: Systematic Search of Major App Stores %A Marshall,Jamie M %A Dunstan,Debra A %A Bartik,Warren %+ School of Psychology, Faculty of Medicine and Health, University of New England, Elm Ave, Armidale, 2351, Australia, 61 2 6773 3012, jmarsh21@myune.edu.au %K mHealth %K apps %K app store %K depression %K anxiety %K e-mental health %K smartphone %K mobile mental health %K digital mental health %K mobile phone %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. Objective: This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. Methods: A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. Results: Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy. Conclusions: The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious mental health apps. %M 32579127 %R 10.2196/16525 %U http://mental.jmir.org/2020/6/e16525/ %U https://doi.org/10.2196/16525 %U http://www.ncbi.nlm.nih.gov/pubmed/32579127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e14618 %T Review and Selection of Online Resources for Carers of Frail Adults or Older People in Five European Countries: Mixed-Methods Study %A Papa,Roberta %A Efthymiou,Areti %A Lamura,Giovanni %A Piccinini,Flavia %A Onorati,Giulia %A Papastavrou,Evridiki %A Tsitsi,Theologia %A Casu,Giulia %A Boccaletti,Licia %A Manattini,Alessandra %A Seneca,Rita %A Vaz de Carvalho,Carlos %A Durão,Rita %A Barbabella,Francesco %A Andréasson,Frida %A Magnusson,Lennart %A Hanson,Elizabeth %+ Centre for Socio-Economic Research on Ageing, IRCCS INRCA, Via Santa Margherita 5, Ancona, 60124, Italy, 39 +390718004602, r.papa@inrca.it %K informal carers %K mobile apps %K websites %K usability %K reliability %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Informal carers have a crucial role in the care of older people, but they are at risk of social isolation and psychological exhaustion. Web-based services like apps and websites are increasingly used to support informal carers in addressing some of their needs and tasks, such as health monitoring of their loved ones, information and communication, and stress management. Despite the growing number of available solutions, the lack of knowledge or skills of carers about the solutions often prevent their usage. Objective: This study aimed to review and select apps and websites offering functionalities useful for informal carers of frail adults or older people in 5 European countries (Cyprus, Greece, Italy, Portugal, and Sweden). Methods: A systematic online search was conducted from January 2017 to mid-March 2017 using selected keywords, followed by an assessment based on a set of commonly agreed criteria and standardized tools. Selected resources were rated and classified in terms of scope. Focus groups with informal carers were conducted to validate the list and the classification of resources. The activities were conducted in parallel in the participating countries using common protocols and guidelines, a standardization process, and scheduled group discussions. Results: From a total of 406 eligible resources retrieved, 138 apps and 86 websites met the inclusion criteria. Half of the selected resources (109/224, 48.7%) were disease-specific, and the remaining resources included information and utilities on a variety of themes. Only 38 resources (38/224, 17.0%) were devoted specifically to carers, addressing the management of health disturbances and diseases of the care recipient and focusing primarily on neurodegenerative diseases. Focus groups with the carers showed that almost all participants had no previous knowledge of any resource specifically targeting carers, even if interest was expressed towards carer-focused resources. The main barriers for using the resources were low digital skills of the carers and reliability of health-related apps and websites. Results of the focus groups led to a new taxonomy of the resources, comprising 4 categories: carer’s wellbeing, managing health and diseases of the care recipient, useful contacts, and technologies for eldercare. Conclusions: The review process allowed the identification of online resources of good quality. However, these resources are still scarce due to a lack of reliability and usability that prevent users from properly benefiting from most of the resources. The involvement of end users provided added value to the resource classification and highlighted the gap between the potential benefits from using information and communication technologies and the real use of online resources by carers. %M 32554378 %R 10.2196/14618 %U http://mhealth.jmir.org/2020/6/e14618/ %U https://doi.org/10.2196/14618 %U http://www.ncbi.nlm.nih.gov/pubmed/32554378 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e14266 %T The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores %A Koepp,Janine %A Baron,Miriam Viviane %A Hernandes Martins,Paulo Ricardo %A Brandenburg,Cristine %A Kira,Ariane Tieko Frare %A Trindade,Vanessa Devens %A Ley Dominguez,Luis Manuel %A Carneiro,Marcelo %A Frozza,Rejane %A Possuelo,Lia Gonçalves %A De Mello Pinto,Marcus Vinicius %A Mahlmann Kipper,Liane %A Pinheiro da Costa,Bartira Ercília %+ University of Santa Cruz do Sul, Avenida Independência, 2293 - Block 35, Santa Cruz do Sul, 96816-501, Brazil, 55 51 99806 2275, janinekoepp@yahoo.com.br %K software %K portable app %K mobile app %K pressure sore %K decubitus ulcer %K wounds and injuries %D 2020 %7 16.6.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. Objective: The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. Results: The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. Conclusions: In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. Trial Registration: PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137 %M 32470916 %R 10.2196/14266 %U http://mhealth.jmir.org/2020/6/e14266/ %U https://doi.org/10.2196/14266 %U http://www.ncbi.nlm.nih.gov/pubmed/32470916 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15752 %T Technologies for Opioid Use Disorder Management: Mobile App Search and Scoping Review %A Nuamah,Joseph %A Mehta,Ranjana %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mHealth %K apps %K wearable sensors %K substance abuse disorder %K mobile phone %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in technology engender the investigation of technological solutions to opioid use disorder (OUD). However, in comparison to chronic disease management, the application of mobile health (mHealth) to OUD has been limited. Objective: The overarching aim of our research was to design OUD management technologies that utilize wearable sensors to provide continuous monitoring capabilities. The objectives of this study were to (1) document the currently available opioid-related mHealth apps, (2) review past and existing technology solutions that address OUD, and (3) discuss opportunities for technological withdrawal management solutions. Methods: We used a two-phase parallel search approach: (1) an app search to determine the availability of opioid-related mHealth apps and (2) a scoping review of relevant literature to identify relevant technologies and mHealth apps used to address OUD. Results: The app search revealed a steady rise in app development, with most apps being clinician-facing. Most of the apps were designed to aid in opioid dose conversion. Despite the availability of these apps, the scoping review found no study that investigated the efficacy of mHealth apps to address OUD. Conclusions: Our findings highlight a general gap in technological solutions of OUD management and the potential for mHealth apps and wearable sensors to address OUD. %M 32501273 %R 10.2196/15752 %U https://mhealth.jmir.org/2020/6/e15752 %U https://doi.org/10.2196/15752 %U http://www.ncbi.nlm.nih.gov/pubmed/32501273 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e13808 %T Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study %A Lim,Jun-Hao %A Lim,Cordelia-Kheng-May %A Ibrahim,Imliya %A Syahrul,Jazlina %A Mohamed Zabil,Mohd Hazli %A Zakaria,Nor Fadhlina %A Daud,Zulfitri Azuan Mat %+ Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 397692431, zulfitri@upm.edu.my %K renal apps %K nutrition %K dialysis %K self-management %K mHealth %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. Objective: This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. Methods: This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05. Results: A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01). Conclusions: Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality. %M 32478665 %R 10.2196/13808 %U https://mhealth.jmir.org/2020/6/e13808 %U https://doi.org/10.2196/13808 %U http://www.ncbi.nlm.nih.gov/pubmed/32478665 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17458 %T Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses %A Lecomte,Tania %A Potvin,Stéphane %A Corbière,Marc %A Guay,Stéphane %A Samson,Crystal %A Cloutier,Briana %A Francoeur,Audrey %A Pennou,Antoine %A Khazaal,Yasser %+ Department of Psychology, University of Montreal, 90 rue Vincent d'Indy, Bur C-358, CP 6128, Succ Centre-Ville, Montreal, QC, H3C 3J7, Canada, 1 343 6274, tania.lecomte@umontreal.ca %K apps %K mental health %K depression %K anxiety %K review %K meta %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5% being actually studied. Objective: This study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far. Methods: Systematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up. Conclusions: This meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations. %M 32348289 %R 10.2196/17458 %U https://mhealth.jmir.org/2020/5/e17458 %U https://doi.org/10.2196/17458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348289 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e16980 %T Categorization of Third-Party Apps in Electronic Health Record App Marketplaces: Systematic Search and Analysis %A Ritchie,Jordon %A Welch,Brandon %+ Medical University of South Carolina, 135 Cannon Street, MSC 200, Suite 405, Charleston, SC, 29425, United States, 1 8435183769, welchbm@musc.edu %K electronic health records %K medical informatics %K software %K interoperability %K apps %K app marketplace %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Third-party electronic health record (EHR) apps allow health care organizations to extend the capabilities and features of their EHR system. Given the widespread utilization of EHRs and the emergence of third-party apps in EHR marketplaces, it has become necessary to conduct a systematic review and analysis of apps in EHR app marketplaces. Objective: The goal of this review is to organize, categorize, and characterize the availability of third-party apps in EHR marketplaces. Methods: Two informaticists (authors JR and BW) used grounded theory principles to review and categorize EHR apps listed in top EHR vendors’ public-facing marketplaces. Results: We categorized a total of 471 EHR apps into a taxonomy consisting of 3 primary categories, 15 secondary categories, and 55 tertiary categories. The three primary categories were administrative (n=203, 43.1%), provider support (n=159, 33.8%), and patient care (n=109, 23.1%). Within administrative apps, we split the apps into four secondary categories: front office (n=77, 37.9%), financial (n=53, 26.1%), office administration (n=49, 24.1%), and office device integration (n=17, 8.4%). Within the provider support primary classification, we split the apps into eight secondary categories: documentation (n=34, 21.3%), records management (n=27, 17.0%), care coordination (n=23, 14.4%), population health (n=18, 11.3%), EHR efficiency (n=16, 10.1%), ordering and prescribing (n=15, 9.4%), medical device integration (n=13, 8.2%), and specialty EHR (n=12, 7.5%). Within the patient care primary classification, we split the apps into three secondary categories: patient engagement (n=50, 45.9%), clinical decision support (n=40, 36.7%), and remote care (n=18, 16.5%). Total app counts varied substantially across EHR vendors. Overall, the distribution of apps across primary categories were relatively similar, with a few exceptions. Conclusions: We characterized and organized a diverse and rich set of third-party EHR apps. This work provides an important reference for developers, researchers, and EHR customers to more easily search, review, and compare apps in EHR app marketplaces. %M 32469324 %R 10.2196/16980 %U http://medinform.jmir.org/2020/5/e16980/ %U https://doi.org/10.2196/16980 %U http://www.ncbi.nlm.nih.gov/pubmed/32469324 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17300 %T Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation %A Cheng,Heilok %A Tutt,Alison %A Llewellyn,Catherine %A Size,Donna %A Jones,Jennifer %A Taki,Sarah %A Rossiter,Chris %A Denney-Wilson,Elizabeth %+ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 1800793864, jessica.cheng@sydney.edu.au %K breast feeding %K bottle feeding %K infant food %K readability %K consumer health information %K breastfeeding %K mobile apps %K smartphones %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective: This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods: The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results: A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions: The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources. %M 32459187 %R 10.2196/17300 %U http://mhealth.jmir.org/2020/5/e17300/ %U https://doi.org/10.2196/17300 %U http://www.ncbi.nlm.nih.gov/pubmed/32459187 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17798 %T Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review %A Lau,Nancy %A O'Daffer,Alison %A Colt,Susannah %A Yi-Frazier,Joyce P %A Palermo,Tonya M %A McCauley,Elizabeth %A Rosenberg,Abby R %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1900 Ninth Ave, JMB 10-C, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mHealth %K mobile health %K mental health %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health–related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence. Objective: This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support. Methods: First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection. Results: We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study. Conclusions: Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness. %M 32357125 %R 10.2196/17798 %U http://mhealth.jmir.org/2020/5/e17798/ %U https://doi.org/10.2196/17798 %U http://www.ncbi.nlm.nih.gov/pubmed/32357125 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17085 %T Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack" %A Dittrich,Florian %A Beck,Sascha %A Harren,Anna Katharina %A Reinecke,Felix %A Serong,Sebastian %A Jung,Jochen %A Back,David Alexander %A Wolf,Milan %A Landgraeber,Stefan %+ Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstr. 100, Homburg, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K app store %K screening %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. Objective: This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. Methods: We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. Results: The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. Conclusions: The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice. %M 32379054 %R 10.2196/17085 %U https://mhealth.jmir.org/2020/5/e17085 %U https://doi.org/10.2196/17085 %U http://www.ncbi.nlm.nih.gov/pubmed/32379054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17246 %T Mobile Health Apps for Improvement of Tuberculosis Treatment: Descriptive Review %A Keutzer,Lina %A Wicha,Sebastian G %A Simonsson,Ulrika SH %+ Department of Pharmaceutical Biosciences, Uppsala University, Box 591, Uppsala, 751 24, Sweden, 46 18 471 400, Ulrika.Simonsson@farmbio.uu.se %K mHealth %K video observed treatment %K eHealth %K model-informed precision dosing %K MIPD %K tuberculosis %K mobile apps %K therapeutic drug monitoring %K smartphone %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) is a rapidly emerging market, which has been implemented in a variety of different disease areas. Tuberculosis remains one of the most common causes of death from an infectious disease worldwide, and mHealth apps offer an important contribution to the improvement of tuberculosis treatment. In particular, apps facilitating dose individualization, adherence monitoring, or provision of information and education about the disease can be powerful tools to prevent the development of drug-resistant tuberculosis or disease relapse. Objective: The aim of this review was to identify, describe, and categorize mobile and Web-based apps related to tuberculosis that are currently available. Methods: PubMed, Google Play Store, Apple Store, Amazon, and Google were searched between February and July 2019 using a combination of 20 keywords. Apps were included in the analysis if they focused on tuberculosis, and were excluded if they were related to other disease areas or if they were games unrelated to tuberculosis. All apps matching the inclusion criteria were classified into the following five categories: adherence monitoring, individualized dosing, eLearning/information, diagnosis, and others. The included apps were then summarized and described based on publicly available information using 12 characteristics. Results: Fifty-five mHealth apps met the inclusion criteria and were included in this analysis. Of the 55 apps, 8 (15%) were intended to monitor patients’ adherence, 6 (11%) were designed for dosage adjustment, 29 (53%) were designed for eLearning/information, 3 (6%) were focused on tuberculosis diagnosis, and 9 (16%) were related to other purposes. Conclusions: The number of mHealth apps related to tuberculosis has increased during the past 3 years. Although some of the discovered apps seem promising, many were found to contain errors or provided harmful or wrong information. Moreover, the majority of mHealth apps currently on the market are focused on making information about tuberculosis available (29/55, 53%). Thus, this review highlights a need for new, high-quality mHealth apps supporting tuberculosis treatment, especially those supporting individualized optimized treatment through model-informed precision dosing and video observed treatment. %M 32314977 %R 10.2196/17246 %U http://mhealth.jmir.org/2020/4/e17246/ %U https://doi.org/10.2196/17246 %U http://www.ncbi.nlm.nih.gov/pubmed/32314977 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14836 %T Quality, Functionality, and Features of Chinese Mobile Apps for Diabetes Self-Management: Systematic Search and Evaluation of Mobile Apps %A Gong,Enying %A Zhang,Zongmuyu %A Jin,Xurui %A Liu,Yishan %A Zhong,Lumin %A Wu,Yao %A Zhong,Xuefeng %A Yan,Lijing L. %A Oldenburg,Brian %+ Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, Melbourne, Victoria, Australia, 61 0452389420, egong@student.unimelb.edu.au %K diabetes mellitus %K self-management %K mobile apps %K China %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The emergence and advancement of mobile technologies offer a promising opportunity for people with diabetes to improve their self-management. Despite the proliferation of mobile apps, few studies have evaluated the apps that are available to the millions of people with diabetes in China. Objective: This study aimed to conduct a systematic search of Chinese mobile apps for diabetes self-management and to evaluate their quality, functionality, and features by using validated rating scales. Methods: A systematic search was conducted to identify Chinese apps for diabetes self-management in the four most popular Chinese language mobile app stores. Apps were included if they were designed for diabetes self-management and contained at least one of the following components: blood glucose management, dietary and physical activity management, medication taking, and prevention of diabetes-related comorbidities. Apps were excluded if they were unrelated to health, not in Chinese, or the targeted users are health care professionals. Apps meeting the identified inclusion criteria were downloaded and evaluated by a team of 5 raters. The quality, functionalities, and features of these apps were assessed by using the Mobile App Rating Scale (MARS), the IMS Institute for Healthcare Informatics Functionality score, and a checklist of self-management activities developed based on the Chinese diabetes self-management guideline, respectively. Results: Among 2072 apps searched, 199 were eligible based on the inclusion criteria, and 67 apps were successfully downloaded for rating. These 67 apps had an average MARS score of 3.42 out of 5, and 76% (51/67) of the apps achieved an acceptable quality (MARS score >3.0). The scores for the four subdomains of MARS were 3.97 for functionality, 3.45 for aesthetics, 3.21 for information, and 3.07 for engagement. On average, reviewed apps applied five out of the 19 examined behavior change techniques, whereas the average score on the subjective quality for the potential impact on behavior change is 3 out of 5. In addition, the average score on IMS functionality was 6 out of 11. Functionalities in collecting, recording, and displaying data were mostly presented in the reviewed apps. Most of the apps were multifeatured with monitoring blood glucose and tracking lifestyle behaviors as common features, but some key self-management activities recommended by clinical guidelines, such as stress and emotional management, were rarely presented in these apps. Conclusions: The general quality of the reviewed apps for diabetes self-management is suboptimal, although the potential for improvement is significant. More attention needs to be paid to the engagement and information quality of these apps through co-design with researchers, public health practitioners, and consumers. There is also a need to promote the awareness of the public on the benefit and potential risks of utilizing health apps for self-management. %M 32255432 %R 10.2196/14836 %U https://mhealth.jmir.org/2020/4/e14836 %U https://doi.org/10.2196/14836 %U http://www.ncbi.nlm.nih.gov/pubmed/32255432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e13057 %T Standards for Mobile Health–Related Apps: Systematic Review and Development of a Guide %A Llorens-Vernet,Pere %A Miró,Jordi %+ Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977558179, jordi.miro@urv.cat %K mHealth %K mobile apps %K review %K medical device %K standards %D 2020 %7 3.3.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: In recent years, the considerable increase in the number of mobile health (mHealth) apps has made health care more accessible and affordable for all. However, the exponential growth in mHealth solutions has occurred with almost no control or regulation of any kind. Despite some recent initiatives, there is still no specific regulation procedure, accreditation system, or standards to help the development of the apps, mitigate risks, or guarantee quality. Objective: The main aim of this study was to propose a set of criteria for mHealth-related apps on the basis of what is available from published studies, guidelines, and standards in the various areas that are related to health app development. Methods: We used three sources of information to identify the most important criteria. First, we conducted a systematic review of all the studies published on pain-related apps. Second, we searched for health app recommendations on the websites of professional organizations. Third, we looked for standards governing the development of software for medical devices on the specialized websites of regulatory organizations. Then, we grouped and subsumed the criteria we had identified on the basis of their shared characteristics. Finally, the comprehensibility and perceived importance of the resulting criteria were evaluated for face validity with a group of 18 stakeholders. Results: We identified a total of 503 criteria from all sources, which, after close analysis, were grouped into eight different categories, including 36 important criteria for health apps. The resulting categories were usability, privacy, security, appropriateness and suitability, transparency and content, safety, technical support and updates, and technology. The results of the preliminary analysis showed that the criteria were mostly understood by the group of stakeholders. In addition, they perceived all of them as important. Conclusions: This set of criteria can help health care providers, developers, patients, and other stakeholders to guide the development of mHealth-related apps and, potentially, to measure the quality of an mHealth app. %M 32130169 %R 10.2196/13057 %U https://mhealth.jmir.org/2020/3/e13057 %U https://doi.org/10.2196/13057 %U http://www.ncbi.nlm.nih.gov/pubmed/32130169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16208 %T Content Analysis of Apps for Growth Monitoring and Growth Hormone Treatment: Systematic Search in the Android App Store %A Fernandez-Luque,Luis %A Labarta,José I %A Palmer,Ella %A Koledova,Ekaterina %+ Merck KGaA, Frankfurter Str. 250, Darmstadt, 64293, Germany, 49 6151 72 20915, ekaterina.koledova@merckgroup.com %K growth hormone %K telemedicine %K growth monitoring %K mobile app %K mobile health %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile apps for health is growing. This rapid growth in the number of health apps can make it hard to assess their quality and features. The increased demand for and availability of mobile health apps highlights the importance of regular publication of reviews to identify potential areas of unmet needs and concern. The focus of this review is mobile apps for monitoring growth for health care professionals, caregivers, and patients. Monitoring growth as a part of healthy physical development is important across different periods of childhood and adolescence. Objective: The goal of this content analysis is to map and understand the types of apps that currently exist that are related to growth monitoring and growth hormone treatment. Methods: A semiautomated search was undertaken using the app search engine 42Matters, complemented by a manual search for growth apps using the web search tool of Google Play (Android App Store). Apps were rated on their relevance to growth monitoring and categorized by independent raters. Results: In total, 76 apps were rated relevant to growth monitoring or growth hormone treatment. The level of agreement was measured for the semiautomated search and was very high (Κ=0.97). The target audience for 87% of the apps (66/76) was patients and relatives, followed by health care professionals (11%; 8/76) and both (3%; 2/76). Apps in the category “growth tracking tools for children and babies” were retrieved most often (46%; 35/76) followed by “general baby care apps” (32%; 24/76), “nonpharmacological solutions for growth” (12%; 9/76) and “growth hormone–related” (11%; 8/76). Overall, 19/76 apps (25%) tracked a precise location. Conclusions: This study mapped the type of apps currently available for growth monitoring or growth hormone treatment that can be used as a foundation for more detailed evaluations of app quality. The popularity of care apps for children and growth monitoring apps should provide a great channel for potential intervention in childhood health in the future. %M 32130162 %R 10.2196/16208 %U http://mhealth.jmir.org/2020/2/e16208/ %U https://doi.org/10.2196/16208 %U http://www.ncbi.nlm.nih.gov/pubmed/32130162 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16741 %T Assessment of Mobile Health Apps Using Built-In Smartphone Sensors for Diagnosis and Treatment: Systematic Survey of Apps Listed in International Curated Health App Libraries %A Baxter,Clarence %A Carroll,Julie-Anne %A Keogh,Brendan %A Vandelanotte,Corneel %+ School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia, 61 488539311, c.baxter@hdr.qut.edu.au %K telehealth %K mHealth %K smartphone %K mobile apps %K instrumentation %K health care quality %K health care access %K and health care evaluation %K medical informatics %K consumer health informatics %K physician-patient relations %K prescriptions %K patient participation %K patient-generated health data %K diagnostic self evaluation %K self-care %K self-management %K medical device legislation %D 2020 %7 3.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: More than a million health and well-being apps are available from the Apple and Google app stores. Some apps use built-in mobile phone sensors to generate health data. Clinicians and patients can find information regarding safe and effective mobile health (mHealth) apps in third party–curated mHealth app libraries. Objective: These independent Web-based repositories guide app selection from trusted lists, but do they offer apps using ubiquitous, low-cost smartphone sensors to improve health? This study aimed to identify the types of built-in mobile phone sensors used in apps listed on curated health app libraries, the range of health conditions these apps address, and the cross-platform availability of the apps. Methods: This systematic survey reviewed three such repositories (National Health Service Apps Library, AppScript, and MyHealthApps), assessing the availability of apps using built-in mobile phone sensors for the diagnosis or treatment of health conditions. Results: A total of 18 such apps were identified and included in this survey, representing 1.1% (8/699) to 3% (2/76) of all apps offered by the respective libraries examined. About one-third (7/18, 39%) of the identified apps offered cross-platform Apple and Android versions, with a further 50% (9/18) only dedicated to Apple and 11% (2/18) to Android. About one-fourth (4/18, 22%) of the identified apps offered dedicated diagnostic functions, with a majority featuring therapeutic (9/18, 50%) or combined functionality (5/18, 28%). Cameras, touch screens, and microphones were the most frequently used built-in sensors. Health concerns addressed by these apps included respiratory, dermatological, neurological, and anxiety conditions. Conclusions: Diligent mHealth app library curation, medical device regulation constraints, and cross-platform differences in mobile phone sensor architectures may all contribute to the observed limited availability of mHealth apps using built-in phone sensors in curated mHealth app libraries. However, more efforts are needed to increase the number of such apps on curated lists, as they offer easily accessible low-cost options to assist people in managing clinical conditions. %M 32012102 %R 10.2196/16741 %U https://mhealth.jmir.org/2020/2/e16741 %U https://doi.org/10.2196/16741 %U http://www.ncbi.nlm.nih.gov/pubmed/32012102 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16247 %T Mobile Health Projects in a High-Complexity Reference Hospital: Case Study %A Grau-Corral,Inmaculada %A Jansà,Margarida %A Gascon,Pau %A Lozano-Rubí,Raimundo %A Pantoja,Percy Efrain %A Roca,Daria %A Aragunde Miguens,Valentín %A Hidalgo-Mazzei,Diego %A Escarrabill,Joan %+ Hospital Clinic de Barcelona, Villarroel 170, Barcelona, 08036, Spain, 34 692241233, Imma.grau.corral@gmail.com %K mobile health %K observational study %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The widespread adoption of mobile and wearable devices and apps makes it essential to assess their possible impact on the management of health and diseases. Health care providers (HCPs) find themselves faced with a new situation in their setting with the proliferation of mobile health (mHealth) intervention tests. Few studies have addressed the development of mHealth and the methodologies to manage these apps in a tertiary hospital. Objective: The aim of this study was to evaluate the mHealth projects implemented in the Hospital Clínic of Barcelona to increase awareness of the context in which they are used and to develop policies for the development of good practice in mHealth innovation. Methods: A prospective, descriptive cross-sectional study was conducted in a highly specialized university hospital with 850 beds for adults and a reference population of 520,000 inhabitants. A specific questionnaire was developed based on the Mobile Health 5 Dimensions European (MOHE 5D-EU) theoretical model to find mHealth projects. Apps, telemedicine, and wearable devices were included in the systematic search. For that purpose, a vertical (top-down) email-based snowball process was conducted. Data were collected from February to December 2018 by conducting personal interviews with HCPs using a structured questionnaire. Results: During the study period, 45 interviews were conducted; 35 mHealth initiatives were found, with 25 targeted to patients and 10 to health professionals. Most mHealth initiatives (34/35, 97%) were related to the software field (apps and telemedicine initiatives), and one was related to wearable devices. Among the projects, 68% (24/35) were classified as medical devices or developments at the edge (developments susceptible to limitations depending on the intended use). In relation to data protection, 27 initiatives managing personal data (27/35, 77%) considered data protection legislation. Only 9% (3/35) of the initiatives had foreseen the use of interconnectivity standards. Most of the initiatives were funded by grants (14/35, 40%), sponsorships (5/35, 14%), or the hospital itself (5/35, 14%). In terms of clinical management, most projects were developed in the field of research, followed by professional tools, clinical information, and therapeutic education. Only 6 projects were involved with health care; all were led by either the industry or small and medium enterprises. Conclusions: This study helped create the design of a map of the mHealth projects conducted in our hospital that showed the stages of development of the different ongoing projects. This will allow monitoring of mHealth projects and construction of tools to reinforce areas with detected deficiencies. Our theoretical approach using a modified MOHE 5D-EU model was found to be useful for analyzing the characteristics of mHealth projects. %M 32012092 %R 10.2196/16247 %U http://mhealth.jmir.org/2020/1/e16247/ %U https://doi.org/10.2196/16247 %U http://www.ncbi.nlm.nih.gov/pubmed/32012092 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e15321 %T Functionality of Top-Rated Mobile Apps for Depression: Systematic Search and Evaluation %A Qu,Chengcheng %A Sas,Corina %A Daudén Roquet,Claudia %A Doherty,Gavin %+ School of Computing and Communications, Lancaster University, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 01524510321, c.qu3@lancaster.ac.uk %K mobile apps %K depression %K review %K ethics %K mHealth %D 2020 %7 24.1.2020 %9 Review %J JMIR Ment Health %G English %X Background: In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality is actually provided by apps for depression, or for whom they are intended. Objective: This paper aimed to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns, to better inform the design of apps for depression. Methods: We reviewed top-rated iPhone OS (iOS) and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data were gathered from the 2 marketplaces and through direct use of the apps. We report an in-depth analysis of app functionality, namely, screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review. Apps were included if they remained accessible at the moment of evaluation, were offered in mental health–relevant categories, received a review score greater than 4.0 out of 5.0 by more than 100 reviewers, and had depression as a primary target. Results: The analysis revealed that a majority of apps specify the evidence base for their intervention (18/29, 62%), whereas a smaller proportion describes receiving clinical input into their design (12/29, 41%). All the selected apps are rated as suitable for children and adolescents on the marketplace, but 83% (24/29) do not provide a privacy policy consistent with their rating. The findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (24/29, 83%) either as a digitalized therapeutic intervention or as support for mood expression; tracking (19/29, 66%) of moods, thoughts, or behaviors for supporting the intervention; and screening (9/29, 31%) to inform the decision to use the app and its intervention. Some apps include overtly negative content. Conclusions: Currently available top-ranked apps for depression on the major marketplaces provide diverse functionality to benefit users across a range of age groups; however, guidelines and frameworks are still needed to ensure users’ privacy and safety while using them. Suggestions include clearly defining the age of the target population and explicit disclosure of the sharing of users’ sensitive data with third parties. In addition, we found an opportunity for apps to better leverage digital affordances for mitigating harm, for personalizing interventions, and for tracking multimodal content. The study further demonstrated the need to consider potential risks while using depression apps, including the use of nonvalidated screening tools, tracking negative moods or thinking patterns, and exposing users to negative emotional expression content. %M 32012079 %R 10.2196/15321 %U https://mental.jmir.org/2020/1/e15321 %U https://doi.org/10.2196/15321 %U http://www.ncbi.nlm.nih.gov/pubmed/32012079 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14082 %T Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis %A Kalke,Kerstin %A Ginossar,Tamar %A Bentley,Joshua M %A Carver,Hannah %A Shah,Sayyed Fawad Ali %A Kinney,Anita Y %+ Department of Communication Studies, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 5054489363, kerstinkalke2023@u.northwestern.edu %K mHealth %K breast cancer %K mobile apps %K health behavior %K health apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective: Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods: Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results: The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions: Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum. %M 32012084 %R 10.2196/14082 %U https://mhealth.jmir.org/2020/1/e14082 %U https://doi.org/10.2196/14082 %U http://www.ncbi.nlm.nih.gov/pubmed/32012084 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e15290 %T Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis %A Guo,Yuqi %A Yang,Fan %A Hu,Fei %A Li,Wei %A Ruggiano,Nicole %A Lee,Hee Yun %+ Social Welfare Program, School of Public Administration, Dongbei University of Finance and Economics, 219 Quanxue Hall, 217 Jianshan Street, Shaohekou District, Dalian, 116025, China, 86 41184710562, fyang10@dufe.edu.cn %K alzheimer disease %K dementia %K self-care %K mobile phone apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64%), self-care tips (6/14, 42%), and social networking capacity (5/14, 35%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy. %M 32012045 %R 10.2196/15290 %U http://aging.jmir.org/2020/1/e15290/ %U https://doi.org/10.2196/15290 %U http://www.ncbi.nlm.nih.gov/pubmed/32012045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14730 %T Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review %A Najm,Aurélie %A Gossec,Laure %A Weill,Catherine %A Benoist,David %A Berenbaum,Francis %A Nikiphorou,Elena %+ Department of Rheumatology, Nantes University Hospital, 1, place Alexis Ricordeau, Nantes, 44000, France, 33 633444793, aurelie.najm@gmail.com %K mobile health %K self-management %K arthritis %K telemedicine %K musculoskeletal diseases %D 2019 %7 26.11.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objective: This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. Methods: A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. Results: Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. Conclusions: The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients’ willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory. %M 31769758 %R 10.2196/14730 %U https://mhealth.jmir.org/2019/11/e14730 %U https://doi.org/10.2196/14730 %U http://www.ncbi.nlm.nih.gov/pubmed/31769758 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 11 %P e15064 %T Predictors of the Number of Installs in Psychiatry Smartphone Apps: Systematic Search on App Stores and Content Analysis %A Pinheiro,Mariana %A Serra,Madalena %A Pereira-Azevedo,Nuno %+ Psychiatric Service of the Psychiatry and Mental Health Department, Centro Hospitalar do Tâmega e Sousa, Av do Hospital Padre Américo, 210, Guilhufe, 4560-136, Portugal, 351 255 714 000, dra.mampi@gmail.com %K eHealth %K mHealth %K mobile applications %K psychiatry %D 2019 %7 19.11.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health is integral to our salubrity, but mental disorders are very debilitating and common. Therefore, it is critical to provide accessible, timely, and inexpensive mental care. This can be done through mobile health (mHealth), namely, mobile medical apps, which are gaining popularity among clinicians and patients. mHealth is a fast-paced field, and there is significant variation in the number of installs among psychiatry apps. However, the factors that influence psychiatry app installs have yet to be studied. Objective: This study aimed to identify predictors of the number of app installs in psychiatry. Methods: A literature review identified which factors influence app installs. Psychiatry apps available in the Google Play Store were reviewed, and publicly available data were collected. A multivariate ordinal logistic regression analysis was performed to evaluate the effect of said factors on the number of installs. Results: Our search identified 128 psychiatry apps: 2.3% (3/128) had never been installed, approximately half (53.1%, 68/128) had less than 500 installs, and only 0.8% (1/128) had over 10,000,000 installs. A multivariate logistic regression analysis identified that apps with a lower price (P<.001), a higher rating (P<.001), optional in-app purchases (P<.001), and age restriction (P=.04) had a higher number of installs. The involvement of a psychiatrist or other health care professional (HCP) had no statistically significant influence on the number of installs. Only data from the Google Play Store and the developers’ websites were available for analysis, and the depth of involvement of HCPs was impossible to document. Conclusions: Psychiatry apps with a lower price, optional in-app purchases, age restriction, and a higher rating are expected to have a higher number of installs. Unlike other medical fields, in this study, the explicit participation of psychiatrists in app development was not a significant predictor of the number of installs. Research is needed to identify other factors that may influence the number of installs, as that can help mHealth app development. %M 31742560 %R 10.2196/15064 %U https://mental.jmir.org/2019/11/e15064 %U https://doi.org/10.2196/15064 %U http://www.ncbi.nlm.nih.gov/pubmed/31742560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16442 %T Quality Awareness and Its Influence on the Evaluation of App Meta-Information by Physicians: Validation Study %A Albrecht,Urs-Vito %A Framke,Theodor %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str 1, Hannover, 30625, Germany, 49 511532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mobile health %K evaluation studies %K mobile apps %K quality principles %K usage decisions %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Meta-information provided about health apps on app stores is often the only readily available source of quality-related information before installation. Objective: The purpose of this study was to assess whether physicians deem a predefined set of quality principles as relevant for health apps; whether they are able to identify corresponding information in a given sample of app descriptions; and whether, and how, this facilitates their informed usage decisions. Methods: All members of the German Society for Internal Medicine were invited by email to participate in an anonymous online survey over a 6-week period. Participants were randomly assigned one app description focusing on cardiology or pulmonology. In the survey, participants were asked three times about whether the assigned description sufficed for a usage decision: they were asked (1) after giving an appraisal of the relevance of nine predefined app quality principles, (2) after determining whether the descriptions covered the quality principles, and (3) after they assessed the availability of detailed quality information by means of 25 additional key questions. Tests for significance of changes in their decisions between assessments 1 and 2, and between assessments 2 and 3, were conducted with the McNemar-Bowker test of symmetry. The effect size represents the discordant proportion ratio sum as a quotient of the test statistics of the Bowker test and the number of observation units. The significance level was set to alpha=.05 with a power of 1-beta=.95. Results: A total of 441 of 724 participants (60.9%) who started the survey fully completed the questionnaires and were included in the evaluation. The participants predominantly rated the specified nine quality principles as important for their decision (approximately 80%-99% of ratings). However, apart from the practicality criterion, information provided in the app descriptions was lacking for both groups (approximately 51%-92%). Reassessment of the apps led to more critical assessments among both groups. After having familiarized themselves with the nine quality principles, approximately one-third of the participants (group A: 63/220, 28.6%; group B: 62/221, 28.1%) came to more critical usage decisions in a statistically significant manner (McNemar-Bowker test, groups A and B: P<.001). After a subsequent reassessment with 25 key questions, critical appraisals further increased, although not in a statistically significant manner (McNemar-Bowker, group A: P=.13; group B: P=.05). Conclusions: Sensitizing physicians to the topic of quality principles via questions about attitudes toward established quality principles, and letting them apply these principles to app descriptions, lead to more critical appraisals of the sufficiency of the information they provided. Even working with only nine generic criteria was sufficient to bring about the majority of decision changes. This may lay the foundation for aiding physicians in their app-related decision processes, without unduly taking up their valuable time. %M 31738179 %R 10.2196/16442 %U http://mhealth.jmir.org/2019/11/e16442/ %U https://doi.org/10.2196/16442 %U http://www.ncbi.nlm.nih.gov/pubmed/31738179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13173 %T Evaluation of Heart Failure Apps to Promote Self-Care: Systematic App Search %A Wali,Sahr %A Demers,Catherine %A Shah,Hiba %A Wali,Huda %A Lim,Delphine %A Naik,Nirav %A Ghany,Ahmad %A Vispute,Ayushi %A Wali,Maya %A Keshavjee,Karim %+ Department of Medicine, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada, 1 905 525 9140 ext 73324, demers@hhsc.ca %K mHealth %K heart failure %K self-care %K mobile phone %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure (HF) is a chronic disease that affects over 1% of Canadians and at least 26 million people worldwide. With the continued rise in disease prevalence and an aging population, HF-related costs are expected to create a significant economic burden. Many mobile health (mHealth) apps have been developed to help support patients’ self-care in the home setting, but it is unclear if they are suited to the needs or capabilities of older adults. Objective: This study aimed to identify HF apps and evaluate whether they met the criteria for optimal HF self-care. Methods: We conducted a systematic search of all apps available exclusively for HF self-care across Google Play and the App Store. We then evaluated the apps according to a list of 25 major functions pivotal to promoting HF self-care for older adults. Results: A total of 74 apps for HF self-care were identified, but only 21 apps were listed as being both HF and self-care specific. None of the apps had all 25 of the listed features for an adequate HF self-care app, and only 41% (31/74) apps had the key weight management feature present. HF Storylines received the highest functionality score (18/25, 72%). Conclusions: Our findings suggest that currently available apps are not adequate for use by older adults with HF. This highlights the need for mHealth apps to refine their development process so that user needs and capabilities are identified during the design stage to ensure the usability of the app. %M 31710298 %R 10.2196/13173 %U https://mhealth.jmir.org/2019/11/e13173 %U https://doi.org/10.2196/13173 %U http://www.ncbi.nlm.nih.gov/pubmed/31710298 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13236 %T Mental Health Apps in China: Analysis and Quality Assessment %A Shang,Jie %A Wei,Shaoming %A Jin,Jianbo %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, 18F Jinqiu Tower B, No 6 Zhichun Rd, Haidian District, Beijing, 100088, China, 86 10 8280 0577, zpuhong@georgeinstitute.org.cn %K mental health %K mental disorder %K quality assessment %K mobile health %K digital health %K innovative health %K smartphone application %D 2019 %7 7.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental disorders have been a great burden on health care systems, affecting the quality of life of millions of people worldwide. Developing countries, including China, suffer from the double burden of both the increasing mental health issues in population and the deficiency in mental health care resources. The use of mobile health technologies, especially for mobile phone apps, can be a possible solution. Objective: This review aimed to describe the features and assess the quality of mental health apps in major mobile phone app markets in China and further discuss the priorities for mental health app development. Methods: Keywords including psychology, psychological health, psychological hygiene, psychological health service(s), mental, mental health, mental hygiene, mental health service(s), depression, and anxiety were searched in Chinese in 3 Android app markets (Baidu Mobile Assistant, Tencent MyApp, and 360 Mobile Assistant) and iOS App Store independently. Mental health apps were then selected according to established criteria for in-depth analysis and quality assessment by the Mobile App Rating Scale. Results: In total, 63 of 997 mental health apps were analyzed in depth, of which 78% (49/63) were developed by commercial entities for general population, 17% (11/63) were for patients or clients of specialized psychiatric hospitals or counseling agencies, 3% (2/63) were by government or local Centers for Disease Control and Prevention for general information, and 2% (1/63) for students of a university. Major built-in features of the apps included counseling services, mental health education, and self-assessment of mental health status by validated self-rating scales. The overall quality score of the MH apps was acceptable. Conclusions: Mental health apps are emerging in the area of mobile health in China. Popular mental health apps usually provide a synthetic platform organizing resources of information, knowledge, counseling services, self-tests, and management for the general population with mental health-related inquiries. The quality of the apps was rated as acceptable on average, suggesting some space for improvement. Official guidelines and regulations are urgently required for the field in the future. %M 31697245 %R 10.2196/13236 %U https://mhealth.jmir.org/2019/11/e13236 %U https://doi.org/10.2196/13236 %U http://www.ncbi.nlm.nih.gov/pubmed/31697245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14198 %T Quality of Deaf and Hard-of-Hearing Mobile Apps: Evaluation Using the Mobile App Rating Scale (MARS) With Additional Criteria From a Content Expert %A Romero,Ryan Lee %A Kates,Frederick %A Hart,Mark %A Ojeda,Amanda %A Meirom,Itai %A Hardy,Stephen %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, FL, United States, 1 (352) 273 6060, ryan.romero1000@ufl.edu %K eHealth %K mobile health %K mHealth %K mobile app %K hearing %K deaf persons %K sign language %D 2019 %7 30.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective. Objective: This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH. Methods: A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria. Results: The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study’s three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation. Conclusions: As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field. %M 31670695 %R 10.2196/14198 %U http://mhealth.jmir.org/2019/10/e14198/ %U https://doi.org/10.2196/14198 %U http://www.ncbi.nlm.nih.gov/pubmed/31670695 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14753 %T Evaluation of Mobile Apps Targeted at Patients With Spondyloarthritis for Disease Monitoring: Systematic App Search %A Kwan,Yu Heng %A Ong,Wei Jie %A Xiong,Mengfei %A Leung,Ying Ying %A Phang,Jie Kie %A Wang,Charmaine Tze May %A Fong,Warren %+ Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 90231226, yuheng@u.duke.nus.edu %K spondylarthropathies %K mobile apps %K ankylosing spondylitis %K psoriatic arthritis %D 2019 %7 28.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are many apps developed for patients with spondyloarthritis in the market, but their purpose and quality are not objectively evaluated. Objective: The objective of this study was to identify and evaluate existing publicly available, high-quality apps that use validated measurement instruments for monitoring spondyloarthritis disease activity. Methods: We conducted a review of apps available on the Apple App Store and the Google Play Store based on a combination of keywords and inclusion and exclusion criteria. Validated disease activity measurement instruments were identified. Data regarding app characteristics, including the presence of validated disease activity measurement, were extracted. The Mobile App Rating Scale (MARS) was used to review the apps for user experience. Results: A total of 1253 apps were identified in the app stores, and 5 apps met the criteria and were further analyzed. Moreover, 2 apps (MySpA and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis App) contained some of the validated disease activity monitoring instruments for specific spondyloarthritis subtypes. These 2 apps were also rated good on the MARS (with total mean scores ≥4 out of 5), whereas the other apps scored poorly in comparison. Conclusions: There are 2 high-quality spondyloarthritis disease activity monitoring apps publicly available, but they only target 2 spondyloarthritis subtypes—ankylosing spondylitis and psoriatic arthritis. There is a lack of high-quality apps that can measure disease activity for other spondyloarthritis subtypes, and no app that consolidates all validated disease activity instruments across subtypes was available. %M 31661080 %R 10.2196/14753 %U http://mhealth.jmir.org/2019/10/e14753/ %U https://doi.org/10.2196/14753 %U http://www.ncbi.nlm.nih.gov/pubmed/31661080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13608 %T Mobile Apps for Medication Management: Review and Analysis %A Tabi,Katarina %A Randhawa,Abnashi Singh %A Choi,Fiona %A Mithani,Zamina %A Albers,Friederike %A Schnieder,Maren %A Nikoo,Mohammadali %A Vigo,Daniel %A Jang,Kerry %A Demlova,Regina %A Krausz,Michael %+ Department of Psychiatry, University of British Columbia, 430-5950 University Boulevard, Vancouver, BC, V6T1Z3, Canada, 1 604 875 3525, katarina.tabi@gmail.com %K eHealth %K mHealth %K drugs %K pharmaceuticals %K therapy %D 2019 %7 11.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient’s needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go. Objective: This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes. Methods: We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation. Results: A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations. Conclusions: We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app. %M 31512580 %R 10.2196/13608 %U http://mhealth.jmir.org/2019/9/e13608/ %U https://doi.org/10.2196/13608 %U http://www.ncbi.nlm.nih.gov/pubmed/31512580 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12604 %T Mobile Apps for the Care Management of Chronic Kidney and End-Stage Renal Diseases: Systematic Search in App Stores and Evaluation %A Siddique,Abu Bakkar %A Krebs,Mary %A Alvarez,Sarai %A Greenspan,Iris %A Patel,Amit %A Kinsolving,Julianna %A Koizumi,Naoru %+ Schar School of Policy and Government, George Mason University, Founders Hall, 3351 Fairfax Dr, Suite 526, Arlington, VA, 22201, United States, 1 5712745328, anirbanju36@gmail.com %K mobile apps %K mhealth %K digital health %K kidney patient %K nutrition tracking %K systematic assessment %K Mobile App Rating Scale %D 2019 %7 04.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous free and low-cost mobile apps for the care management of kidney disease have become available in recent years. Although these appear to be promising tools, they have not been evaluated comparatively based on standard mobile app metrics, and thus, limited evidence is available regarding their efficacy. This study systematically cataloged and assessed mobile apps designed to assist medication compliance and nutrition tracking that are useful to the chronic kidney disease (CKD) and the end-stage renal disease (ESRD) patients who are on dialysis. Objective: The objective of this study was to comprehensively evaluate mobile apps used for medication compliance and nutrition tracking for possible use by CKD and ESRD patients. Methods: A systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The internal consistency and interrater reliability were tested using Cronbach alpha and interclass correlation coefficients (ICCs), respectively. Results: The MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating. The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); My Food Coach (MARS=4.48); and National Kidney Foundation Malaysia (MARS=4.20). The study identified 2 general weaknesses in the existing apps: the apps fell short of accommodating advanced interactive features such as providing motivational feedback and promoting family member and caregiver participations in the app utilization. Conclusions: The MARS rating system performed well in the app evaluation. The 3 highest ranked apps scored consistently high across the 5 dimensions specified in MARS. These apps were developed in collaboration with reputable organizations and field experts, demonstrating the importance of expert guidance in developing medical apps. %M 31486408 %R 10.2196/12604 %U https://mhealth.jmir.org/2019/9/e12604/ %U https://doi.org/10.2196/12604 %U http://www.ncbi.nlm.nih.gov/pubmed/31486408 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13971 %T A Comparison of Functional Features in Chinese and US Mobile Apps for Diabetes Self-Management: A Systematic Search in App Stores and Content Analysis %A Wu,Yuan %A Zhou,Yiling %A Wang,Xuan %A Zhang,Qi %A Yao,Xun %A Li,Xiaodan %A Li,Jianshu %A Tian,Haoming %A Li,Sheyu %+ Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guoxue Road, Wuhou District, Chengdu, 610041, China, 86 13194874843, lisheyu@gmail.com %K diabetes mellitus %K self-management %K mobile apps %K risk assessment %K prevalence %K China %K United States %D 2019 %7 28.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are widely used for self-management of diabetes, which is one of the most burdensome noncommunicable chronic diseases worldwide. However, little is known about the distribution of characteristics and functions of in-store mobile apps for diabetes. Objective: This study aimed to investigate the distribution of characteristics and functions of the in-store mobile apps for self-management of diabetes in the United States and China using a predefined functional taxonomy, which was developed and published in our previous study. Methods: We identified apps by searching diabetes in English or Chinese in the Apple iTunes Store and Android Markets (both in the United States and China) and included apps for diabetes self-management. We examined the validity and reliability of the predefined functional taxonomy with 3 dimensions: clinical module, functional module, and potential risk. We then classified all functions in the included apps according to the predefined taxonomy and compared the differences in the features of these apps between the United States and China. Results: We included 171 mobile diabetes apps, with 133 from the United States and 38 from China. Apps from both countries faced the challenges of evidence-based information, proper risk assessment, and declaration, especially Chinese apps. More Chinese apps provide app-based communication functions (general communication: Chinese vs US apps, 39%, 15/38 vs 18.0%, 24/133; P=.006 and patient-clinician communication: Chinese vs US apps, 68%, 26/38 vs 6.0%, 8/133; P<.001), whereas more US apps provide the decision-making module (Chinese vs US apps, 0%, 0/38 vs 23.3%, 31/133; P=.001), which is a high-risk module. Both complication prevention (Chinese vs US apps, 8%, 3/38 vs 3.8%, 5/133; P=.50) and psychological care (Chinese vs US apps, 0%, 0/38 vs 0.8%, 1/133; P>.99) are neglected by the 2 countries. Conclusions: The distribution of characteristics and functions of in-store mobile apps for diabetes self-management in the United States was different from China. The design of in-store diabetes apps needs to be monitored closely. %M 31464191 %R 10.2196/13971 %U http://mhealth.jmir.org/2019/8/e13971/ %U https://doi.org/10.2196/13971 %U http://www.ncbi.nlm.nih.gov/pubmed/31464191 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13494 %T Behavior Change Content, Understandability, and Actionability of Chronic Condition Self-Management Apps Available in France: Systematic Search and Evaluation %A Siqueira do Prado,Luiza %A Carpentier,Camille %A Preau,Marie %A Schott,Anne-Marie %A Dima,Alexandra Lelia %+ Équipe d'Accueil 7425 Health Services and Performance Research, Université de Lyon, 8 avenue Rockefeller, Lyon, 69373, France, 33 4 26 68 82 23, luiza.siqueira-do-prado@univ-lyon1.fr %K mHealth %K mobile phone %K app %K self-management %K chronic conditions %K target behaviors %K behavior change techniques %K understandability %K actionability %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The quality of life of people living with chronic conditions is highly dependent on self-management behaviors. Mobile health (mHealth) apps could facilitate self-management and thus help improve population health. To achieve their potential, apps need to target specific behaviors with appropriate techniques that support change and do so in a way that allows users to understand and act upon the content with which they interact. Objective: Our objective was to identify apps targeted toward the self-management of chronic conditions and that are available in France. We aimed to examine what target behaviors and behavior change techniques (BCTs) they include, their level of understandability and actionability, and the associations between these characteristics. Methods: We extracted data from the Google Play store on apps labelled as Top in the Medicine category. We also extracted data on apps that were found through 12 popular terms (ie, keywords) for the four most common chronic condition groups—cardiovascular diseases, cancers, respiratory diseases, and diabetes—along with apps identified through a literature search. We selected and downloaded native Android apps available in French for the self-management of any chronic condition in one of the four groups and extracted background characteristics (eg, stars and number of ratings), coded the presence of target behaviors and BCTs using the BCT taxonomy, and coded the understandability and actionability of apps using the Patient Education Material Assessment Tool for audiovisual materials (PEMAT-A/V). We performed descriptive statistics and bivariate statistical tests. Results: A total of 44 distinct native apps were available for download in France and in French: 39 (89%) were found via the Google Play store and 5 (11%) were found via literature search. A total of 19 (43%) apps were for diabetes, 10 for cardiovascular diseases (23%), 8 for more than one condition in the four groups (18%), 6 for respiratory diseases (14%), and 1 for cancer (2%). The median number of target behaviors per app was 2 (range 0-7) and of BCTs per app was 3 (range 0-12). The most common BCT was self-monitoring of outcome(s) of behavior (31 apps), while the most common target behavior was tracking symptoms (30 apps). The median level of understandability was 42% and of actionability was 0%. Apps with more target behaviors and more BCTs were also more understandable (ρ=.31, P=.04 and ρ=.35, P=.02, respectively), but were not significantly more actionable (ρ=.24, P=.12 and ρ=.29, P=.054, respectively). Conclusions: These apps target few behaviors and include few BCTs, limiting their potential for behavior change. While content is moderately understandable, clear instructions on when and how to act are uncommon. Developers need to work closely with health professionals, users, and behavior change experts to improve content and format so apps can better support patients in coping with chronic conditions. Developers may use these criteria for assessing content and format to guide app development and evaluation of app performance. Trial Registration: PROSPERO CRD42018094012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94012 %M 31452522 %R 10.2196/13494 %U http://mhealth.jmir.org/2019/8/e13494/ %U https://doi.org/10.2196/13494 %U http://www.ncbi.nlm.nih.gov/pubmed/31452522 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 8 %P e12820 %T Mindful Eating Mobile Health Apps: Review and Appraisal %A Lyzwinski,Lynnette Nathalie %A Edirippulige,Sisira %A Caffery,Liam %A Bambling,Matthew %+ Centre for Online Health, School of Medicine, University of Queensland, Princess Alexandria Hospital, Wooloongabba, 4102, Australia, 61 7 3176 7704, lynnettenathalie@icloud.com %K feeding behavior %K mindfulness %K mHealth %K diet %D 2019 %7 22.08.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindful eating is an emerging area of research for managing unhealthy eating and weight-related behaviors such as binge eating and emotional eating. Although there are numerous commercial mindful eating apps available, their quality, effectiveness, and whether they are accurately based on mindfulness-based eating awareness are unknown. Objective: This review aimed to appraise the quality of the mindful eating apps and to appraise the quality of content on mindful eating apps. Methods: A review of mindful eating apps available on Apple iTunes was undertaken from March to April 2018. Relevant apps meeting the inclusion criteria were subjectively appraised for general app quality using the Mobile App Rating Scale (MARS) guidelines and for the quality of content on mindful eating. A total of 22 apps met the inclusion criteria and were appraised. Results: Many of the reviewed apps were assessed as functional and had moderate scores in aesthetics based on the criteria in the MARS assessment. However, some received lower scores in the domains of information and engagement. The majority of the apps did not teach users how to eat mindfully using all five senses. Hence, they were scored as incomplete in accurately providing mindfulness-based eating awareness. Instead, most apps were either eating timers, hunger rating apps, or diaries. Areas of potential improvement were in comprehensiveness and diversity of media, in the quantity and quality of information, and in the inclusion of privacy and security policies. To truly teach mindful eating, the apps need to provide guided examples involving the five senses beyond simply timing eating or writing in a diary. They also need to include eating meditations to assist people with their disordered eating such as binge eating, fullness, satiety, and craving meditations that may help them with coping when experiencing difficulties. They should also have engaging and entertaining features delivered through diverse media to ensure sustained use and interest by consumers. Conclusions: Future mindful eating apps could be improved by accurate adherence to mindful eating. Further improvement could be achieved by ameliorating the domains of information, engagement, and aesthetics and having adequate privacy policies. %M 31441431 %R 10.2196/12820 %U https://mental.jmir.org/2019/8/e12820/ %U https://doi.org/10.2196/12820 %U http://www.ncbi.nlm.nih.gov/pubmed/31441431 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14630 %T Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review %A Yin,Andrew Lukas %A Hachuel,David %A Pollak,John P %A Scherl,Ellen J %A Estrin,Deborah %+ Medical College, Weill Cornell Medicine, 1300 York Avenue, New York, NY,, United States, 1 212 746 1067, aly2011@med.cornell.edu %K digital health %K mHealth %K mobile health %K mobile technology %K smartphone %K eHealth %K review %K inflammatory bowel disease %K Crohn’s disease %K ulcerative colitis %D 2019 %7 19.08.2019 %9 Review %J J Med Internet Res %G English %X Background: Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. Objective: This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. Methods: We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. Results: A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. Conclusions: While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses. %M 31429410 %R 10.2196/14630 %U http://www.jmir.org/2019/8/e14630/ %U https://doi.org/10.2196/14630 %U http://www.ncbi.nlm.nih.gov/pubmed/31429410 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13885 %T Suicide Prevention Mobile Apps: Descriptive Analysis of Apps from the Most Popular Virtual Stores %A Castillo-Sánchez,Gema %A Camargo-Henríquez,Ismael %A Muñoz-Sánchez,Juan Luis %A Franco-Martín,Manuel %A de la Torre-Díez,Isabel %+ Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, isator@tel.uva.es %K apps %K prevention %K suicide %K virtual store %K analysis %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Provision of follow-up and care during treatment of people with suicidal intentions is a challenge for health professionals and experts in information and communications technology (ICT). Therefore, health professionals and ICT experts are making efforts to carry out these activities in collaboration by using mobile apps as a technological resource. Objective: This study aimed to descriptively analyze mobile apps aimed at suicide prevention and to determine relevant factors in their design and development. In addition, it sought to analyze their impact on the support of treatment for patients at risk for suicide. Methods: We considered 20 apps previously listed in the article “Mobile Apps for Suicide Prevention: Review of Virtual Stores and Literature” (de la Torre et al, JMIR mHealth uHealth 2017;5[10]:e130). To find the apps in this list, the most popular app stores (Android and iOS) were searched using the keyword “suicide prevention.” The research focused on publicly available app information: language, platform, and user ratings. The results obtained were statistically evaluated using 16 parameters that establish various factors that may affect the choice of the user, and the consequent support that the app can offer to a person at risk for suicide. Results: Of the 20 mobile apps, 4 no longer appeared in the app stores and were therefore excluded. Analysis of the remaining 16 apps sampled showed the following: (1) a high percentage of the apps analyzed in the study (n=13, 82%) are provided in English language; (2) the sampled apps were last updated in 2017, when only 45% of them were updated, but the constant and progressive update of treatments should be reflected in the apps; and (3) the technical quality of these apps cannot be determined on the basis of the distribution of scores, because their popularity indices can be subjective (according to the users). User preference for a particular operating system would require further, more specific research, including study of the differences in the technical and usability aspects between both platforms and the design of medical apps. Conclusions: Although there are positive approaches to the use of apps for suicide prevention and follow-up, the technical and human aspects are yet to be explored and defined. For example, the design and development of apps that support suicide prevention should be strongly supported by health personnel to humanize these apps, so that the effectiveness of the treatments supported by them can be improved. %M 31411144 %R 10.2196/13885 %U http://mhealth.jmir.org/2019/8/e13885/ %U https://doi.org/10.2196/13885 %U http://www.ncbi.nlm.nih.gov/pubmed/31411144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14991 %T German Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS) %A Knitza,Johannes %A Tascilar,Koray %A Messner,Eva-Maria %A Meyer,Marco %A Vossen,Diana %A Pulla,Almut %A Bosch,Philipp %A Kittler,Julia %A Kleyer,Arnd %A Sewerin,Philipp %A Mucke,Johanna %A Haase,Isabell %A Simon,David %A Krusche,Martin %+ Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, Erlangen,, Germany, 49 0913 1853 4742, johannes.knitza@uk-erlangen.de %K mobile apps %K eHealth %K rheumatology %K mHealth %K Mobile Application Rating Scale %D 2019 %7 05.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety. Objective: The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists. Methods: The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers. Results: In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms. Conclusions: To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital. %M 31381501 %R 10.2196/14991 %U https://mhealth.jmir.org/2019/8/e14991/ %U https://doi.org/10.2196/14991 %U http://www.ncbi.nlm.nih.gov/pubmed/31381501 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13261 %T Nutrition-Related Mobile Apps in the China App Store: Assessment of Functionality and Quality %A Li,Yuan %A Ding,Jingmin %A Wang,Yishan %A Tang,Chengyao %A Zhang,Puhong %+ The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No 6 Zhichun Rd, Beijing,, China, 86 108 280 0577 ext 512, zpuhong@georgeinstitute.org.cn %K mobile phone %K mobile apps %K apps %K nutrition %K diet %K food %K behavior change %D 2019 %7 30.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are an increasing number of mobile apps that provide dietary guidance to support a healthy lifestyle and disease management. However, the characteristics of these nutrition-related apps are not well analyzed. Objective: This study aimed to evaluate the functionality and quality of nutrition-related apps in China. Methods: Mobile apps providing dietary guidance were screened in the Chinese iOS and Android app stores in November 2017, using stepwise searching criteria. The first screening consisted of extracting information from the app descriptions. Apps that (1) were free, (2) contain information on diet and nutrition, and (3) were last updated after January 1, 2016, were downloaded for further analysis. Nutritional functionalities were determined according to the Chinese Dietary Guidelines framework. Market-related functionalities were developed from previous studies and tailored to downloaded apps. The quality of apps was assessed with the user version of the Mobile App Rating Scale (uMARS). Results: Out of 628 dietary guidance apps screened, 44 were nutrition-related. Of these, guidance was provided on diet exclusively (11/44, 25%), fitness (17/44, 39%), disease management (11/44, 25%), or maternal health (5/44, 11%). Nutritional functionalities included nutritional information inquiry (40/44, 91%), nutrition education (35/44, 80%), food record (34/44, 77%), diet analysis (34/44, 77%), and personalized recipes (21/44, 48%). Dietary analysis and suggestions mainly focused on energy intake (33/44, 75%) and less on other factors such as dietary structure (10/44, 23%). Social communication functionalities were available in 42 apps (96%), user incentives were supported in 26 apps (59%), and intelligent recognition technology was available in 8 apps (18%). The median score for the quality of the 44 apps, as determined on a 5-point uMARS scale, was 3.6 (interquartile range 0.7). Conclusions: Most nutrition-related apps are developed for health management rather than for dietary guidance exclusively. Although basic principles of energy balance are used, their nutritional functionality was relatively limited and not individualized. More efforts should be made to develop nutrition-related apps with evidence-based nutritional knowledge, comprehensive and personalized dietary guidance, and innovative technology. %M 31364606 %R 10.2196/13261 %U http://mhealth.jmir.org/2019/7/e13261/ %U https://doi.org/10.2196/13261 %U http://www.ncbi.nlm.nih.gov/pubmed/31364606 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14655 %T Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants %A Hansen,William B %A Scheier,Lawrence M %+ Prevention Strategies, LLC, 5900 Summit Avenue, Brown Summit, NC, 27214, United States, 1 336 253 8354, billhansen1949@gmail.com %K smartphone %K intervention %K funded grants %K mobile phone %D 2019 %7 29.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future. Objective: The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018. Methods: We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant’s abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted. Results: We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0%) or two (39.0%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8%) and Research Project Grants (R01s) (26.2%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018. Conclusions: Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings. %M 31359866 %R 10.2196/14655 %U http://mhealth.jmir.org/2019/7/e14655/ %U https://doi.org/10.2196/14655 %U http://www.ncbi.nlm.nih.gov/pubmed/31359866 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e11926 %T Using Health and Well-Being Apps for Behavior Change: A Systematic Search and Rating of Apps %A McKay,Fiona H %A Wright,Annemarie %A Shill,Jane %A Stephens,Hugh %A Uccellini,Mary %+ Deakin University, School of Health and Social Development, Burwood Hwy, Burwood, 3125, Australia, 61 392517183, fiona.mckay@deakin.edu.au %K smartphone %K mobile apps %K health promotion %K health behavior %K rating %D 2019 %7 04.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have allowed for the development and use of apps. There is now a proliferation of mobile health interventions for physical activity, healthy eating, smoking and alcohol cessation or reduction, and improved mental well-being. However, the strength or potential of these apps to lead to behavior change remains uncertain. Objective: The aim of this study was to review a large sample of healthy lifestyle apps at a single point in time (June to July 2018) to determine their potential for promoting health-related behavior change with a view to sharing this information with the public. In addition, the study sought to test a wide range of apps using a new scale, the App Behavior Change Scale (ABACUS). Methods: Apps focusing on 5 major modifiable lifestyle behaviors were identified using a priori key search terms across the Australian Apple iTunes and Google Play stores. Lifestyle behavior categories were selected for their impact on health and included smoking, alcohol use, physical activity, nutrition, and mental well-being. Apps were included if they had an average user rating between 3 and 5, if they were updated in the last 18 months, if the description of the app included 2 of 4 behavior change features, and if they were in English. The selected behavior change apps were rated in 2 ways using previously developed rating scales: the Mobile App Rating Scale (MARS) for functionality and the ABACUS for potential to encourage behavior change. Results: The initial search identified 212,352 apps. After applying the filtering criteria, 5018 apps remained. Of these, 344 were classified as behavior change apps and were reviewed and rated. Apps were given an average MARS score of 2.93 out of 5 (SD 0.58, range 1.42-4.16), indicating low-to-moderate functionality. Scores for the ABACUS ranged from 1 to 17, out of 21, with an average score of 7.8 (SD 2.8), indicating a low-to-moderate number of behavior change techniques included in apps. The ability of an app to encourage practice or rehearsal, in addition to daily activities, was the most commonly identified feature across all apps (310/344, 90.1%), whereas the second most common feature was the ability of the user to easily self-monitor behavior (289/344, 84.0%). Conclusions: The wide variety of apps included in this 2018 study and the limited number of behavior change techniques found in many apps suggest an opportunity for improvement in app design that will promote sustained and significant lifestyle behavior change and, therefore, better health. The use of the 2 scales for the review and rating of the apps was successful and provided a method that could be replicated and tested in other behavior change areas. %M 31274112 %R 10.2196/11926 %U https://mhealth.jmir.org/2019/7/e11926/ %U https://doi.org/10.2196/11926 %U http://www.ncbi.nlm.nih.gov/pubmed/31274112 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13641 %T Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review %A Giebel,Godwin Denk %A Gissel,Christian %+ Health Economics, Department of Economics and Business, Justus Liebig University, Licher Strasse 62, Giessen, 35394, Germany, 49 641 99 22070, christian.gissel@wirtschaft.uni-giessen.de %K mHealth %K atrial fibrillation %K wearable %K app %D 2019 %7 16.6.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) devices can be used for the diagnosis of atrial fibrillation. Early diagnosis allows better treatment and prevention of secondary diseases like stroke. Although there are many different mHealth devices to screen for atrial fibrillation, their accuracy varies due to different technological approaches. Objective: We aimed to systematically review available studies that assessed the accuracy of mHealth devices in screening for atrial fibrillation. The goal of this review was to provide a comprehensive overview of available technologies, specific characteristics, and accuracy of all relevant studies. Methods: PubMed and Web of Science databases were searched from January 2014 until January 2019. Our systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. We restricted the search by year of publication, language, noninvasive methods, and focus on diagnosis of atrial fibrillation. Articles not including information about the accuracy of devices were excluded. Results: We found 467 relevant studies. After removing duplicates and excluding ineligible records, 22 studies were included. The accuracy of mHealth devices varied among different technologies, their application settings, and study populations. We described and summarized the eligible studies. Conclusions: Our systematic review identifies different technologies for screening for atrial fibrillation with mHealth devices. A specific technology’s suitability depends on the underlying form of atrial fibrillation to be diagnosed. With the suitable use of mHealth, early diagnosis and treatment of atrial fibrillation are possible. Successful application of mHealth technologies could contribute to significantly reducing the cost of illness of atrial fibrillation. %M 31199337 %R 10.2196/13641 %U http://mhealth.jmir.org/2019/6/e13641/ %U https://doi.org/10.2196/13641 %U http://www.ncbi.nlm.nih.gov/pubmed/31199337 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13257 %T Apps to Support Self-Management for People With Hypertension: Content Analysis %A Hui,Chi Yan %A Creamer,Emily %A Pinnock,Hilary %A McKinstry,Brian %+ Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Number 9 Bioquarter, 9 Little France Rd, Edinburgh, EH16 4UX, United Kingdom, 44 131 650 2683, Brian.mckinstry@ed.ac.uk %K hypertension %K self-management %K telehealth %K telemedicine %K mobile app %D 2019 %7 03.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Home blood pressure monitoring (HBPM) is one component of effective supported self-management, which may potentially be mediated by mobile apps. Objective: The aim of this study was to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated with download frequency and user ratings. Methods: We searched Google Play store, Apple App store, National Health Services Apps Library and myhealthapps.net (first search on February 1, 2018; updated August 18, 2018). We included high blood pressure apps available in the United Kingdom and extracted their features, number of downloads, and the average users’ rating from the app stores. We mapped the features to the holistic Practical Reviews In Self-Management Support (PRISMS) taxonomy of self-management support. We employed a regression analysis to determine if any features were associated with download frequency or user rating. Results: We included 151 apps. The 3 most common features were as follows: monitoring blood pressure (BP) and charting logs; lifestyle (exercise or dietary) advice; and providing information about hypertension. The other 11 components of the PRISMS taxonomy were rarely featured. There was little evidence to support associations between specific features and the download statistics and rating scores, with only 2 uncommon features achieving borderline significant associations. The presence of social support features, such as a forum, was weakly but significantly (R2=.04, P=.02) correlated with the number of downloads. Apps designed specifically for particular BP monitors/smart watches were weakly associated with a higher rating score (R2=.05, P<.001). Apps with more ratings were associated with more downloads (R2=.91, P<.001). Conclusions: The functionality of currently available apps is limited to logging BP, offering lifestyle advice, and providing information about hypertension. Future app development should consider broadening the remit to produce a system that can respond flexibly to the diversity of support that enables people to self-manage their hypertension. %M 31162124 %R 10.2196/13257 %U https://mhealth.jmir.org/2019/6/e13257/ %U https://doi.org/10.2196/13257 %U http://www.ncbi.nlm.nih.gov/pubmed/31162124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13645 %T Smartphone Apps to Support Self-Management of Hypertension: Review and Content Analysis %A Alessa,Tourkiah %A Hawley,Mark S %A Hock,Emma S %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield,, United Kingdom, 44 1142224399, l.p.dewitte@sheffield.ac.uk %K smartphone apps %K mobile apps %K self-management %K hypertension %K blood pressure %K mobile applications %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a widespread chronic disease, and its effective treatment requires self-management by patients. Health-related apps provide an effective way of supporting hypertension self-management. However, the increasing range and variety of hypertension apps available on the market, owing to the global growth in apps, creates the need for patients and health care professionals to be informed about the effectiveness of these apps and the levels of privacy and security that they provide. Objective: This study aimed to describe and assess all available apps supporting hypertension self-management in the most popular app stores and investigate their functionalities. Methods: In January 2018, the UK Apple and Google Play stores were scanned for all free and paid apps supporting hypertension self-management. Apps were included if they were in English, had functionality supporting hypertension self-management, and targeted adult users with hypertension. The included apps were downloaded and their functionalities were investigated. Behavior change techniques (BCTs) linked with the theoretical domain framework (TDF) underpinning potentially effective apps were independently coded by two reviewers. The data privacy and security of the apps were also independently assessed. Results: A total of 186 hypertension apps that met the inclusion criteria were included in this review. The majority of these apps had only one functionality (n=108), while the remainder offered different combinations of functionalities. A small number of apps had comprehensive functionalities (n=30) that are likely to be more effective in supporting hypertension self-management. Most apps lacked a clear theoretical basis, and 24 BCTs identified in these 30 apps were mapped to 10 TDF mechanisms of actions. On an average, 18.4 BCTs were mapped to 6 TDF mechanisms of actions that may support hypertension self-management behaviors. There was a concerning absence of evidence related to the effectiveness and usability of all 186 apps, and involvement of health care professionals in the app development process was minimal. Most apps did not meet the current standards of data security and privacy. Conclusions: Despite the widespread accessibility and availability of smartphone apps with a range of combinations of functionalities that can support the self-management of hypertension, only a small number of apps are likely to be effective. Many apps lack security measures as well as a clear theoretical basis and do not provide any evidence concerning their effectiveness and usability. This raises a serious issue, as health professionals and those with hypertension have insufficient information to make decisions on which apps are safe and effective. %M 31140434 %R 10.2196/13645 %U http://mhealth.jmir.org/2019/5/e13645/ %U https://doi.org/10.2196/13645 %U http://www.ncbi.nlm.nih.gov/pubmed/31140434 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e9232 %T A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates %A Ferrara,Giannina %A Kim,Jenna %A Lin,Shuhao %A Hua,Jenna %A Seto,Edmund %+ Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA, 98195, United States, 1 206 543 1475, eseto@uw.edu %K diet %K nutrition assessment %K behavior and behavior mechanisms %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and −6.5% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. %M 31102369 %R 10.2196/mhealth.9232 %U http://mhealth.jmir.org/2019/5/e9232/ %U https://doi.org/10.2196/mhealth.9232 %U http://www.ncbi.nlm.nih.gov/pubmed/31102369 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13019 %T Assessing the Quality of Mobile Apps Used by Occupational Therapists: Evaluation Using the User Version of the Mobile Application Rating Scale %A LeBeau,Kelsea %A Huey,Lauren G %A Hart,Mark %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Health Professions, Nusring & Pharmacy Room 4176, PO Box 100175
, Gainesville, FL, 32610, United States, 1 850 499 1952, klebeau@ufl.edu %K occupational therapy %K occupational therapists %K mobile apps %K mobile applications %K technology %K computers, handheld %K mHealth %K mobile health %D 2019 %7 1.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The continuous development of mobile apps has led to many health care professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings. Objective: The purpose of this study was to use the user version of the Mobile Application Rating Scale (uMARS) to evaluate the quality of the most frequently noted mobile health (mHealth) apps used by OTs and to demonstrate the utility of the uMARS to assess the quality of mHealth apps. Methods: A previous study surveying OTs’ use of apps in therapy compiled a list of apps frequently noted. A total of 25 of these apps were evaluated individually by 2 trained researchers using the uMARS, a simple, multidimensional analysis tool that can be reliably used to evaluate the quality of mHealth apps. Results: The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps. Conclusions: Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality. %M 31066712 %R 10.2196/13019 %U https://mhealth.jmir.org/2019/5/e13019/ %U https://doi.org/10.2196/13019 %U http://www.ncbi.nlm.nih.gov/pubmed/31066712 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12364 %T Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory %A Sidhu,Suhail %A Ma,Kaoer %A Sadovnikova,Anna %+ LiquidGoldConcept, Inc, , Ypsilanti, MI,, United States, 1 916 905 3544, anna@liquidgoldconcept.com %K milk production %K milk supply %K human lactation %K breastfeeding %K breastfeeding app %K smartphone app %K Social Cognitive Theory %K breastfeeding self-efficacy %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. %M 31518317 %R 10.2196/12364 %U http://pediatrics.jmir.org/2019/1/e12364/ %U https://doi.org/10.2196/12364 %U http://www.ncbi.nlm.nih.gov/pubmed/31518317 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11831 %T Smartphone Apps Targeting Alcohol and Illicit Substance Use: Systematic Search in in Commercial App Stores and Critical Content Analysis %A Tofighi,Babak %A Chemi,Chemi %A Ruiz-Valcarcel,Jose %A Hein,Paul %A Hu,Lu %+ Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 713, New York, NY, 10016, United States, 1 6468017345, babak.tofighi@nyumc.org %K mHealth %K substance use disorder %K mobile health %K alcohol abuse %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps promise to enhance the reach of evidence-based interventions (cognitive behavior therapy, contingency management and therapeutic education system) for populations with substance use disorders, with minimal disruption to health systems. However, further studies are needed to systematically evaluate smartphone apps targeting alcohol and illicit substances. Objective: The aim of this study was to evaluate the functionality, aesthetics, and quality of information of free or low-cost apps claiming to target alcohol, benzodiazepine, cocaine, crack/cocaine, crystal methamphetamine, and heroin use using the validated Mobile App Rating Scale (MARS) and critical content analysis. Methods: A systematic search of iTunes and Google Play app stores for free or low-cost apps facilitating recovery was conducted in March 2018 and yielded 904 apps using the keywords described in previous studies (eg, recovery, sobriety, sober, alcohol, and heroin). An interdisciplinary team of clinicians, behavioral informatics, and public health reviewers trained in substance use disorders conducted a descriptive analysis of 74 apps categorized as reducing use. In addition to the MARS scale, a descriptive analysis of relevant apps was conducted by the study team to assess for quality indicators emphasized by expert guidelines and review articles. Results: Most apps (n=74) claimed to reduce use or promote abstinence and yielded an overall low median MARS score of 2.82 (0.55) and a wide range of scores (1.64, 4.20). Ratings were also low for engagement (2.75 (0.72)), functionality (3.64 (0.78)), aesthetics (3.03 (0.87)), information (2.82 (0.62)), and satisfaction (1.76 (0.67)) subdomains. Innovative design and content features elicited in the review included initial assessments of substance use following app download, tracking substance use, and related consequences (eg, cost or calorie intake), remote and proximate peer support per geospatial positioning, and allowing users and family members of individuals with substance use disorders to locate 12-step meetings, treatment programs, and mental health services. Few apps integrated evidence-based psychotherapeutic (eg, cognitive behavioral therapy [CBT] or motivational interviewing) and pharmacologic interventions (eg, naloxone or buprenorphine). Conclusions: Few commercially available apps yielded in our search integrated evidence-based interventions (eg, extended-release naltrexone, buprenorphine, naloxone, Self-Management and Recovery Training recovery, or CBT), and a concerning number of apps promoted harmful drinking and illicit substance use. %M 31008713 %R 10.2196/11831 %U https://mhealth.jmir.org/2019/4/e11831/ %U https://doi.org/10.2196/11831 %U http://www.ncbi.nlm.nih.gov/pubmed/31008713 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11620 %T Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review %A Richardson,Brianna %A Dol,Justine %A Rutledge,Kallen %A Monaghan,Joelle %A Orovec,Adele %A Howie,Katie %A Boates,Talia %A Smit,Michael %A Campbell-Yeo,Marsha %+ School of Nursing, Dalhousie University, PO Box 15000, Forrest Bldg, 5869 University Avenue, Halifax, NS, B3H4R2, Canada, 1 9024944283, marsha.campbell-yeo@dal.ca %K parenting %K intensive care units, neonatal %K review %K mobile health %K mHealth %K mobile apps %K eHealth %K education, nonprofessional %K infant, premature %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents. Objective: This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility. Methods: We systematically searched the Apple App Store and Google Play using 49 key terms (eg, “preterm infant”) from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app’s content usability; and Trust it or Trash It to measure credibility. Results: The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer’s expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures. Conclusions: This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility. %M 30985282 %R 10.2196/11620 %U http://mhealth.jmir.org/2019/4/e11620/ %U https://doi.org/10.2196/11620 %U http://www.ncbi.nlm.nih.gov/pubmed/30985282 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10809 %T Quality of Blood Pressure Tracking Apps for the iPhone: Content Analysis and Evaluation of Adherence With Home Blood Pressure Measurement Best Practices %A Leong,Amanda Y %A Makowsky,Mark J %+ Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 (780) 492 1735, makowsky@ualberta.ca %K hypertension %K mobile apps %K self-management %K blood pressure monitoring, ambulatory %K cross-sectional studies %D 2019 %7 12.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Blood pressure (BP) tracking apps may aid in hypertension (HTN) self-management, but app quality may be problematic. Objective: This study aimed to develop a content-dependent rating system for BP tracking apps and systematically evaluate BP tracking features, content-independent quality, functional characteristics, and educational comprehensiveness of English language iPhone apps developed with the primary purpose of tracking a consumer’s BP measurements. Methods: We created a 28-item checklist reflecting overall app quality and a simplified 2-item checklist to assess adherence with home BP monitoring best practices. Apps with educational information were evaluated for comprehensiveness on a 7-point scale and for consistency with evidence-based guidelines. Higher scores represent better quality and comprehensiveness. We searched the Canadian App Store on June 28, 2016, using the keywords hypertension and blood pressure. A total of 2 reviewers independently assessed apps according to the standardized template. We determined if paid apps, educational apps, or those rated ≥4 stars were of higher quality. Results: Of the 948 apps screened, 62 met the inclusion criteria. The mean overall quality score was 12.2 (SD 4.6, out of 28) and 6 apps (10%, 6/62) met the home BP monitoring best practice criteria. In all, 12 apps contained educational content (mean comprehensiveness 2.4, SD 1.6 out of 14), most commonly, background information on HTN. Apps with educational content (mean 15.1, SD 3.8 vs 11.8, SD 4.8; P=.03) or a ≥4 star rating (median 19, interquartile range [IQR] 15-20, vs 12, IQR 9-15; P=.02) had higher overall quality. Conclusions: The BP tracking apps reviewed had variable quality and few met the home BP monitoring best practice criteria. When deciding to recommend a specific BP tracking app, we suggest clinicians should evaluate whether the app allows input of duplicate BP readings in the morning and evening for at least seven days and presents the mean BP value for user-specified dates. Greater attention to home BP measurement best practices is required during app development. %M 30977739 %R 10.2196/10809 %U https://mhealth.jmir.org/2019/4/e10809/ %U https://doi.org/10.2196/10809 %U http://www.ncbi.nlm.nih.gov/pubmed/30977739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12573 %T The Characteristics and Quality of Mobile Phone Apps Targeted at Men Who Have Sex With Men in China: A Window of Opportunity for Health Information Dissemination? %A Yang,Guoli %A Long,Jian %A Luo,Dan %A Xiao,Shuiyuan %A Kaminga,Atipatsa Chiwanda %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Road, Changsha, 410078, China, 86 0731 84805414, xiaosy@live.com %K mobile application %K homosexuality, male %K quality %K character %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A number of mobile phone apps has been developed specifically for men who have sex with men (MSM). We will call these mobile phone apps MSM apps for simplicity. At present, the characteristics and quality and purpose of these MSM apps are unclear. Objective: The aim of this study was to objectively and comprehensively evaluate the characteristics and quality of the MSM apps to assess whether they disseminated health information among the MSM in China. Methods: We searched 2 dominant mobile phone app stores (Apple Store and Android Market) to obtain MSM apps using the keywords MSM, gay, lesbian, gay, bisexual, and transgender (LGBT), 男同，同志，男男性接触者，同性恋，基友, and 双性恋. Apps were excluded if they did not have a Chinese language interface or if their target population was not MSM. Basic information about the eligible apps for this study, such as app name, app store category, and date of last update was gathered from the specified app stores. The quality of apps was rated by 2 independent raters using Mobile App Rating Scale (MARS). The intraclass correlation coefficient (ICC) between raters was computed as a measure for interrater reliability of the MARS. All analyses were conducted using SPSS version 20.0 (SPSS Inc). Results: A total of 575 apps were reviewed between September 15, 2018 and September 30, 2018, out of which, 532 apps were excluded. Finally, 43 apps were included. Of the 43 apps, 16 were from the Apple Store, 10 were from Android Market, and 17 were available in both app stores. In addition, 39 out of 43 apps were for social and sexual networking, whereas 10 contained sexual health information, for example, HIV/sexually transmitted diseases knowledge, HIV test, and condom use. The average rating was 4 stars. The number of downloads for 21 apps exceeded 10,000. A total of 31 apps had acceptable quality (as defined by a MARS score of >3), with functionality as the highest scoring domain, followed by information quality, esthetics, and engagement. Interrater reliability was excellent for the overall mean app quality scores (ICC=.946; 95% CI 0.904-0.970) and the subjective quality scores (ICC=.910; 95% CI 0.841-0.950). Conclusions: By reviewing the available apps, we found that MSM apps are popular. The majority of MSM apps are for dating, whereas few of them contain HIV prevention and health information. The overall quality of the apps is acceptable. The utilization of mobile phone technologies is a promising way for delivering HIV prevention messages to MSM. We recommend that researchers and app developers should work together to disseminate health information for MSM via mobile technologies. %M 30916658 %R 10.2196/12573 %U http://mhealth.jmir.org/2019/3/e12573/ %U https://doi.org/10.2196/12573 %U http://www.ncbi.nlm.nih.gov/pubmed/30916658 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e9838 %T Popular Nutrition-Related Mobile Apps: An Agreement Assessment Against a UK Reference Method %A Fallaize,Rosalind %A Zenun Franco,Rodrigo %A Pasang,Jennifer %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 1183786418, j.a.lovegrove@reading.ac.uk %K weighed food records %K smartphone application %K dietary assessment %K diet apps %K nutrition apps %K diet records %K mobile applications %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition-related apps are commonly used to provide information about the user’s dietary intake, but limited research has been performed to assess how well their outputs agree with those from standard methods. Objective: The objective of our study was to evaluate the level of agreement of popular nutrition-related apps for the assessment of energy and available macronutrients and micronutrients against a UK reference method. Methods: We compared dietary analysis of 24-hour weighed food records (n=20) between 5 nutrition-related apps (Samsung Health, MyFitnessPal, FatSecret, Noom Coach, and Lose It!) and Dietplan6 (reference method), using app versions available in the United Kingdom. We compared estimates of energy, macronutrients (carbohydrate, protein, fat, saturated fat, and fiber), and micronutrients (sodium, calcium, iron, vitamin A, and vitamin C) using paired t tests and Wilcoxon signed-rank tests, correlation coefficients, and Bland-Altman plots. We obtained 24-hour weighed food records from 20 participants (15 female, 5 male participants; mean age 36.3 years; mean body mass index 22.9 kg/m2) from previous controlled studies conducted at the Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK. Participants had recorded their food consumption over a 24-hour period using standard protocols. Results: The difference in estimation of energy and saturated fat intake between Dietplan6 and the diet apps was not significant. Estimates of protein and sodium intake were significantly lower using Lose It! and FatSecret than using Dietplan6. Lose It! also gave significantly lower estimates for other reported outputs (carbohydrate, fat, fiber, and sodium) than did Dietplan6. Samsung Health and MyFitnessPal significantly underestimated calcium, iron, and vitamin C compared with Dietplan6, although there was no significant difference for vitamin A. We observed no other significant differences between Dietplan6 and the apps. Correlation coefficients ranged from r=–.12 for iron (Samsung Health vs Dietplan6) to r=.91 for protein (FatSecret vs Dietplan6). Noom Coach was limited to energy output, but it had a high correlation with Dietplan6 (r=.91). Samsung Health had the greatest variation of correlation, with energy at r=.79. Bland-Altman analysis revealed potential proportional bias for vitamin A. Conclusions: The findings suggest that the apps provide estimates of energy and saturated fat intake comparable with estimates by Dietplan6. With the exception of Lose It!, the apps also provided comparable estimates of carbohydrate, total fat, and fiber. FatSecret and Lose It! tended to underestimate protein and sodium. Estimates of micronutrient intake (calcium, iron, vitamin A, and vitamin C) by 2 apps (Samsung Health and MyFitnessPal) were inconsistent and less reliable. Lose It! was the app least comparable with Dietplan6. As the use and availability of apps grows, this study helps clinicians and researchers to make better-informed decisions about using these apps in research and practice. %M 30785409 %R 10.2196/mhealth.9838 %U http://mhealth.jmir.org/2019/2/e9838/ %U https://doi.org/10.2196/mhealth.9838 %U http://www.ncbi.nlm.nih.gov/pubmed/30785409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11919 %T Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews %A Park,Jamie Yea Eun %A Li,Jenny %A Howren,Alyssa %A Tsao,Nicole Wen %A De Vera,Mary %+ Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 2138, mdevera@mail.ubc.ca %K medication adherence %K mobile apps %K mHealth %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed. Objective: Our objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users’ perspectives and experiences with mobile phone medication adherence apps. Methods: We searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes. Results: We identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features—specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability). Conclusions: A large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps. %M 30702435 %R 10.2196/11919 %U http://mhealth.jmir.org/2019/1/e11919/ %U https://doi.org/10.2196/11919 %U http://www.ncbi.nlm.nih.gov/pubmed/30702435 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10353 %T Mobile Apps for Management of Tinnitus: Users’ Survey, Quality Assessment, and Content Analysis %A Sereda,Magdalena %A Smith,Sandra %A Newton,Kiri %A Stockdale,David %+ National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232600, Magdalena.Sereda@nottingham.ac.uk %K tinnitus %K mobile apps %K disease management %K surveys and questionnaires %K Mobile Apps Rating Scale %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tinnitus is the perception of a sound without any outside source. It affects 6 million people in the United Kingdom. Sound therapy is a core component of many tinnitus management programs. Potential mechanisms of benefit include making tinnitus less noticeable, habituation, distracting attention from tinnitus, relaxation, and promoting neuroplastic changes within the brain. In recent years, there has been a substantial increase in the use of mobile technology. This provided an additional medium through which people with tinnitus can access different tinnitus management options, including sound therapy. Objective: The aim of this study was to (1) generate the list of apps that people use for management of their tinnitus, (2) explore reasons for app use and nonuse, (3) perform quality assessment of the most cited apps, and (4) perform content analysis to explore and describe options and management techniques available in the most cited apps. Methods: A Web-based survey consisting of 33 open and closed questions captured (1) demographic information, information about tinnitus, and hearing loss and (2) mobile app–specific information about the motivation to use an app, the apps which respondents used for tinnitus, important factors when choosing an app, devices used to access apps, and reasons for not using apps. The quality of the most cited apps was assessed using the Mobile Apps Rating Scale (MARS). Content and features of the most cited apps were analyzed. Results: Data from 643 respondents were analyzed. The majority of respondents (482/643, 75.0%) had never used an app for management of tinnitus mainly because of lack of awareness (381/643, 59.3%). The list of the 55 apps that people use for their tinnitus was generated. These included apps that were developed specifically for the management of tinnitus; however, the majority of cited apps were developed for other problems (eg, sleep, depression or anxiety, and relaxation). Quality assessment of the 18 most popular apps using MARS resulted in a range of mean scores from 1.6 to 4.2 (out of 5). In line with the current model of tinnitus management, sound was the main focus of the majority of the apps. Other components included relaxation exercises, elements of cognitive behavioral therapy, information and education, and hypnosis. Conclusions: People used apps for the management of their tinnitus; however, this was done mostly as a self-help option, without conjunction with management provided by hearing health care professionals. Further research should consider the place for apps in tinnitus management (stand-alone self-management intervention vs part of the management by a hearing professional). As the content of the apps varies with respect to sound options, information, and management strategies, it seems that the choice of the best management app should be guided by individual patient’s needs and preferences. %M 30672739 %R 10.2196/10353 %U http://mhealth.jmir.org/2019/1/e10353/ %U https://doi.org/10.2196/10353 %U http://www.ncbi.nlm.nih.gov/pubmed/30672739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9836 %T Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University %A Bardus,Marco %A Ali,Ahmed %A Demachkieh,Farah %A Hamadeh,Ghassan %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, PO Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 000 ext 4694, marco.bardus@gmail.com %K mobile apps %K weight loss %K physical activity %K healthy diet %K workplace %K mHealth %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective: This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods: A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results: Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions: Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings. %M 30672742 %R 10.2196/mhealth.9836 %U https://mhealth.jmir.org/2019/1/e9836/ %U https://doi.org/10.2196/mhealth.9836 %U http://www.ncbi.nlm.nih.gov/pubmed/30672742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11848 %T Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis %A Jimenez,Geronimo %A Lum,Elaine %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18, Clinical Sciences Building, LKC Medicine, Singapore, 308232, Singapore, 65 69047027, geronimo.jimenez@ntu.edu.sg %K chronic diseases %K diabetes %K Google %K health apps %K mobile phone %D 2019 %7 16.1.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: The availability of smartphone health apps empowers people to manage their own health. Currently, there are over 300,000 health apps available in the market targeting a variety of user needs from weight loss to management of chronic conditions, with diabetes being the most commonly targeted condition. To date, health apps largely fall outside government regulation, and there are no official guidelines to help clinicians and patients in app selection. Patients commonly resort to the internet for suggestions on which diabetes app to use. Objective: The objective of this study was to investigate apps identified through a Google search and characterize these apps in terms of features that support diabetes management. Methods: We performed a Google search for the “best diabetes apps 2017” and explored the first 4 search results. We identified and compiled a list of the apps recommended in the returned search results, which were Web articles. Information about each app was extracted from the papers and corresponding app store descriptions. We examined the apps for the following diabetes management features: medication management, blood glucose self-management, physical activity, diet and nutrition, and weight management. Results: Overall, 26 apps were recommended in 4 papers. One app was listed in all 4 papers, and 3 apps appeared on 3 of the 4 lists. Apart from one paper, there were no explicit criteria to justify or explain the selection of apps. We found a wide variation in the type and the number of diabetes management features in the recommended apps. Five apps required payment to be used. Two-thirds of the apps had blood glucose management features, and less than half had medication management features. The most prevalent app features were nutrition or diet-related (19/24, 79%) and physical activity tracking (14/24, 58%). Conclusions: The ambiguity of app selection and the wide variability in key features of the apps recommended for diabetes management may pose difficulties for patients when selecting the most appropriate app. It is critical to involve patients, clinicians, relevant professional bodies, and policy makers to define the key features an app should have for it to be classified as a “diabetes management” app. The lessons learned here may be extrapolated for the development and recommendation of apps for the management of other chronic conditions. %R 10.2196/11848 %U http://mhealth.jmir.org/2019/1/e11848/ %U https://doi.org/10.2196/11848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11867 %T Mobile Apps to Support Healthy Family Food Provision: Systematic Assessment of Popular, Commercially Available Apps %A Mauch,Chelsea E %A Wycherley,Thomas P %A Laws,Rachel A %A Johnson,Brittany J %A Bell,Lucinda K %A Golley,Rebecca K %+ Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Level 7, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, Australia, 61 882047075, chelsea.mauch@flinders.edu.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern families are facing conflicting demands on their time and resources, which may be at the detriment of child and family diet quality. Innovative nutrition interventions providing parents with behavioral support for the provision of healthy food could alleviate this issue. Mobile apps have the potential to deliver such interventions by providing practical behavioral support remotely, interactively, and in context. Objective: This review aimed to identify and assess popular, commercially available food- and nutrition-related mobile apps that offer support for the provision of healthy family food by (1) describing app scope and characteristics, (2) assessing app quality, and (3) conducting a behavioral analysis of app content and features. Methods: Searches in the Google Play Store and Apple App Store between August 2017 and November 2017 identified apps addressing the food provision process. Apps were included if they were applicable to parents or families, written in English, and with a user rating of ≥4 stars. Weight loss and diet monitoring apps and subscription apps with no free versions were excluded. App quality was assessed using the Mobile App Rating Scale (4 domains: engagement, functionality, aesthetics, and information). App content and features were extracted and behavior change techniques (BCTs) identified. Results: Of the 2881 apps screened, 1.77% (51/2881) were included for assessment, comprising 23 recipe and recipe manager apps, 12 meal planning apps, 10 shopping list apps, 4 family organizers, and 2 food choice apps. Half (n=26) of the apps functioned primarily through user data input. Food choice and family organizer apps scored highest for app quality (mean 3.5 [SD 0.6] out of 5), whereas most apps scored well for functionality and poorly for engagement. Common app features with the potential to support healthy food provision included meal planners (n=26), shopping lists (n=44), and the ability to share app content (n=48). Behavioral support features mapped to relatively few BCTs (mean 3.9 [SD 1.9] per app), with Adding objects to the environment present in all apps, and 65% (33/51) including Instruction on how to perform the behavior. Conclusions: Recipe and recipe manager apps, meal planning apps, and family organizers with integrated meal planning and shopping lists scored well for functionality and incorporated behavioral support features that could be used to address barriers to healthy food provision, although features were focused on planning behaviors. Future apps should combine a range of features such as meal planners, shopping lists, simple recipes, reminders and prompts, and food ordering to reduce the burden of the food provision pathway and incorporate a range of BCTs to maximize behavior change potential. Researchers and developers should consider features and content that improve the engagement quality of such apps. %M 30578213 %R 10.2196/11867 %U http://mhealth.jmir.org/2018/12/e11867/ %U https://doi.org/10.2196/11867 %U http://www.ncbi.nlm.nih.gov/pubmed/30578213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e10314 %T Identifying Evidence-Informed Physical Activity Apps: Content Analysis %A Kebede,Mihiretu %A Steenbock,Berit %A Helmer,Stefanie Maria %A Sill,Janna %A Möllers,Tobias %A Pischke,Claudia R %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstraße 1, Duesseldorf, 40225, Germany, 49 221 81 08599, ClaudiaRuth.Pischke@med.uni-duesseldorf.de %K guidelines %K mHealth %K mobile apps %K physical activity %K mobile phone %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps. Objective: This study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps. Methods: We identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1). Results: The initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters “goals and planning” and “feedback and monitoring” were identified in all apps. Conclusions: Despite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion. %M 30563810 %R 10.2196/10314 %U https://mhealth.jmir.org/2018/12/e10314/ %U https://doi.org/10.2196/10314 %U http://www.ncbi.nlm.nih.gov/pubmed/30563810 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12274 %T Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search %A Wozney,Lori %A Freitas de Souza,Luciane M %A Kervin,Emily %A Queluz,Francine %A McGrath,Patrick J %A Keefe,Janice %+ Nova Scotia Health Authority, 302 Pleasant Street, Dartmouth, NS, B2Y 3Z9, Canada, 1 9024490603, loriwozney@gmail.com %K alzheimer and other related dementias %K apps %K caregivers %K eHealth %K mobile phone %D 2018 %7 07.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: More than 15 million Americans provide unpaid care for persons with Alzheimer disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group format. Alternatively, offering electronic health (eHealth) interventions may assist caregivers in providing quality care while remaining in good health. Research to date has generated little knowledge about what app features support ADRD caregivers’ behavioral changes and how developers might optimize features over the long term. Objective: There is an evident knowledge gap in the current landscape of commercially available apps, their integration of behavioral techniques, content focus, and compliance with usability recommendations. This paper systematically reviews and inventories the apps caregivers might typically be exposed to and determines the support integrated into the apps and their functionality for older adults. Methods: The search strategy was designed to mimic typical Web-based health information-seeking behavior for adults. Apps were included based on their explicit focus on ADRD caregiver knowledge and skill improvement. Two coders with expertise in behavioral interventions and eHealth pilot-tested the data extraction. One coder retained app characteristics and design features. Techniques used to promote change were determined, and 2 questions from the Mobile App Rating Scale were used to assess the app credibility and evidence base. Content topics were evaluated using a thematic framing technique, and each app was assessed using a usability heuristic checklist. Results: The search results generated 18 unique apps that met the inclusion criteria. Some apps were unavailable, and only 8 unique apps were reviewed. Of the 8, 7 (88%) apps did not state which scientific orientation was followed to develop their content. None of the apps made clinical claims of improving caregivers’ and care recipients’ overall health. All apps relied on textual information to disseminate their contents. None of the apps was trialed and evidence based. Apps included on average 7 out of 10 behavioral change techniques, 5 out of 10 C.A.R.E. (Caregivers, Aspirations, Realities, and Expectations) features, and 10 out of 18 features on the usability heuristics checklist. Conclusions: Our findings suggest that caregivers are likely to discover apps that are not actually accessible and have low or no evidence base. Apps were found to be largely static, text-based informational resources, and few supported behaviors needed to maintain caregivers’ health. While apps may be providing a high volume of information, caregivers must still navigate what resources they need with limited guidance. Finally, the commercial marketplace is addressing some of the major usability elements, but many design elements are not addressed. %M 31518255 %R 10.2196/12274 %U http://aging.jmir.org/2018/2/e12274/ %U https://doi.org/10.2196/12274 %U http://www.ncbi.nlm.nih.gov/pubmed/31518255 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10442 %T Smartphone Apps About Crystal Methamphetamine (“Ice”): Systematic Search in App Stores and Assessment of Composition and Quality %A Chapman,Cath %A Champion,Katrina Elizabeth %A Birrell,Louise %A Deen,Hannah %A Brierley,Mary-Ellen %A Stapinski,Lexine A %A Kay-Lambkin,Frances %A Newton,Nicola C %A Teesson,Maree %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Building R1, 22–32 King Street, Sydney, 2031, Australia, 61 2 9385 ext 0317, c.chapman@unsw.edu.au %K internet %K methamphetamine %K mobile phone %K review %K substance-related disorder %D 2018 %7 21.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Amid considerable community concern about the prevalence and harms associated with the use of crystal methamphetamine (“ice”), the increased use of smartphones to access health information and a growing number of available smartphone apps related to crystal methamphetamine, no previous reviews have examined the content and quality of these apps. Objective: This study aims to systematically review existing apps in the iTunes and Google Play Stores to determine the existence, composition, and quality of educational smartphone apps about methamphetamines, including ice. Methods: The iTunes and Google Play Stores were systematically searched in April 2017 for iOS Apple and Android apps, respectively. English-language apps that provided educational content or information about methamphetamine were eligible for inclusion. Eligible apps were downloaded and independently evaluated for quality by 2 reviewers using the Mobile Application Rating Scale (MARS). Results: A total of 2205 apps were initially identified, of which 18 were eligible and rated using the MARS. The mean MARS quality total score for all rated apps was 3.0 (SD 0.6), indicating poor to acceptable quality. Overall, mean scores were the highest for functionality (mean 4.0, SD 0.5) and lowest for engagement (mean 2.3, SD 0.7). Conclusions: This study demonstrates a shortage of high-quality educational and engaging smartphone apps specifically related to methamphetamine. The findings from this review highlight a need for further development of engaging and evidence-based apps that provide educational information about crystal methamphetamine. %M 30463834 %R 10.2196/10442 %U http://mhealth.jmir.org/2018/11/e10442/ %U https://doi.org/10.2196/10442 %U http://www.ncbi.nlm.nih.gov/pubmed/30463834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12237 %T App Features for Type 1 Diabetes Support and Patient Empowerment: Systematic Literature Review and Benchmark Comparison %A Martinez-Millana,Antonio %A Jarones,Elena %A Fernandez-Llatas,Carlos %A Hartvigsen,Gunnar %A Traver,Vicente %+ ITACA, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 963877606, anmarmil@itaca.upv.es %K mHealth %K type 1 diabetes mellitus %K patient empowerment %K apps %K diabetes self-management %D 2018 %7 21.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Research in type 1 diabetes management has increased exponentially since the irruption of mobile health apps for its remote and self-management. Despite this fact, the features affect in the disease management and patient empowerment are adopted by app makers and provided to the general population remain unexplored. Objective: To study the gap between literature and available apps for type 1 diabetes self-management and patient empowerment and to discover the features that an ideal app should provide to people with diabetes. Methods: The methodology comprises systematic reviews in the scientific literature and app marketplaces. We included articles describing interventions that demonstrated an effect on diabetes management with particular clinical endpoints through the use of mobile technologies. The features of these apps were gathered in a taxonomy of what an ideal app should look like to then assess which of these features are available in the market. Results: The literature search resulted in 231 matches. Of these, 55 met the inclusion criteria. A taxonomy featuring 3 levels of characteristics was designed based on 5 papers which were selected for the synthesis. Level 1 includes 10 general features (Personalization, Family support, Agenda, Data record, Insulin bolus calculator, Data management, Interaction, Tips and support, Reminders, and Rewards) Level 2 and Level 3 included features providing a descriptive detail of Level 1 features. Eighty apps matching the inclusion criteria were analyzed. None of the assessed apps fulfilled the features of the taxonomy of an ideal app. Personalization (70/80, 87.5%) and Data record (64/80, 80.0%) were the 2 top prevalent features, whereas Agenda (5/80, 6.3%) and Rewards (3/80, 3.8%) where the less predominant. The operating system was not associated with the number of features (P=.42, F=.81) nor the type of feature (P=.20, χ2=11.7). Apps were classified according to the number of level 1 features and sorted into quartiles. First quartile apps had a regular distribution of the ten features in the taxonomy whereas the other 3 quartiles had an irregular distribution. Conclusions: There are significant gaps between research and the market in mobile health for type 1 diabetes management. While the literature focuses on aspects related to gamification, rewarding, and social communities, the available apps are focused on disease management aspects such as data record and appointments. Personalized and tailored empowerment features should be included in commercial apps for large-scale assessment of potential in the self-management of the disease. %M 30463839 %R 10.2196/12237 %U http://mhealth.jmir.org/2018/11/e12237/ %U https://doi.org/10.2196/12237 %U http://www.ncbi.nlm.nih.gov/pubmed/30463839 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11753 %T Description of Cardiological Apps From the German App Store: Semiautomated Retrospective App Store Analysis %A Albrecht,Urs-Vito %A Hasenfuß,Gerd %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str 1, Hannover, 30625, Germany, 49 511532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mHealth %K mobile health %K mobile apps %K retrospective app store analysis %K cardiology %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the app stores of mobile platforms, consumers are confronted with an enormous number of mobile apps. Over the past few years, considerable research has been undertaken into to identifying, characterizing, and evaluating apps, be it in health-related or other contexts. However, many of these projects are restricted to specific areas of application and offer little flexibility in adapting the applied criteria. Objective: This paper presents an adaptable method for selecting and characterizing mobile apps listed in a mobile App Store (the Apple App Store). The method is based on filtering processes using predefined criteria, through a semiautomated retrospective App Store analysis (SARASA). Methods: To illustrate the SARASA process, keyword-based filtering and metadata-based description, review, and ranking steps were applied to a dataset, more specifically, an April 2018 readout of the Medical category of the German App Store, with the aim of obtaining a list of cardiology-related apps. Results: From the original list of 39,427 apps within the “Medical” category of the App Store on April 14, 2018, 34,382 apps with store descriptions in languages other than German were removed. For the remaining 5045 apps, keywords related to cardiology were applied to filter the output, obtaining a final total of 335 subject-specific apps for further analysis and description. Conclusions: SARASA provides an easy to use method for applying filtering processes to identify apps matching predefined, formal criteria from app stores. The criteria can be well adapted to the needs of users. Automatic and manual analyses are easily combined when using SARASA. In the future, additional features, such as algorithmic topic analyses, may supplement the process. Although the area of application is currently limited to Apple’s App Store, expansion to other stores is planned. The method stands or falls with the transparency of the app store providers and the manufacturers to make relevant meta-information available. It is up to them to liberalize information and restrict censorship to provide clients, customers, and users truly fair circumstances finding their way around the app market. %M 30459140 %R 10.2196/11753 %U http://mhealth.jmir.org/2018/11/e11753/ %U https://doi.org/10.2196/11753 %U http://www.ncbi.nlm.nih.gov/pubmed/30459140 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12261 %T Mobile Phone Apps for Low-Income Participants in a Public Health Nutrition Program for Women, Infants, and Children (WIC): Review and Analysis of Features %A Weber,Summer J %A Dawson,Daniela %A Greene,Haley %A Hull,Pamela C %+ Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN,, United States, 1 615 936 3241, pam.hull@vanderbilt.edu %K WIC %K low-income %K mobile phone %K mHealth %D 2018 %7 19.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Since 1972, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been proven to improve the health of participating low-income women and children in the United States. Despite positive nutritional outcomes associated with WIC, the program needs updated tools to help future generations. Improving technology in federal nutrition programs is crucial for keeping nutrition resources accessible and easy for low-income families to use. Objective: This review aimed to analyze the main features of publicly available mobile phone apps for WIC participants. Methods: Keyword searches were performed in the app stores for the 2 most commonly used mobile phone operating systems between December 2017 and June 2018. Apps were included if they were relevant to WIC and excluded if the target users were not WIC participants. App features were reviewed and classified according to type and function. User reviews from the app stores were examined, including ratings and categorization of user review comments. Results: A total of 17 apps met selection criteria. Most apps (n=12) contained features that required verified access available only to WIC participants. Apps features were classified into categories: (1) shopping management (eg, finding and redeeming food benefits), (2) clinic appointment management (eg, appointment reminders and scheduling), (3) informational resources (eg, recipes, general food list, tips about how to use WIC, links to other resources), (4) WIC-required nutrition education modules, and (5) other user input. Positive user reviews indicated that apps with shopping management features were very useful. Conclusions: WIC apps are becoming increasingly prevalent, especially in states that have implemented electronic benefits transfer for WIC. This review offers new contributions to the literature and practice, as practitioners, software developers, and health researchers seek to improve and expand technology in the program. %M 30455172 %R 10.2196/12261 %U http://mhealth.jmir.org/2018/11/e12261/ %U https://doi.org/10.2196/12261 %U http://www.ncbi.nlm.nih.gov/pubmed/30455172 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e190 %T Medical Correctness and User Friendliness of Available Apps for Cardiopulmonary Resuscitation: Systematic Search Combined With Guideline Adherence and Usability Evaluation %A Metelmann,Bibiana %A Metelmann,Camilla %A Schuffert,Louisa %A Hahnenkamp,Klaus %A Brinkrolf,Peter %+ Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, 17489, Germany, 49 38348760 ext 2848, bibiana.metelmann@uni-greifswald.de %K mHealth %K resuscitation %K review %K guidelines %K mobile phones %K health care information systems %K health informatics %D 2018 %7 06.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In case of a cardiac arrest, start of cardiopulmonary resuscitation by a bystander before the arrival of the emergency personnel increases the probability of survival. However, the steps of high-quality resuscitation are not known by every bystander or might be forgotten in this complex and time-critical situation. Mobile phone apps offering real-time step-by-step instructions might be a valuable source of information. Objective: The aim of this study was to examine mobile phone apps offering real-time instructions in German or English in case of a cardiac arrest, to evaluate their adherence to current resuscitation guidelines, and to test their usability. Methods: Our 3-step approach combines a systematic review of currently available apps guiding a medical layperson through a resuscitation situation, an adherence testing to medical guidelines, and a usability evaluation of the determined apps. The systematic review followed an adapted preferred reporting items for systematic reviews and meta-analyses flow diagram, the guideline adherence was tested by applying a conformity checklist, and the usability was evaluated by a group of mobile phone frequent users and emergency physicians with the system usability scale (SUS) tool. Results: The structured search in Google Play Store and Apple App Store resulted in 3890 hits. After removing redundant ones, 2640 hits were checked for fulfilling the inclusion criteria. As a result, 34 apps meeting all inclusion criteria were identified. These included apps were analyzed to determine medical accuracy as defined by the European Resuscitation Council’s guidelines. Only 5 out of 34 apps (15%, 5/34) fulfilled all criteria chosen to determine guideline adherence. All other apps provided no or wrong information on at least one relevant topic. The usability of 3 apps was evaluated by 10 mobile phone frequent users and 9 emergency physicians. Of these 3 apps, solely the app “HELP Notfall” (median=87.5) was ranked with an SUS score above the published average of 68. This app was rated significantly superior to “HAMBURG SCHOCKT” (median=55; asymptotic Wilcoxon test: z=−3.63, P<.01, n=19) and “Mein DRK” (median=32.5; asymptotic Wilcoxon test: z=−3.83, P<.01, n=19). Conclusions: Implementing a systematic quality control for health-related apps should be enforced to ensure that all products provide medically accurate content and sufficient usability in complex situations. This is of exceptional importance for apps dealing with the treatment of life-threatening events such as cardiac arrest. %M 30401673 %R 10.2196/mhealth.9651 %U http://mhealth.jmir.org/2018/11/e190/ %U https://doi.org/10.2196/mhealth.9651 %U http://www.ncbi.nlm.nih.gov/pubmed/30401673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e68 %T Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review %A Tom-Aba,Daniel %A Nguku,Patrick Mboya %A Arinze,Chinedu Chukwujekwu %A Krause,Gerard %+ Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffen Strasse 7, Braunschweig, 38124, Germany, 49 01739136081, daniel.tom-aba@helmholtz-hzi.de %K case management %K contact tracing %K Ebola virus disease %K eHealth %K mHealth %K systematic review %K West Africa %D 2018 %7 29.10.2018 %9 Review %J JMIR Public Health Surveill %G English %X Background: The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language using the search strategy: (“outbreak” OR “epidemic”) AND (“mobile phone” OR “smartphone” OR “smart phone” OR “mobile phone” OR “tablet” OR “mHealth”) AND (“Ebola” OR ”EVD” OR “VHF” OR “Ebola virus disease” OR “viral hemorrhagic fever”) AND (“2014” OR “2015”). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools’ functionalities. Results: We identified 1220 publications through the search strategy, of which 6.31% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62% (34/55) offered functionalities for surveillance, 22% (10/45) for case management, 18% (7/38) for contact tracing, and 6% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities. Conclusions: Among the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development. %M 30373727 %R 10.2196/publichealth.9015 %U http://publichealth.jmir.org/2018/4/e68/ %U https://doi.org/10.2196/publichealth.9015 %U http://www.ncbi.nlm.nih.gov/pubmed/30373727 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11281 %T Features, Behavioral Change Techniques, and Quality of the Most Popular Mobile Apps to Measure Physical Activity: Systematic Search in App Stores %A Simões,Patrícia %A Silva,Anabela G %A Amaral,João %A Queirós,Alexandra %A Rocha,Nelson P %A Rodrigues,Mário %+ School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234401558 ext 27120, asilva@ua.pt %K behavioral change techniques %K mobile phone app %K physical activity %K quality %K technical features %K mobile phone %D 2018 %7 26.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is estimated that 23% of adults and 55% of older adults do not meet the recommended levels of physical activity. Thus, improving the levels of physical activity is of paramount importance, but it requires the use of low-cost resources that facilitate universal access without depleting the health system. The high number of apps available constitutes an opportunity, but it also makes it quite difficult for the layperson to select the most appropriate app. Furthermore, the information available in the app stores is often insufficient, lacks quality, and is not evidence based, and the systematic reviews fail to assess app quality using standardized and validated instruments. Objective: The objective of this study was to systematically assess the features, content, and quality of the most popular apps that can be used to measure and, potentially, promote physical activity. Methods: Systematic searches were conducted on Apple App Store, Google Play, and Windows Phone Store between December 2017 and January 2018. Apps were included if their primary objective was to assess the aspects of physical activity, if they had a user rating of at least 4, if their number of ratings was ≥100, and if they were free. Apps meeting these criteria were independently assessed by two reviewers regarding their general and technical information, aspects of physical activity, presence of behavioral change techniques, and quality. Data were analyzed using means and SDs or frequencies and percentages. Results: Of 51 apps included, none specified the age of the target group and only one mentioned the involvement of health professionals. Most apps offered the possibility to work in background (n=50) and allowed data sharing (n=40). Regarding physical activity, most apps measured steps and distance (n=11) or steps, distance, and time (n=17). Only 18 apps, all of which measured number of steps, followed the guidelines on recommendations for physical activity. On average, 5.5 (SD 1.8) behavioral change techniques were identified per app; the most frequently used techniques were “provide feedback on performance” (n=50) and “prompt self-monitoring of behavior” (n=50). The overall quality score was 3.88 (SD 0.34). Conclusions: Although the overall quality of the apps was moderate, the quality of their content, particularly the use of international guidelines on physical activity, should be improved. Additionally, a more in-depth assessment of apps should be performed before releasing them for public use, particularly regarding their reliability and validity. %M 30368438 %R 10.2196/11281 %U http://mhealth.jmir.org/2018/10/e11281/ %U https://doi.org/10.2196/11281 %U http://www.ncbi.nlm.nih.gov/pubmed/30368438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10718 %T Measuring the Quality of Mobile Apps for the Management of Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale %A Salazar,Alejandro %A de Sola,Helena %A Failde,Inmaculada %A Moral-Munoz,Jose Antonio %+ The Observatory of Pain, University of Cádiz, Edificio Ciencias de la Salud, Avenida Ana de Viya 52, Cádiz, 11009, Spain, 34 956019086, helena.desolaperea@alum.uca.es %K mobile app %K chronic pain %K Mobile App Rating Scale %K mHealth %K mobile phones %D 2018 %7 25.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic pain is a major health issue requiring an approach that not only considers medication, but also many other factors included in the biopsychosocial model of pain. New technologies, such as mobile apps, are tools to address these factors, although in many cases they lack proven quality or are not based on scientific evidence, so it is necessary to review and measure their quality. Objective: The aim is to evaluate and measure the quality of mobile apps for the management of pain using the Mobile App Rating Scale (MARS). Methods: This study included 18 pain-related mobile apps from the App Store and Play Store. The MARS was administered to measure their quality. We list the scores (of each section and the final score) of every app and we report the mean score (and standard deviation) for an overall vision of the quality of the pain-related apps. We compare the section scores between the groups defined according to the tertiles via analysis of variance (ANOVA) or Kruskal-Wallis test, depending on the normality of the distribution (Shapiro-Wilk test). Results: The global quality ranged from 1.74 (worst app) to 4.35 (best app). Overall, the 18 apps obtained a mean score of 3.17 (SD 0.75). The best-rated sections were functionality (mean 3.92, SD 0.72), esthetics (mean 3.29, SD 1.05), and engagement (mean 2.87, SD 1.14), whereas the worst rated were app specific (mean 2.48, SD 1.00), information (mean 2.52, SD 0.82), and app subjective quality (mean 2.68, SD 1.22). The main differences between tertiles were found on app subjective quality, engagement, esthetics, and app specific. Conclusions: Current pain-related apps are of a certain quality mainly regarding their technical aspects, although they fail to offer information and have an impact on the user. Most apps are not based on scientific evidence, have not been rigorously tested, and the confidentiality of the information collected is not guaranteed. Future apps would need to improve these aspects and exploit the capabilities of current devices. %M 30361196 %R 10.2196/10718 %U http://mhealth.jmir.org/2018/10/e10718/ %U https://doi.org/10.2196/10718 %U http://www.ncbi.nlm.nih.gov/pubmed/30361196 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10237 %T Health Care Apps Reported in Newspapers: Content Analysis %A Al Bawab,Abdel Qader %A AlQahtani,Fahad %A McElnay,James %+ Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom, 44 2890975221, J.mcelnay@qub.ac.uk %K apps %K newspaper articles %K newspapers %K health %D 2018 %7 22.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Newspapers are considered one of the most viewed and influential media sources in both the United Kingdom and United States. However, information about how newspapers portray health care apps to the readers has been lacking. Objective: This study investigated the reporting on health care apps in newspapers published in the United Kingdom and United States. Methods: The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles that met the inclusion criteria (articles of any format that contained reference to health care apps or medical apps) within the highest circulated newspapers in the United Kingdom and United States over a period of 10 years (2006-2015) was conducted. Interrater reliability of coding was established using a 10% sample of the chosen articles. Results: A total of 220 (151 UK and 69 US) relevant newspaper articles were retrieved. Health care apps were most frequently reported on in the Daily Mail and The Guardian (UK newspapers) and in the New York Times and the Washington Post (US newspapers). An exponential rise in published scientific articles (PubMed) on health care-related apps was noted during the study period. A total of 26.4% (58/220) and 19.1% (42/220) of the retrieved newspaper articles appeared in the features and main news sections, respectively. General information about health care apps was the main theme coved by the newspapers (45.9%, 101/220). Most of the articles represented a societal point of view (72.3%, 159/220). The main focus of the articles was on general health matters (48.2%, 106/220) and specific disease matters (36.8%, 81/220). Diabetes was the most frequently mentioned disease in the articles. A high proportion (91.4%, 201/220) of the articles mentioned benefits of using health care apps mainly for personalized care, whereas 24.1% (53/220) of the articles commented on related risks such as anxiety and confidentiality issues. Almost half (45.9%, 101/220) of the articles mentioned potential facilitators to the use of apps; less than 10% (16/220) discussed barriers. Most of the articles (83.6%, 184/220) were judged as having balanced judgment on the present topic and more than half (60.0%, 132/220) of the articles were judged to be of generally low quality. Conclusions: Health care apps were not widely reported in newspaper articles in the United Kingdom and United States over the study period; however, there appeared to be much more recent interest. Characteristically, the articles focused more frequently on societal impact and on general health rather than on disease-specific apps. %M 30348632 %R 10.2196/10237 %U http://mhealth.jmir.org/2018/10/e10237/ %U https://doi.org/10.2196/10237 %U http://www.ncbi.nlm.nih.gov/pubmed/30348632 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e185 %T Assessing the Privacy of mHealth Apps for Self-Tracking: Heuristic Evaluation Approach %A Hutton,Luke %A Price,Blaine A %A Kelly,Ryan %A McCormick,Ciaran %A Bandara,Arosha K %A Hatzakis,Tally %A Meadows,Maureen %A Nuseibeh,Bashar %+ Software Engineering and Design Group, School of Computing and Communications, The Open University, Jenny Lee Building, Milton Keynes, MK7 6AA, United Kingdom, 44 1908653701, b.a.price@open.ac.uk %K privacy %K usable security and privacy %K mHealth apps %K mobile phone %D 2018 %7 22.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The recent proliferation of self-tracking technologies has allowed individuals to generate significant quantities of data about their lifestyle. These data can be used to support health interventions and monitor outcomes. However, these data are often stored and processed by vendors who have commercial motivations, and thus, they may not be treated with the sensitivity with which other medical data are treated. As sensors and apps that enable self-tracking continue to become more sophisticated, the privacy implications become more severe in turn. However, methods for systematically identifying privacy issues in such apps are currently lacking. Objective: The objective of our study was to understand how current mass-market apps perform with respect to privacy. We did this by introducing a set of heuristics for evaluating privacy characteristics of self-tracking services. Methods: Using our heuristics, we conducted an analysis of 64 popular self-tracking services to determine the extent to which the services satisfy various dimensions of privacy. We then used descriptive statistics and statistical models to explore whether any particular categories of an app perform better than others in terms of privacy. Results: We found that the majority of services examined failed to provide users with full access to their own data, did not acquire sufficient consent for the use of the data, or inadequately extended controls over disclosures to third parties. Furthermore, the type of app, in terms of the category of data collected, was not a useful predictor of its privacy. However, we found that apps that collected health-related data (eg, exercise and weight) performed worse for privacy than those designed for other types of self-tracking. Conclusions: Our study draws attention to the poor performance of current self-tracking technologies in terms of privacy, motivating the need for standards that can ensure that future self-tracking apps are stronger with respect to upholding users’ privacy. Our heuristic evaluation method supports the retrospective evaluation of privacy in self-tracking apps and can be used as a prescriptive framework to achieve privacy-by-design in future apps. %M 30348623 %R 10.2196/mhealth.9217 %U http://mhealth.jmir.org/2018/10/e185/ %U https://doi.org/10.2196/mhealth.9217 %U http://www.ncbi.nlm.nih.gov/pubmed/30348623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e174 %T Health and Fitness Apps for Hands-Free Voice-Activated Assistants: Content Analysis %A Chung,Arlene E %A Griffin,Ashley C %A Selezneva,Dasha %A Gotz,David %+ Division of General Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, 5034 Old Clinic Building, CB 7110, Chapel Hill, NC, 27599-7110, United States, 1 9199662276, arlene_chung@med.unc.edu %K voice-activated assistant %K intelligent personal assistant %K virtual personal assistant %K Amazon Alexa %K Google Assistant %K artificial intelligence %K voice-activated technology %K voice assistant %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hands-free voice-activated assistants and their associated devices have recently gained popularity with the release of commercial products, including Amazon Alexa and Google Assistant. Voice-activated assistants have many potential use cases in healthcare including education, health tracking and monitoring, and assistance with locating health providers. However, little is known about the types of health and fitness apps available for voice-activated assistants as it is an emerging market. Objective: This review aimed to examine the characteristics of health and fitness apps for commercially available, hands-free voice-activated assistants, including Amazon Alexa and Google Assistant. Methods: Amazon Alexa Skills Store and Google Assistant app were searched to find voice-activated assistant apps designated by vendors as health and fitness apps. Information was extracted for each app including name, description, vendor, vendor rating, user reviews and ratings, cost, developer and security policies, and the ability to pair with a smartphone app and website and device. Using a codebook, two reviewers independently coded each app using the vendor’s descriptions and the app name into one or more health and fitness, intended age group, and target audience categories. A third reviewer adjudicated coding disagreements until consensus was reached. Descriptive statistics were used to summarize app characteristics. Results: Overall, 309 apps were reviewed; health education apps (87) were the most commonly occurring, followed by fitness and training (72), nutrition (33), brain training and games (31), and health monitoring (25). Diet and calorie tracking apps were infrequent. Apps were mostly targeted towards adults and general audiences with few specifically geared towards patients, caregivers, or medical professionals. Most apps were free to enable or use and 18.1% (56/309) could be paired with a smartphone app and website and device; 30.7% (95/309) of vendors provided privacy policies; and 22.3% (69/309) provided terms of use. The majority (36/42, 85.7%) of Amazon Alexa apps were rated by the vendor as mature or guidance suggested, which were geared towards adults only. When there was a user rating available, apps had a wide range of ratings from 1 to 5 stars with a mean of 2.97. Google Assistant apps did not have user reviews available, whereas most of Amazon Alexa apps had at least 1-9 reviews available. Conclusions: The emerging market of health and fitness apps for voice-activated assistants is still nascent and mainly focused on health education and fitness. Voice-activated assistant apps had a wide range of content areas but many published in the health and fitness categories did not actually have a clear health or fitness focus. This may, in part, be due to Amazon and Google policies, which place restrictions on the delivery of care or direct recording of health data. As in the mobile app market, the content and functionalities may evolve to meet growing demands for self-monitoring and disease management. %M 30249581 %R 10.2196/mhealth.9705 %U http://mhealth.jmir.org/2018/9/e174/ %U https://doi.org/10.2196/mhealth.9705 %U http://www.ncbi.nlm.nih.gov/pubmed/30249581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e11432 %T Mobile Apps for Oral Health Promotion: Content Review and Heuristic Usability Analysis %A Tiffany,Brooks %A Blasi,Paula %A Catz,Sheryl L %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA,, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K oral health %K oral hygiene %K dental care %K mobile health %K eHealth %K review %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been an increase in consumer-facing mobile health (mHealth) apps in recent years. Prior reviews have characterized the availability, usability, or quality of popular mHealth apps targeting a range of health behaviors, but none has examined apps that promote better oral health care. Oral disease affects billions of people worldwide and mobile phone use is on the rise, so the market for well-designed and effective oral health apps is substantial. Objective: We examined the content and usability of popular oral health promotion apps to better understand the current state of these self-help interventions and inform the need and opportunity for future app development. Methods: Between February and March 2018, we identified oral health-focused apps that were designed for Android or iOS, available in English, and targeted adult consumers (as opposed to children or dental health professionals). The sample was limited to the most popular and highly rated apps on each platform. For each app reviewed, we assessed its basic descriptive characteristics (eg, platform, cost), evidence of a theoretical basis or empirical validation, key program functionality, and the extent to which the app addressed diet and tobacco and alcohol use as risk factors for oral disease. We characterized the framing (ie, gain vs loss) of all persuasive messaging and conducted a heuristic analysis to assess each app’s usability as a persuasive health technology. Results: Thirty-three apps were eligible for review based on the selection criteria. Two-thirds (22/33, 67%) were geared toward the general public as opposed to dental clinic patients, insurance plan members, or owners of specific electric toothbrushes. Most (31/33, 94%) were free to download, and a majority (19/33, 58%) were sponsored by software developers as opposed to oral health experts. None offered any theoretical basis for the content or had been empirically validated. Common program features included tools for tracking or reminding one to brush their teeth and assistance scheduling dental appointments. Nineteen apps (58%) included educational or persuasive content intended to influence oral health behavior. Only 32% (6/19) of these included a larger proportion of gain-framed than loss-framed messaging. Most of the apps did not mention diet, alcohol or tobacco—important risk factors for oral disease. Overall, the apps performed poorly on standard usability heuristics recommended for persuasive health technologies. Conclusions: The quality of the reviewed apps was generally poor. Important opportunities exist to develop oral health promotion apps that have theoretically grounded content, are empirically validated, and adhere to good design principles for persuasive health technologies. %M 30181114 %R 10.2196/11432 %U http://mhealth.jmir.org/2018/9/e11432/ %U https://doi.org/10.2196/11432 %U http://www.ncbi.nlm.nih.gov/pubmed/30181114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e158 %T The Complexity of Mental Health App Privacy Policies: A Potential Barrier to Privacy %A Powell,Adam C %A Singh,Preeti %A Torous,John %+ Payer+Provider Syndicate, 111 Beach Street Suite 4e, Boston, MA 02111, United States, 1 617 939 9168, powell@payerprovider.com %K apps %K privacy %K ethics %K mobile phone %D 2018 %7 30.7.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2017, the Supreme Court of India ruled that privacy is a fundamental right of every citizen. Although mobile phone apps have the potential to help people with noncommunicable diseases, such as diabetes and mental illness, they often contain complex privacy policies, which consumers may not understand. This complexity may impede the ability of consumers to make decisions regarding privacy, a critical issue due to the stigma of mental illness. Objective: Our objective is to determine whether mental health apps have more complex privacy policies than diabetes apps. Methods: The study used privacy policies extracted from apps. The apps pertained to diabetes or mental health, and were all of Indian origin. Privacy policy reading complexity was compared between the two types of apps using a series of 15 readability measures. The universe of applicable apps on the Google Play store, as viewed between May and June 2017, was considered. The measures of readability were compared using chi-square tests. Results: No significant difference was found between the privacy policy readability of the diabetes apps versus the mental health apps for each of the measures considered. The mean Flesch-Kincaid Grade Level was 13.9 for diabetes apps and 13.6 for mental health apps; therefore, the mean policy grade level for both types of apps was written at a college level. Privacy policies in the 25th percentile of complexity were also written at a college level for both types of apps. Conclusions: Privacy policy complexity may be a barrier for informed decision making. %M 30061090 %R 10.2196/mhealth.9871 %U http://mhealth.jmir.org/2018/7/e158/ %U https://doi.org/10.2196/mhealth.9871 %U http://www.ncbi.nlm.nih.gov/pubmed/30061090 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e162 %T Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis %A Grossman,Molli R %A Zak,Deanah Kim %A Zelinski,Elizabeth M %+ Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, United States, 1 (213) 740 5156, molliegr@usc.edu %K mobile apps %K aged %K elderly %K caregivers %K family caregivers %K carers %K adult children %K quality of life %K dementia %D 2018 %7 30.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Informal caregivers of older adults provide critical support for their loved ones but are subject to negative health outcomes because of burden and stress. Interventions to provide information and resources as well as social and emotional support reduce burden. Mobile apps featuring access to information, assistance with scheduling, and other features can automate support functions inexpensively and conveniently and reach a greater proportion of caregivers than otherwise possible. Objective: The aim of this study was to identify mobile apps geared towards caregivers of older adults, catalog features, and suggest best practices for adoption based on empirical findings of beneficial interventions in the caregiving literature. Methods: Search for apps focused on ones catered for caregivers of older adults in Google Play and iTunes, compiling their features, and identifying features reflecting categories of support identified in successful intervention studies to negative caregiver outcomes. Intervention research indicates that provision of information and resources, assistance in practical problem solving, coordinating care among multiple caregivers, and emotional support reduce caregiver burden. Results: Despite approximately over 200,000 mobile health–related apps, the availability of mobile apps for caregivers is relatively sparse (n=44 apps) as of October 2017. Apps generally addressed specific categories of support, including information and resources, family communication, and caregiver-recipient interactions. Few apps were comprehensive. Only 8 out of 44 (18%) had features that addressed three or more categories. Few apps provided specific stress reduction exercises for caregivers, which is important for reducing burden. Conclusions: Mobile apps have the potential to provide resources, just­-in­-time information for problem-solving, and stress reduction strategies for caregivers. Many apps offer functions that have been shown to reduce burden and improve health outcomes in caregivers, but few provide emotional support. Using an evidence­-based practice approach, mobile apps for caregivers can provide multiple beneficial support functions. Apps can serve a much larger proportion of this highly underserved population in their mobile form than more traditional means, improving their health and quality of life. %M 30061093 %R 10.2196/mhealth.9345 %U http://mhealth.jmir.org/2018/7/e162/ %U https://doi.org/10.2196/mhealth.9345 %U http://www.ncbi.nlm.nih.gov/pubmed/30061093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e143 %T Analysis of the Features Important for the Effectiveness of Physical Activity–Related Apps for Recreational Sports: Expert Panel Approach %A Dallinga,Joan %A Janssen,Mark %A van der Werf,Jet %A Walravens,Ruben %A Vos,Steven %A Deutekom,Marije %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 621156682, j.m.dallinga@hva.nl %K mobile applications %K exercise %K healthy lifestyle %K mHealth %K measures %K health behavior %K features %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A large number of people participate in individual or unorganized sports on a recreational level. Furthermore, many participants drop out because of injury or lowered motivation. Potentially, physical activity–related apps could motivate people during sport participation and help them to follow and maintain a healthy active lifestyle. It remains unclear what the quality of running, cycling, and walking apps is and how it can be assessed. Quality of these apps was defined as having a positive influence on participation in recreational sports. This information will show which features need to be assessed when rating physical activity–related app quality. Objective: The aim of this study was to identify expert perception on which features are important for the effectiveness of physical activity–related apps for participation in individual, recreational sports. Methods: Data were gathered via an expert panel approach using the nominal group technique. Two expert panels were organized to identify and rank app features relevant for sport participation. Experts were researchers or professionals in the field of industrial design and information technology (technology expert panel) and in the field of behavior change, health, and human movement sciences who had affinity with physical activity–related apps (health science expert panel). Of the 24 experts who were approached, 11 (46%) agreed to participate. Each panel session consisted of three consultation rounds. The 10 most important features per expert were collected. We calculated the frequency of the top 10 features and the mean importance score per feature (0-100). The sessions were taped and transcribed verbatim; a thematic analysis was conducted on the qualitative data. Results: In the technology expert panel, applied feedback and feedforward (91.3) and fun (91.3) were found most important (scale 0-100). Together with flexibility and look and feel, these features were mentioned most often (all n=4 [number of experts]; importance scores=41.3 and 43.8, respectively). The experts in the health science expert panels a and b found instructional feedback (95.0), motivating or challenging (95.0), peer rating and use (92.0), motivating feedback (91.3), and monitoring or statistics (91.0) most important. Most often ranked features were monitoring or statistics, motivating feedback, works good technically, tailoring starting point, fun, usability anticipating or context awareness, and privacy (all n=3-4 [number of experts]; importance scores=16.7-95.0). The qualitative analysis resulted in four overarching themes: (1) combination behavior change, technical, and design features needed; (2) extended feedback and tailoring is advised; (3) theoretical or evidence base as standard; and (4) entry requirements related to app use. Conclusions: The results show that a variety of features, including design, technical, and behavior change, are considered important for the effectiveness of physical activity–related apps by experts from different fields of expertise. These insights may assist in the development of an improved app rating scale. %M 29914863 %R 10.2196/mhealth.9459 %U http://mhealth.jmir.org/2018/6/e143/ %U https://doi.org/10.2196/mhealth.9459 %U http://www.ncbi.nlm.nih.gov/pubmed/29914863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e140 %T The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets %A Zhang,Puhong %A Dong,Le %A Chen,Huan %A Chai,Yanling %A Liu,Jianbo %+ Department of Women and Child Health, The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Beijing, 100088, China, 86 1082800577 ext 512, zpuhong@georgeinstitute.org.cn %K mHealth %K health services, maternal-child %K mobile apps %K market research %D 2018 %7 08.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health services are thriving in the field of maternal and child health in China due to expansions in the field of electronic health and the introduction of the two-child policy. There are numerous maternal and child health apps in computer stores, but the exact number of apps, number of downloads, and features of these apps is not known. Objective: This study aimed to explore the use of maternal and child health apps in Android and iOS app stores and to describe the key functional features of the most popular apps, with the purpose of providing insight into further research and development of maternal and child health mobile health products. Methods: The researchers conducted a search in the 3 most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant, and 360 Mobile Assistant) and the iTunes App Store in China. All apps regarding family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were included in the initial analysis. Maternal and child health mobile apps with predominant features of product marketing, children’s songs, animation, or games were excluded from the study. The 50 most frequently used apps in each of the Android stores as well as the iTunes store (a total of 78 deduplicated apps) were selected and downloaded for an in-depth analysis. Results: A total of 5276 Android apps and 877 iOS apps developed for maternal and child health care were identified. Of the 78 most frequently used apps, 43 (55%) apps focused on one stage of MCH care, mainly targeting child care (25 apps) and before pregnancy care (11 apps), whereas 35 (45%) of the apps covered 2 or more stages, most of which (32 apps) included both pregnancy and child care services. The app features that were commonly adopted by the popular apps were health education, communication, health status self-monitoring, a diary, reminders, and counseling. Within the app feature of “health status self-monitoring,” the researchers found 47 specific tools supporting activities such as pregnancy preparation, fetal heart monitoring, blood glucose and blood pressure monitoring, and doctor visits. A few apps were equipped with external devices (n=3) or sensors. No app with intelligent decision-support features to support disease management for conditions such as gestational diabetes and pregnancy-induced hypertension was found. A small number of apps (n=5) had a Web connection with hospital information systems to support appointment making, payments, hospital service guidance, or checking of laboratory results. Conclusions: There are thousands of maternal and child health apps in the Chinese market. Child care, pregnancy, and before pregnancy were the mostly covered maternal and child health stages, in that order. Various app features and tools were adopted by maternal and child health apps, but the use of internal or external sensors, intelligent decision support, and tethering with existing hospital information systems was rare and these features need more research and development. %M 29884601 %R 10.2196/mhealth.9302 %U http://mhealth.jmir.org/2018/6/e140/ %U https://doi.org/10.2196/mhealth.9302 %U http://www.ncbi.nlm.nih.gov/pubmed/29884601 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10120 %T User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews %A Stawarz,Katarzyna %A Preist,Chris %A Tallon,Debbie %A Wiles,Nicola %A Coyle,David %+ Bristol Interaction Group, Faculty of Engineering, University of Bristol, Merchant Venturers Building, Woodland Road, Bristol, BS8 1UB, United Kingdom, 44 1179545289, k.stawarz@bristol.ac.uk %K mental health %K mobile apps %K cognitive behavioral therapy %K depression %K user experience %K mHealth %D 2018 %7 06.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Hundreds of mental health apps are available to the general public. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. However, although many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited. Objective: The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement. Methods: We systematically identified apps described as being based on cognitive behavioral therapy for depression. We then conducted 2 studies. In the first, we analyzed the therapeutic functionality of apps. This corroborated existing work on apps’ fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression. Results: We identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Privacy, security, and trust were crucial to the user experience. Conclusions: Cognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence-based cognitive behavioral therapy elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidence-based strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance between evidence-based cognitive behavioral therapy strategies and evidence-based design strategies, including the possibility of eclectic therapeutic techniques. %R 10.2196/10120 %U http://www.jmir.org/2018/6/e10120/ %U https://doi.org/10.2196/10120 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10034 %T Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps %A Zhang,Melvyn %A Ying,JiangBo %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K smartphone %K mHealth %K psychiatry %K telemedicine %K mobile applications %D 2018 %7 24.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. %M 29793899 %R 10.2196/10034 %U http://mhealth.jmir.org/2018/5/e10034/ %U https://doi.org/10.2196/10034 %U http://www.ncbi.nlm.nih.gov/pubmed/29793899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10512 %T Supply and Demand in mHealth Apps for Persons With Multiple Sclerosis: Systematic Search in App Stores and Scoping Literature Review %A Giunti,Guido %A Guisado Fernández,Estefanía %A Dorronzoro Zubiete,Enrique %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Seville, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K mHealth %K fatigue %K fatigue management %K apps %K gamification %K user-centered design %K usability, physical activity %K eHealth %K chronic conditions %D 2018 %7 23.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is a non-curable chronic inflammatory disease of the central nervous system that affects more than 2 million people worldwide. MS-related symptoms impact negatively on the quality of life of persons with MS, who need to be active in the management of their health. mHealth apps could support these patient groups by offering useful tools, providing reliable information, and monitoring symptoms. A previous study from this group identified needs, barriers, and facilitators for the use of mHealth solutions among persons with MS. It is unknown how commercially available health apps meet these needs. Objective: The main objective of this review was to assess how the features present in MS apps meet the reported needs of persons with MS. Methods: We followed a combination of scoping review methodology and systematic assessment of features and content of mHealth apps. A search strategy was defined for the two most popular app stores (Google Play and Apple App Store) to identify relevant apps. Reviewers independently conducted a screening process to filter apps according to the selection criteria. Interrater reliability was assessed through the Fleiss-Cohen coefficient (k=.885). Data from the included MS apps were extracted and explored according to classification criteria. Results: An initial total of 581 potentially relevant apps was found. After removing duplicates and applying inclusion and exclusion criteria, 30 unique apps were included in the study. A similar number of apps was found in both stores. The majority of the apps dealt with disease management and disease and treatment information. Most apps were developed by small and medium-sized enterprises, followed by pharmaceutical companies. Patient education and personal data management were among the most frequently included features in these apps. Energy management and remote monitoring were often not present in MS apps. Very few contained gamification elements. Conclusions: Currently available MS apps fail to meet the needs and demands of persons with MS. There is a need for health professionals, researchers, and industry partners to collaborate in the design of mHealth solutions for persons with MS to increase adoption and engagement. %M 29792295 %R 10.2196/10512 %U http://mhealth.jmir.org/2018/5/e10512/ %U https://doi.org/10.2196/10512 %U http://www.ncbi.nlm.nih.gov/pubmed/29792295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e124 %T Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores %A Owens,Otis L %A Beer,Jenay M %A Reyes,Ligia I %A Gallerani,David G %A Myhren-Bennett,Amanda R %A McDonnell,Karen K %+ College of Social Work, University of South Carolina, 1512 Pendelton Street, Room 106, Columbia, SC, 29208, United States, 1 803 777 0384, owenso@mailbox.sc.edu %K mindfulness %K lung neoplasms %K chronic obstructive pulmonary disease %K mobile apps %K review %D 2018 %7 15.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual’s quality of life. Objective: The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). Methods: For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps’ (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. Results: The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. Conclusions: This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language. %M 29764800 %R 10.2196/mhealth.9831 %U http://mhealth.jmir.org/2018/5/e124/ %U https://doi.org/10.2196/mhealth.9831 %U http://www.ncbi.nlm.nih.gov/pubmed/29764800 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e111 %T Managing and Controlling Stress Using mHealth: Systematic Search in App Stores %A Blázquez Martín,David %A De La Torre,Isabel %A Garcia-Zapirain,Begonya %A Lopez-Coronado,Miguel %A Rodrigues,Joel %+ Faculty of Engineering, University of Deusto, Avenida de las Universidades 24, Bilbao,, Spain, 34 944 139 000, mbgarciazapi@deusto.es %K apps %K control %K management %K mHealth %K stress %D 2018 %7 09.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional stress management techniques have been proven insufficient to tackle the needs of today’s population. Computational-based techniques and now mobile health (mHealth) apps are showing promise to enable ease of use and access while educating end users on self-management. Objective: The main aim of this paper was to put forward a systematic review of mHealth apps for stress management. Methods: The scenario chosen for this study consists of a sample of the most relevant mHealth apps found on the British and Spanish online stores of the two main mobile operating systems: iOS and Android. The apps have been categorized and scored base on their impact, presence, number of results, language, and operating system. Results: A total of 433 different mobile apps for stress management was analyzed. Of these apps, 21.7% (94/433) belonged to the “relaxing music” category, 10.9% (47/433) were in the “draw and paint” category, 1.2% (5/433) belonged to the “heart rate control” category, and 1.2% (5/433) fell under “integral methodology.” Only 2.0% (8/433) of the apps qualified as high or medium interest while 98.0% were low interest. Furthermore, 2.0% (8/433) of the apps were available on both iOS and Android, and 98% of apps ran on only one platform (iOS or Android). Conclusions: There are many low-value apps available at the moment, but the analysis shows that they are adding new functionalities and becoming fully integrated self-management systems with extra capabilities such as professional assistance services and online support communities. %M 29743152 %R 10.2196/mhealth.8866 %U http://mhealth.jmir.org/2018/5/e111/ %U https://doi.org/10.2196/mhealth.8866 %U http://www.ncbi.nlm.nih.gov/pubmed/29743152 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e10057 %T Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review %A Athilingam,Ponrathi %A Jenkins,Bradlee %+ University of South Florida, 12901 Bruce B Downs Blvd, MDN 22, Tampa, FL,, United States, 1 813 974 7526, pathilin@health.usf.edu %K heart failure %K self-care management %K mobile health %D 2018 %7 02.05.2018 %9 Review %J JMIR Cardio %G English %X Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration’s tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure–related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. %M 31758762 %R 10.2196/10057 %U http://cardio.jmir.org/2018/1/e10057/ %U https://doi.org/10.2196/10057 %U http://www.ncbi.nlm.nih.gov/pubmed/31758762 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e10394 %T Relevance of Trust Marks and CE Labels in German-Language Store Descriptions of Health Apps: Analysis %A Albrecht,Urs-Vito %A Hillebrand,Uta %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany, 49 511532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mobile phone %K mobile health app %K quality assessment %K quality seals %K medical device regulation %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In addition to mandatory CE marking (“CE” representing Conformité Européenne, with the CE marking being a symbol of free marketability in the European Economic Area) for medical devices, there are various seals, initiatives, action groups, etc, in the health app context. However, whether manufacturers use them to distinguish their apps and attach relevance to them is unclear. Objective: The objective was to take a snapshot of quality seals, regulatory marks, and other orientation aids available on the German app market and to determine whether manufacturers deem such labels relevant enough to apply them to their apps, namely as reflected by mentions in app description texts in a typical app store (ie, Apple’s App Store). Methods: A full survey of the metadata of 103,046 apps from Apple’s German App Store in the Medicine and Health & Fitness categories was carried out. For apps with German-language store descriptions (N=8767), these were automatically searched for the occurrence of relevant keywords and validated manually (N=41). In addition, the websites of various app seal providers were checked for assigned seals. Results: Few manufacturers referenced seals in the descriptions (5/41), although this would have been expected more often based on the seals we were able to identify from the seal providers’ Web pages, and there were 34 of 41 that mentioned CE status in the descriptions. Two apps referenced an app directory curated by experts; however, this is not an alternative to CE marks and seals of approval. Conclusions: Currently, quality seals seem to be irrelevant for manufacturers. In line with regulatory requirements, mentions of medical device status are more frequent; however, neither characteristic is effective for identifying high-quality apps. To improve this situation, a possibly legally obligatory, standardized reporting system should be implemented. %M 29695374 %R 10.2196/10394 %U http://mhealth.jmir.org/2018/4/e10394/ %U https://doi.org/10.2196/10394 %U http://www.ncbi.nlm.nih.gov/pubmed/29695374 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e10173 %T Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps %A Lee,Ying-Li %A Cui,Yan-Yan %A Tu,Ming-Hsiang %A Chen,Yu-Chi %A Chang,Polun %+ Institute of Biomedical Informatics, National Yang-Ming University, No 155, Section 2, Linong St, Beitou District, Taipei, 112, Taiwan, 886 2 2826 7238, polun@ym.edu.tw %K mobile apps %K chronic kidney diseases %K self-management %K continuity of patient care %K patient-centered care %D 2018 %7 20.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients’ self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. Objective: This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. Methods: We used the CKD-related keywords “kidney,” “renal,” “nephro,” “chronic kidney disease,” “CKD,” and “kidney disease” in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. Results: A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were comprehensive clinical calculators (including eGFR; 30/67; 45%), CKD medical professional information (16/67, 24%), stand-alone eGFR calculators (14/67, 21%), and CKD clinical decision support (14/67, 21%). A total of 43 apps with single- or multiple-indicator calculators were found to be suitable for health care professionals and patients. The aspects of patient care apps intended to support self-management of CKD patients were encouraging patients to actively participate in health care (92/110, 83.6%), recognizing and effectively responding to symptoms (56/110, 50.9%), and disease-specific knowledge (53/110, 48.2%). Only 13 apps contained consulting management functions, patient management functions or teleconsultation functions designed to support health care professionals in CKD patient management. Conclusions: This study revealed that the continuity of patient-centered care for CKD provided by mobile health apps is inadequate for both CKD self-management by patients and patient care support for health care professionals. More comprehensive solutions are required to enhance the continuity of patient-centered care for CKD. %M 29678805 %R 10.2196/10173 %U http://mhealth.jmir.org/2018/4/e10173/ %U https://doi.org/10.2196/10173 %U http://www.ncbi.nlm.nih.gov/pubmed/29678805 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e74 %T Consumer Mobile Apps for Potential Drug-Drug Interaction Check: Systematic Review and Content Analysis Using the Mobile App Rating Scale (MARS) %A Kim,Ben YB %A Sharafoddini,Anis %A Tran,Nam %A Wen,Emily Y %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Lyle Hallman North, 3rd Floor, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 31567, joon.lee@uwaterloo.ca %K drug interactions %K telemedicine %K mobile applications %K smartphone %K consumer health informatics %K consumer health information %D 2018 %7 28.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: General consumers can now easily access drug information and quickly check for potential drug-drug interactions (PDDIs) through mobile health (mHealth) apps. With aging population in Canada, more people have chronic diseases and comorbidities leading to increasing numbers of medications. The use of mHealth apps for checking PDDIs can be helpful in ensuring patient safety and empowerment. Objective: The aim of this study was to review the characteristics and quality of publicly available mHealth apps that check for PDDIs. Methods: Apple App Store and Google Play were searched to identify apps with PDDI functionality. The apps’ general and feature characteristics were extracted. The Mobile App Rating Scale (MARS) was used to assess the quality. Results: A total of 23 apps were included for the review—12 from Apple App Store and 11 from Google Play. Only 5 of these were paid apps, with an average price of $7.19 CAD. The mean MARS score was 3.23 out of 5 (interquartile range 1.34). The mean MARS scores for the apps from Google Play and Apple App Store were not statistically different (P=.84). The information dimension was associated with the highest score (3.63), whereas the engagement dimension resulted in the lowest score (2.75). The total number of features per app, average rating, and price were significantly associated with the total MARS score. Conclusions: Some apps provided accurate and comprehensive information about potential adverse drug effects from PDDIs. Given the potentially severe consequences of incorrect drug information, there is a need for oversight to eliminate low quality and potentially harmful apps. Because managing PDDIs is complex in the absence of complete information, secondary features such as medication reminder, refill reminder, medication history tracking, and pill identification could help enhance the effectiveness of PDDI apps. %M 29592848 %R 10.2196/mhealth.8613 %U http://mhealth.jmir.org/2018/3/e74/ %U https://doi.org/10.2196/mhealth.8613 %U http://www.ncbi.nlm.nih.gov/pubmed/29592848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e53 %T Quality of Publicly Available Physical Activity Apps: Review and Content Analysis %A Bondaronek,Paulina %A Alkhaldi,Ghadah %A Slee,April %A Hamilton,Fiona L %A Murray,Elizabeth %+ eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3002 878, p.bondaronek@ucl.ac.uk %K exercise %K health behavior %K mobile applications %K health promotion %K mHealth %K eHealth review %D 2018 %7 21.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. Objective: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. Methods: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users’ data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. Results: Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent—86.3 out of 100. Conclusions: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion. %M 29563080 %R 10.2196/mhealth.9069 %U http://mhealth.jmir.org/2018/3/e53/ %U https://doi.org/10.2196/mhealth.9069 %U http://www.ncbi.nlm.nih.gov/pubmed/29563080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e62 %T Medication Adherence Apps: Review and Content Analysis %A Ahmed,Imran %A Ahmad,Niall Safir %A Ali,Shahnaz %A Ali,Shair %A George,Anju %A Saleem Danish,Hiba %A Uppal,Encarl %A Soo,James %A Mobasheri,Mohammad H %A King,Dominic %A Cox,Benita %A Darzi,Ara %+ Undergraduate Department of Medicine, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 7533568682, Imran.ahmed92@outlook.com %K medication adherence %K patient compliance %K mobile apps %K telemedicine %K smartphone %K reminder systems %K treatment outcome %D 2018 %7 16.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. Objective: The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. Methods: In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. Results: The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were further analyzed to identify strategies used to improve medication adherence. This identified three broad categories of adherence strategies, reminder, behavioral, and educational. A total of 250 apps utilized a single method, 149 apps used two methods, and only 22 apps utilized all three methods. Conclusions: To our knowledge, this is the first study to systematically review all available medication adherence apps on the two largest app repositories. The results demonstrate a concerning lack of HCP involvement in app development and evidence base of effectiveness. More collaboration is required between relevant stakeholders to ensure development of high quality and relevant adherence apps with well-powered and robust clinical trials investigating the effectiveness of these interventions. A sound evidence base will encourage the adoption of effective adherence apps, and thus improve patient welfare in the process. %M 29549075 %R 10.2196/mhealth.6432 %U http://mhealth.jmir.org/2018/3/e62/ %U https://doi.org/10.2196/mhealth.6432 %U http://www.ncbi.nlm.nih.gov/pubmed/29549075 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e4 %T Smartphone Apps Using Photoplethysmography for Heart Rate Monitoring: Meta-Analysis %A De Ridder,Benjamin %A Van Rompaey,Bart %A Kampen,Jarl K %A Haine,Steven %A Dilles,Tinne %+ University Hospital Ghent, De Pintelaan 185, Ghent, 9000, Belgium, 32 472260561, benjaminderidder@gmail.com %K mobile applications %K heart rate %K photoplethysmography %K electrocardiography %K oximetry %K meta-analysis %D 2018 %7 27.02.2018 %9 Review %J JMIR Cardio %G English %X Background: Smartphone ownership is rising at a stunning rate. Moreover, smartphones prove to be suitable for use in health care due to their availability, portability, user-friendliness, relatively low price, wireless connectivity, far-reaching computing capabilities, and comprehensive memory. To measure vital signs, smartphones are often connected to a mobile sensor or a medical device. However, by using the white light-emitting diode as light source and the phone camera as photodetector, a smartphone could be used to perform photoplethysmography (PPG), enabling the assessment of vital signs. Objective: The objective of this meta-analysis was to evaluate the available evidence on the use of smartphone apps to measure heart rate by performing PPG in comparison with a validated method. Methods: PubMed and ISI Web of Knowledge were searched for relevant studies published between January 1, 2009 and December 7, 2016. The reference lists of included studies were hand-searched to find additional eligible studies. Critical Appraisal Skills Programme (CASP) Diagnostic Test Study checklist and some extra items were used for quality assessment. A fixed effects model of the mean difference and a random effects model of Pearson correlation coefficient were applied to pool the outcomes of the studies. Results: In total, 14 studies were included. The pooled result showed no significant difference between heart rate measurements with a smartphone and a validated method (mean difference −0.32; 99% CI −1.24 to 0.60; P=.37). In adults, the Pearson correlation coefficient of the relation between heart rate measurement with a smartphone and a validated method was always ≥.90. In children, the results varied depending on measuring point and heart rate. The pooled result showed a strong correlation that was significant (correlation coefficient .951; 95% CI 0.906-0.975; P<.001). The reported limits of agreement showed good agreement between a smartphone and a validated method. There was a moderately strong significant negative correlation between the year of publication of the included studies and the mean difference (r=−.69; P<.001). Conclusions: Smartphone apps measuring heart rate by performing PPG appear to agree with a validated method in an adult population during resting sinus rhythm. In a pediatric population, the use of these apps is currently not validated. %M 31758768 %R 10.2196/cardio.8802 %U http://cardio.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/cardio.8802 %U http://www.ncbi.nlm.nih.gov/pubmed/31758768 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e22 %T Hospital-Owned Apps in Taiwan: Nationwide Survey %A Liu,Hao-Yen %A Lee,Wui-Chiang %A Sun,Ying-Chou %A Fen,Jun-Jeng %A Chen,Tzeng-Ji %A Chou,Li-Fang %A Hwang,Shinn-Jang %+ Department of Medical Affairs and Planning, Taipei Veterans General Hospital, No 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan, 886 2 28216999, wclee@vghtpe.gov.tw %K hospitals %K telemedicine %K mobile apps %K Taiwan %K mHealth %D 2018 %7 16.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over the last decade, the use of mobile phone apps in the health care industry has grown rapidly. Owing to the high penetration rate of Internet use in Taiwan, hospitals are eager to provide their own apps to improve the accessibility of medical care for patients. Objective: The aims of this study were to provide an overview of the currently available hospital-owned apps in Taiwan and to conduct a cross-hospital comparison of app features. Methods: In May 2017, the availability of apps from all 414 hospitals in Taiwan was surveyed from the hospital home pages and the Google Play app store. The features of the downloaded apps were then examined in detail and, for each app, the release date of the last update, download frequency, and rating score were obtained from Google Play. Results: Among all the 414 hospitals in Taiwan, 150 (36.2%) owned Android apps that had been made available for public use, including 95% (18/19) of the academic medical centers, 77% (63/82) of the regional hospitals, and 22.0% (69/313) of the local community hospitals. Among the 13 different functionalities made available by the various hospital-owned apps, the most common were the doctor search (100%, 150/150), real-time queue monitoring (100%, 150/150), and online appointment scheduling (94.7%, 142/150) functionalities. The majority of apps (57.3%, 86/150) had a rating greater than 4 out of 5, 49.3% (74/150) had been updated at some point in 2017, and 36.0% (54/150) had been downloaded 10,000 to 50,000 times. Conclusions: More than one-third of the hospitals owned apps intended to increase patient access to health care. The most common app features might reflect the health care situation in Taiwan, where the overcrowded outpatient departments of hospitals operate in an open-access mode without any strict referral system. Further research should focus on the effectiveness and safety of these apps. %M 29339347 %R 10.2196/mhealth.8636 %U http://mhealth.jmir.org/2018/1/e22/ %U https://doi.org/10.2196/mhealth.8636 %U http://www.ncbi.nlm.nih.gov/pubmed/29339347 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e3 %T Privacy Policies for Apps Targeted Toward Youth: Descriptive Analysis of Readability %A Das,Gitanjali %A Cheung,Cynthia %A Nebeker,Camille %A Bietz,Matthew %A Bloss,Cinnamon %+ Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, Atkinson Hall, La Jolla, CA, 92093-0811, United States, 1 858 534 9595, cbloss@ucsd.edu %K privacy %K comprehension %K mobile applications %K adolescent %D 2018 %7 04.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Due to the growing availability of consumer information, the protection of personal data is of increasing concern. Objective: We assessed readability metrics of privacy policies for apps that are either available to or targeted toward youth to inform strategies to educate and protect youth from unintentional sharing of personal data. Methods: We reviewed the 1200 highest ranked apps from the Apple and Google Play Stores and systematically selected apps geared toward youth. After applying exclusion criteria, 99 highly ranked apps geared toward minors remained, 64 of which had a privacy policy. We obtained and analyzed these privacy policies using reading grade level (RGL) as a metric. Policies were further compared as a function of app category (free vs paid; entertainment vs social networking vs utility). Results: Analysis of privacy policies for these 64 apps revealed an average RGL of 12.78, which is well above the average reading level (8.0) of adults in the United States. There was also a small but statistically significant difference in word count as a function of app category (entertainment: 2546 words, social networking: 3493 words, and utility: 1038 words; P=.02). Conclusions: Although users must agree to privacy policies to access digital tools and products, readability analyses suggest that these agreements are not comprehensible to most adults, let alone youth. We propose that stakeholders, including pediatricians and other health care professionals, play a role in educating youth and their guardians about the use of Web-based services and potential privacy risks, including the unintentional sharing of personal data. %M 29301737 %R 10.2196/mhealth.7626 %U http://mhealth.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/mhealth.7626 %U http://www.ncbi.nlm.nih.gov/pubmed/29301737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e190 %T Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps %A Jake-Schoffman,Danielle E %A Silfee,Valerie J %A Waring,Molly E %A Boudreaux,Edwin D %A Sadasivam,Rajani S %A Mullen,Sean P %A Carey,Jennifer L %A Hayes,Rashelle B %A Ding,Eric Y %A Bennett,Gary G %A Pagoto,Sherry L %+ Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 (508) 856 6517, danielle.jakeschoffman@umassmed.edu %K mHealth %K mobile health %K mobile applications %K telemedicine/methods %K treatment efficacy %K behavioral medicine %K chronic disease %D 2017 %7 18.12.2017 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Commercial mobile apps for health behavior change are flourishing in the marketplace, but little evidence exists to support their use. This paper summarizes methods for evaluating the content, usability, and efficacy of commercially available health apps. Content analyses can be used to compare app features with clinical guidelines, evidence-based protocols, and behavior change techniques. Usability testing can establish how well an app functions and serves its intended purpose for a target population. Observational studies can explore the association between use and clinical and behavioral outcomes. Finally, efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study designs, including randomized trials, multiphase optimization studies, and N-of-1 studies. Evidence in all these forms would increase adoption of commercial apps in clinical practice, inform the development of the next generation of apps, and ultimately increase the impact of commercial apps. %M 29254914 %R 10.2196/mhealth.8758 %U http://mhealth.jmir.org/2017/12/e190/ %U https://doi.org/10.2196/mhealth.8758 %U http://www.ncbi.nlm.nih.gov/pubmed/29254914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e195 %T Chinese Cardiovascular Disease Mobile Apps’ Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review %A Xie,Bo %A Su,Zhaohui %A Zhang,Wenhui %A Cai,Run %+ Chongqing Cancer Institute, 181 Hanyu Road, Shapingba District, Chongqing, 400030, China, 86 23 6507 5628, cairun0519@163.com %K mobile health %K mHealth %K cardiovascular disease %K CVD %K patient preferences %K information quality %K self-management %K mobile applications %K mobile apps %K China %D 2017 %7 14.12.2017 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. Objective: We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Methods: Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Results: Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps’ providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps’ information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Conclusions: Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users’ preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. %M 29242176 %R 10.2196/mhealth.8549 %U http://mhealth.jmir.org/2017/12/e195/ %U https://doi.org/10.2196/mhealth.8549 %U http://www.ncbi.nlm.nih.gov/pubmed/29242176 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e186 %T How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment %A Zhao,Jing %A Freeman,Becky %A Li,Mu %+ School of Public Health, University of Sydney, Edward Ford Building, A27, Camperdown, New South Wales, 2006, Australia, 61 406502156, jzha5010@uni.sydney.edu.au %K apps %K mobile phone %K Chinese %D 2017 %7 06.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers’ perceptions on apps’ quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. Results: A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization’s infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. Conclusions: The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies. %M 29212627 %R 10.2196/mhealth.8764 %U http://mhealth.jmir.org/2017/12/e186/ %U https://doi.org/10.2196/mhealth.8764 %U http://www.ncbi.nlm.nih.gov/pubmed/29212627 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e156 %T Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review %A Rodriguez-Paras,Carolina %A Tippey,Kathryn %A Brown,Elaine %A Sasangohar,Farzan %A Creech,Suzannah %A Kum,Hye-Chung %A Lawley,Mark %A Benzer,Justin K %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K posttraumatic stress disorders %K PTSD %K mobile health %K mHealth %K anxietys %D 2017 %7 26.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barriers. Objective: The emergence of mobile health (mHealth) apps has the potential to bridge many of these access gaps by providing remote resources and monitoring that can offer discrete assistance to trauma survivors with PTSD and enhance patient-clinician relationships. In this study, we investigate the current mHealth capabilities relevant to PTSD. Methods: This study consists of two parts: (1) a review of publicly available PTSD apps designed to determine the availability of PTSD apps, which includes more detailed information about three dominant apps and (2) a scoping literature review performed using a systematic method to determine app usage and efforts toward validation of such mHealth apps. App usage relates to how the end users (eg, clinicians and patients) are interacting with the app, whereas validation is testing performed to ensure the app’s purpose and specifications are met. Results: The results suggest that though numerous apps have been developed to aid in the diagnosis and treatment of PTSD symptoms, few apps were designed to be integrated with clinical PTSD treatment, and minimal efforts have been made toward enhancing the usability and validation of PTSD apps. Conclusions: These findings expose the need for studies relating to the human factors evaluation of such tools, with the ultimate goal of increasing access to treatment and widening the app adoption rate for patients with PTSD. %M 29074470 %R 10.2196/mhealth.7318 %U http://mhealth.jmir.org/2017/10/e156/ %U https://doi.org/10.2196/mhealth.7318 %U http://www.ncbi.nlm.nih.gov/pubmed/29074470 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e162 %T Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review %A Lalloo,Chitra %A Shah,Ushma %A Birnie,Kathryn A %A Davies-Chalmers,Cleo %A Rivera,Jordan %A Stinson,Jennifer %A Campbell,Fiona %+ The Hospital for Sick Children, Department of Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G1X8, Canada, 1 4168137654 ext 302332, chitra.lalloo@sickkids.ca %K pain, postoperative %K smartphone %K mobile applications %K review %K pain management %K self care %D 2017 %7 23.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recently, the use of smartphones to deliver health-related content has experienced rapid growth, with more than 165,000 mobile health (mHealth) apps currently available in the digital marketplace. With 3 out of 4 Canadians currently owning a smartphone, mHealth apps offer opportunities to deliver accessible health-related knowledge and support. Many individuals experience pain after surgery, which can negatively impact their health-related quality of life, including sleep, emotional, and social functioning. Smartphone apps that provide remote real-time monitoring and symptom management have the potential to improve self-management skills in patients experiencing postoperative pain. Increased confidence and practice of self-management skills could contribute to decreased postoperative pain and reduce risk of developing persistent pain. Published reviews of general pain self-management apps demonstrate a lack of evidence-based content, theoretical grounding, and health care professional involvement. However, no review to date has focused on the app marketplace specific for individuals with postoperative pain. Objective: The aim of this study was to characterize and critically appraise the content and functionality of commercially available postoperative pain self-management apps. Methods: An electronic search and extraction was conducted between December 2016 and March 2017 of the official Canadian app stores for the three major smartphone operating systems (iPhone operating system [iOS], Android, and Windows). Stores were searched separately using predetermined search terms. Two authors screened apps based on information provided in the public app description. Metadata from all included apps were abstracted into a standard spreadsheet. Two authors verified the data with reference to the apps and downloaded apps themselves. The content and functionality of each app as it pertained to postoperative pain self-management was rated. Results: A total of 10 apps met the inclusion criteria. All included apps were designed exclusively for the Android platform. Education was the most common self-management feature offered (8/10, 80%), with none of the apps offering features related to goal setting or social support. Overall, no single app was comprehensive in terms of pain self-management content. Five (50%) apps reported the involvement of a health care provider in their development. However, not a single app involved end users in their development, and none of the apps underwent scientific evaluation. Additionally, none of the apps were designed for use in pediatric patients. Conclusions: Currently available postoperative pain apps for patients lack evidence-based content, goal setting, and social support functions. There is a need to develop and test comprehensive theory-based apps to support patients with pain self-management care following surgery. %M 29061558 %R 10.2196/mhealth.8230 %U http://mhealth.jmir.org/2017/10/e162/ %U https://doi.org/10.2196/mhealth.8230 %U http://www.ncbi.nlm.nih.gov/pubmed/29061558 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e147 %T Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues %A Müthing,Jannis %A Jäschke,Thomas %A Friedrich,Christoph M %+ Department of Computer Science, University of Applied Sciences and Arts Dortmund, Emil-Figge Str. 42, Dortmund, 44227, Germany, 49 231755 ext 6796, christoph.friedrich@fh-dortmund.de %K mobile health %K mobile apps %K data security %K computer security %K confidentiality %K health information technology %D 2017 %7 18.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. Objective: The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Methods: Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Results: Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. Conclusions: The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps used secure connections only for selected tasks, leaving all other traffic vulnerable. %M 29046271 %R 10.2196/mhealth.7791 %U https://mhealth.jmir.org/2017/10/e147/ %U https://doi.org/10.2196/mhealth.7791 %U http://www.ncbi.nlm.nih.gov/pubmed/29046271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e149 %T ADHD: Is There an App for That? A Suitability Assessment of Apps for the Parents of Children and Young People With ADHD %A Powell,Lauren %A Parker,Jack %A Harpin,Valerie %+ School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 114 222 8275, l.a.powell@sheffield.ac.uk %K attention deficit disorder with hyperactivity %K mobile applications %K technology %D 2017 %7 13.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Attention-deficit hyperactivity disorder (ADHD) is a highly comorbid disorder that can impact significantly on the individual and their family. ADHD is managed via pharmacological and nonpharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms, as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile apps have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence-based, and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: The aim of this study was to explore the (1) parents’ views of the suitability of the top ten listed apps for parents of children and young people with ADHD and (2) the views of clinicians that work with them on the suitability and value of the apps. Methods: The top 10 listed apps specifically targeted toward the parents of children and young people with ADHD were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 7 parents of children or young people with ADHD and 6 clinicians who specialize in working with this population to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Four themes emerged from clinician and parent interviews: (1) the importance of relating to the app, (2) apps that address ADHD-related difficulties, (3) how the apps can affect family relationships, and (4) apps as an educational tool. Two additional themes emerged from the clinician interviews alone: monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme: the importance of the technology. Overall, the characteristics of the current top 10 listed apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required to explore the value of apps with this population and how they can be tailored to their very specific needs. %M 29030325 %R 10.2196/mhealth.7941 %U http://mhealth.jmir.org/2017/10/e149/ %U https://doi.org/10.2196/mhealth.7941 %U http://www.ncbi.nlm.nih.gov/pubmed/29030325 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e130 %T Mobile Apps for Suicide Prevention: Review of Virtual Stores and Literature %A de la Torre,Isabel %A Castillo,Gema %A Arambarri,Jon %A López-Coronado,Miguel %A Franco,Manuel A %+ Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, isator@tel.uva.es %K app %K literature %K prevention %K suicide %K virtual stores %D 2017 %7 10.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The best manner to prevent suicide is to recognize suicidal signs and signals, and know how to respond to them. Objective: We aim to study the existing mobile apps for suicide prevention in the literature and the most commonly used virtual stores. Methods: Two reviews were carried out. The first was done by searching the most commonly used commercial app stores, which are iTunes and Google Play. The second was a review of mobile health (mHealth) apps in published articles within the last 10 years in the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore, and Google Scholar. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically designed for suicide prevention. All apps were free and most were designed for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases; in these studies, some real experiences with physicians, caregivers, and families were described. The importance of these people in suicide prevention was indicated. Conclusions: The number of apps regarding suicide prevention is small, and there was little information available from literature searches, indicating that technology-based suicide prevention remains understudied. Many of the apps provided no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these apps can benefit end users, either by improving their health monitoring or simply to verify their body condition. %M 29017992 %R 10.2196/mhealth.8036 %U https://mhealth.jmir.org/2017/10/e130/ %U https://doi.org/10.2196/mhealth.8036 %U http://www.ncbi.nlm.nih.gov/pubmed/29017992 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e145 %T Attention Deficit Hyperactivity Disorder: Is There an App for That? Suitability Assessment of Apps for Children and Young People With ADHD %A Powell,Lauren %A Parker,Jack %A Robertson,Naomi %A Harpin,Valerie %+ School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 11422 ext 28275, l.a.powell@sheffield.ac.uk %K attention deficit disorder with hyperactivity %K mobile applications %K technology %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is a complex highly comorbid disorder, which can have a huge impact on those with ADHD, their family, and the community around them. ADHD is currently managed using pharmacological and nonpharmacological interventions. However, with advances in technology and an increase in the use of mobile apps, managing ADHD can be augmented using apps specifically designed for this population. However, little is known regarding the suitability and usability of currently available apps. Objective: The aim of this study was to explore the suitability of the top 10 listed apps for children and young people with ADHD and clinicians who work with them. It is hypothesized that mobile apps designed for this population could be more suitably designed for this population. Methods: The top 10 listed apps that are specifically targeted toward children and young people with ADHD in the United Kingdom were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 5 clinicians who specialize in treating this population and 5 children and young people with ADHD themselves, to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable for this population. Results: Five themes emerged from clinician and young people interviews: the accessibility of the technology, the importance of relating to apps, addressing ADHD symptoms and related difficulties, age appropriateness, and app interaction. Three additional themes emerged from the clinician interviews alone: monitoring symptoms, side effects and app effect on relationships, and the impact of common comorbid conditions. The characteristics of the apps did not appear to match well with the views of our sample. Conclusions: These findings suggest that the apps may not be suitable in meeting the complex needs associated with this condition. Further research is required to explore the value of apps for children and young people with ADHD and their families and, in particular, any positive role for apps in the management of ADHD in this age group. A systematic review on how technology can be used to engage this population and how it can be used to help them would be a useful way forward. This could be the platform to begin exploring the use of apps further. %M 28978497 %R 10.2196/mhealth.7371 %U http://mhealth.jmir.org/2017/10/e145/ %U https://doi.org/10.2196/mhealth.7371 %U http://www.ncbi.nlm.nih.gov/pubmed/28978497 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 2 %P e15 %T Mobile Apps for Teaching Intubation: Scoping Review and Critical Analysis in eLearning %A Matava,Clyde %A Leo,Anne-Marie %A Alam,Fahad %+ Hospital for Sick Children, Anesthesia and Pain Medicine, 555 University Avenue, Toronto, ON,, Canada, 1 416 813 7445, clyde.matava@sickkids.ca %K anesthesia %K apps %K eLearning %K mLearning %K intubation %K difficult airway %K residents %K anesthesiology %D 2017 %7 05.09.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Airway management is a core skill in anesthesia ensuring adequate oxygenation and delivery of inhalational agents for the patient. Objective: The goals of this study were to critically evaluate the quality of airway management apps and target revised Bloom's Taxonomy cognitive levels. Methods: An electronic search using the keywords “airway” and “airway management” was conducted in May 2015 across the App Store, Google Play, BlackBerry World, and Windows Store. Apps were included in the study if their content was related to airway management. App content and characteristics were extracted into a standard form and evaluated. Results: A total of 65 apps met the inclusion criteria, and 73% (47/65) of apps were developed by companies or industry. Anesthesiology trainees were the target audience in only 20% (13/65) of apps. Bag mask ventilation and laryngeal mask airways were covered in only 20% (13/65) of apps. Only 2 apps were supported in the scientific literature. For Bloom’s Taxonomy, 37% (24/65) of apps targeted knowledge, 5% (3/65) comprehension, 22% (14/65) application, 28% (18/65) analysis, 9% (6/65) evaluation, and 0% synthesis. Multivariate analysis identified cost of apps, size of apps (MB), and apps targeting trainees and paramedics to be associated with higher levels of cognitive processing of revised Bloom’s Taxonomy. Conclusions: Apps developed for teaching intubation target lower levels of cognitive processing and are largely not validated by research. Cost, app size, and targeted user are associated with higher cognitive levels. Trainees and all users should be aware of the paucity of the published evidence behind the efficacy of some of these apps. %M 28874335 %R 10.2196/mededu.7919 %U http://mededu.jmir.org/2017/2/e15/ %U https://doi.org/10.2196/mededu.7919 %U http://www.ncbi.nlm.nih.gov/pubmed/28874335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e113 %T The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps %A Tinschert,Peter %A Jakob,Robert %A Barata,Filipe %A Kramer,Jan-Niklas %A Kowatsch,Tobias %+ Center for Digital Health Interventions, Institute of Technology Management (ITEM-HSG), University of St. Gallen, Central Institute Buidling, 1st Fl., Dufourstrasse 40a, St. Gallen, 9000, Switzerland, 41 71 224 ext 7244, tobias.kowatsch@unisg.ch %K asthma %K self care %K disease management %K mobile applications %K smartphone %K mHealth %K eHealth %K mobile health %K behavior and behavior mechanisms %K review %D 2017 %7 02.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective disease self-management lowers asthma’s burden of disease for both individual patients and health care systems. In principle, mobile health (mHealth) apps could enable effective asthma self-management interventions that improve a patient’s quality of life while simultaneously reducing the overall treatment costs for health care systems. However, prior reviews in this field have found that mHealth apps for asthma lack clinical evaluation and are often not based on medical guidelines. Yet, beyond the missing evidence for clinical efficacy, little is known about the potential apps might have for improving asthma self-management. Objective: The aim of this study was to assess the potential of publicly available and well-adopted mHealth apps for improving asthma self-management. Methods: The Apple App store and Google Play store were systematically searched for asthma apps. In total, 523 apps were identified, of which 38 apps matched the selection criteria to be included in the review. Four requirements of app potential were investigated: app functions, potential to change behavior (by means of a behavior change technique taxonomy), potential to promote app use (by means of a gamification components taxonomy), and app quality (by means of the Mobile Application Rating Scale [MARS]). Results: The most commonly implemented functions in the 38 reviewed asthma apps were tracking (30/38, 79%) and information (26/38, 68%) functions, followed by assessment (20/38, 53%) and notification (18/38, 47%) functions. On average, the reviewed apps applied 7.12 of 26 available behavior change techniques (standard deviation [SD]=4.46) and 4.89 of 31 available gamification components (SD=4.21). Average app quality was acceptable (mean=3.17/5, SD=0.58), whereas subjective app quality lied between poor and acceptable (mean=2.65/5, SD=0.87). Additionally, the sum scores of all review frameworks were significantly correlated (lowest correlation: r36=.33, P=.04 between number of functions and gamification components; highest correlation: r36=.80, P<.001 between number of behavior change techniques and gamification components), which suggests that an app’s potential tends to be consistent across review frameworks. Conclusions: Several apps were identified that performed consistently well across all applied review frameworks, thus indicating the potential mHealth apps offer for improving asthma self-management. However, many apps suffer from low quality. Therefore, app reviews should be considered as a decision support tool before deciding which app to integrate into a patient’s asthma self-management. Furthermore, several research-practice gaps were identified that app developers should consider addressing in future asthma apps. %M 28768606 %R 10.2196/mhealth.7177 %U http://mhealth.jmir.org/2017/8/e113/ %U https://doi.org/10.2196/mhealth.7177 %U http://www.ncbi.nlm.nih.gov/pubmed/28768606 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e12 %T iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in Medication Adherence %A Martinez,Mark %A Park,Su Bin %A Maison,Isaac %A Mody,Vicky %A Soh,Lewis Sungkon %A Parihar,Harish Singh %+ Philadelphia College of Osteopathic Medicine - GA campus, School of Pharmacy, 625 Old Peachtree Rd NW, School of Pharmacy, Suwanee, GA, 30024, United States, 1 6784077350, harishpa@pcom.edu %K diabetes %K telemedicine %K blood glucose self-monitoring glucose monitoring %K mobile applications %K self-care %K mobile health %D 2017 %7 11.07.2017 %9 Case Report %J JMIR Diabetes %G English %X Background: Currently, various phone apps have been developed to assist patients. Many of these apps are developed to assist patients in the self-management of chronic diseases such as diabetes. It is essential to analyze these various apps to understand the key features that would potentially be instrumental in helping patients successfully achieve goals in disease self-management. Objective: The objective of this study was to conduct a review of all the available diabetes-related apps in the iOS App Store to evaluate which diabetic app is more interactive and offers a wide variety of operations such as monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI), medication, blood pressure (BP) levels, reminders or push notifications, food database, charts, exercise management, email, sync between devices, syncing data directly to the prescribers, and other miscellaneous functions such as (Twitter integration, password protection, retina display, barcode scanner, apple watch functionality, and cloud syncing). Methods: Data was gathered using the iOS App Store on an iPad. The search term “diabetes” resulted in 1209 results. Many of the results obtained were remotely related to diabetes and focused mainly on diet, exercise, emergency services, refill reminders, providing general diabetes information, and other nontherapeutic options. We reviewed each app description and only included apps that were meant for tracking blood glucose levels. All data were obtained in one sitting by one person on the same device, as we found that carrying out the search at different times or on different devices (iPhones) resulted in varying results. Apps that did not have a feature for tracking glucose levels were excluded from the study. Results: The search resulted in 1209 results; 85 apps were retained based on the inclusion criteria mentioned above. All the apps were reviewed for average customer ratings, number of reviews, price, and functions. Of all the apps surveyed, 18 apps with the highest number of user ratings were used for in-depth analysis. Of these 18 apps, 50% (9/18) also had a medication adherence function. Our analysis revealed that the Diabetes logbook used by the mySugr app was one of the best; it differentiated itself by introducing fun as a method of increasing adherence. Conclusions: A large variation was seen in patient ratings of app features. Many patient reviewers desired simplicity of app functions. Glucose level tracking and email features potentially helped patients and health care providers manage the disease more efficiently. However, none of the apps could sync data directly to the prescribers. Additional features such as graph customization, availability of data backup, and recording previous entries were also requested by many users. Thus, the use of apps in disease management and patient and health-care provider involvement in future app refinement and development should be encouraged. %M 30291096 %R 10.2196/diabetes.6468 %U http://diabetes.jmir.org/2017/2/e12/ %U https://doi.org/10.2196/diabetes.6468 %U http://www.ncbi.nlm.nih.gov/pubmed/30291096 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e93 %T Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study %A Cheng,Feng %A Xu,Junfang %A Su,Chunyan %A Fu,Xiaoxing %A Bricker,Jonathan %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA,, United States, 1 206 667 5074, jbricker@fredhutch.org %K smoking cessation %K smartphone apps %K China %D 2017 %7 11.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. %M 28698170 %R 10.2196/mhealth.7462 %U http://mhealth.jmir.org/2017/7/e93/ %U https://doi.org/10.2196/mhealth.7462 %U http://www.ncbi.nlm.nih.gov/pubmed/28698170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e233 %T Tracing the Potential Flow of Consumer Data: A Network Analysis of Prominent Health and Fitness Apps %A Grundy,Quinn %A Held,Fabian P %A Bero,Lisa A %+ Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, D17, Level 6 The Hub, Charles Perkins Centre, Sydney, 2006, Australia, 61 286271566, quinn.grundy@sydney.edu.au %K mobile health %K smartphone %K privacy %D 2017 %7 28.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A great deal of consumer data, collected actively through consumer reporting or passively through sensors, is shared among apps. Developers increasingly allow their programs to communicate with other apps, sensors, and Web-based services, which are promoted as features to potential users. However, health apps also routinely pose risks related to information leaks, information manipulation, and loss of information. There has been less investigation into the kinds of user data that developers are likely to collect, and who might have access to it. Objective: We sought to describe how consumer data generated from mobile health apps might be distributed and reused. We also aimed to outline risks to individual privacy and security presented by this potential for aggregating and combining user data across apps. Methods: We purposively sampled prominent health and fitness apps available in the United States, Canada, and Australia Google Play and iTunes app stores in November 2015. Two independent coders extracted data from app promotional materials on app and developer characteristics, and the developer-reported collection and sharing of user data. We conducted a descriptive analysis of app, developer, and user data collection characteristics. Using structural equivalence analysis, we conducted a network analysis of sampled apps’ self-reported sharing of user-generated data. Results: We included 297 unique apps published by 231 individual developers, which requested 58 different permissions (mean 7.95, SD 6.57). We grouped apps into 222 app families on the basis of shared ownership. Analysis of self-reported data sharing revealed a network of 359 app family nodes, with one connected central component of 210 app families (58.5%). Most (143/222, 64.4%) of the sampled app families did not report sharing any data and were therefore isolated from each other and from the core network. Fifteen app families assumed more central network positions as gatekeepers on the shortest paths that data would have to travel between other app families. Conclusions: This cross-sectional analysis highlights the possibilities for user data collection and potential paths that data is able to travel among a sample of prominent health and fitness apps. While individual apps may not collect personally identifiable information, app families and the partners with which they share data may be able to aggregate consumer data, thus achieving a much more comprehensive picture of the individual consumer. The organizations behind the centrally connected app families represent diverse industries, including apparel manufacturers and social media platforms that are not traditionally involved in health or fitness. This analysis highlights the potential for anticipated and voluntary but also possibly unanticipated and involuntary sharing of user data, validating privacy and security concerns in mobile health. %M 28659254 %R 10.2196/jmir.7347 %U http://www.jmir.org/2017/6/e233/ %U https://doi.org/10.2196/jmir.7347 %U http://www.ncbi.nlm.nih.gov/pubmed/28659254 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e83 %T Users’ Adoption of Mental Health Apps: Examining the Impact of Information Cues %A Huang,Hsiao-Ying %A Bashir,Masooda %+ School of Information Sciences, University of Illinois at Urbana-Champaign, 501 Daniel St., Champaign, IL, 61802, United States, 1 217 244 1139, mnb@illinois.edu %K user interaction design %K recommendation system %K mobile app search %K mental health %K anxiety %D 2017 %7 28.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous mental health apps have been developed and made available to users on the current app market. Users may find it difficult and overwhelming to select apps from the hundreds of choices that are available in the app marketplace. Clarifying what information cues may impact a user’s selection and adoption of mental health apps is now a critical and pressing issue. Objective: The aim of this study was to investigate the impact of information cues on users’ adoption of anxiety apps using observational data from the Android app market. Methods: A systematic search of anxiety apps was conducted on the Android app store by using keywords search. The title and metadata information of a total of 274 apps that met our criteria were collected and analyzed. Three trained researchers recorded the app rankings from the search results page on different dates and Web browsers. Results: Our results show that ratings (r=.56, P<.001) and reviews (r=.39, P<.001) have significant positive correlations with the number of installs, and app prices have significant negative correlations with installs (r=−.36). The results also reveal that lower-priced apps have higher ratings (r=−.23, P<.001) and a greater number of app permission requests (r=.18, P=.002) from the device. For app titles, we found that apps with titles related to symptoms have significantly lower installs than apps with titles that are not related to symptoms (P<.001). Conclusions: This study revealed a relationship between information cues and users’ adoption of mental health apps by analyzing observational data. As the first of its kind, we found impactful indicators for mental health app adoptions. We also discovered a labeling effect of app titles that could hinder mental health app adoptions and which may provide insight for future designs of mental health apps and their search mechanisms. %M 28659256 %R 10.2196/mhealth.6827 %U http://mhealth.jmir.org/2017/6/e83/ %U https://doi.org/10.2196/mhealth.6827 %U http://www.ncbi.nlm.nih.gov/pubmed/28659256 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e84 %T Mobile Apps for Eye Care in Canada: An Analysis of the iTunes Store %A Rodin,Alexander %A Shachak,Aviv %A Miller,Aaron %A Akopyan,Vladimir %A Semenova,Nataliya %+ TorontoEyeExam.com, Sears Optical, 240 Leighland Ave, Oakville, ON, L6H 3H6, Canada, 1 905 338 84 54, optometristrichmondhill@gmail.com %K mobile applications %K mobile phone %K ophthalmology %K optometry %D 2017 %7 14.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone screens can facilitate stimulation to various components of the visual system and many mobile apps are accepted as a means of providing clinical assessments for the oculo-visual system. Although many of these apps are intended for use in clinical settings, there is a growing number of apps in eye care developed for self-tests and eye exercises for lay people. These and other features, however, have not yet been well described. Objective: Our objective was to identify, describe, and categorize mobile apps related to eye care that are available to users in the Canadian iTunes market. Methods: We conducted an extensive search of the Apple iTunes Store for apps related to eye care. We used the terms “eye,” “eye care,” “vision,” and “eye test” and included apps that are targeted at both lay people and medical professionals. We excluded apps whose primary function is not related to eye care. Eligible apps were categorized by primary purpose, based on how they were described by their developers in the iTunes Store. Results: Our search yielded 10,657 apps, of which 427 met our inclusion criteria. After removing duplicates, 355 unique apps were subject to further review. We assigned the eligible apps to three distinct categories: 39/355 apps (11.0%) were intended for use by medical professionals, 236 apps (66.5%, 236/355) were intended for use by lay people, and 80 apps (22.5%, 80/355) were intended for marketing eye care and eye-care products. We identified 9 subcategories of apps based on the descriptions of their primary functions. Apps for medical professionals fell into three subcategories: clinical calculators (n=6), clinical diagnostic tools (n=18), and education and networking apps for professionals (n=15). Apps for lay people fell into four subcategories: self-testing (n=153), eye exercises (n=30), patient tools and low vision aids (n=35), and apps for patient education (n=18). Mixed-use apps (n=80) were placed into two subcategories: marketing of individual practitioners or eye-care products (n=72) and marketing of multiple eye-care products or professional services. Conclusions: The most extensive subcategory pertaining to eye care consisted of apps for use by lay people, especially for conducting self-tests (n=236). This study revealed a previously uncharacterized category of apps intended for use by doctors and patients, of which the primary goal is marketing of eye-care services and products (n=80). %M 28615154 %R 10.2196/mhealth.7055 %U http://mhealth.jmir.org/2017/6/e84/ %U https://doi.org/10.2196/mhealth.7055 %U http://www.ncbi.nlm.nih.gov/pubmed/28615154 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e13 %T Gamification in Stress Management Apps: A Critical App Review %A Hoffmann,Alexandra %A Christmann,Corinna A %A Bleser,Gabriele %+ Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Gottlieb-Daimler-Str. 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, hoffmann@cs.uni-kl.de %K game element %K mHealth, motivation %K app %K behavior change %K gamification %D 2017 %7 07.06.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective: The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods: A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results: Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions: This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. %M 28592397 %R 10.2196/games.7216 %U http://games.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/games.7216 %U http://www.ncbi.nlm.nih.gov/pubmed/28592397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e152 %T Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service %A Bastl,Katharina %A Berger,Uwe %A Kmenta,Maximilian %+ Research group Aerobiology and pollen information, Department of Oto-Rhino-Laryngology, Medical University of Vienna, HNO-Klinik, 8J, Währinger Gürtel 18-20, Wien, 1090, Austria, 43 140400 ext 33380, katharina.bastl@meduniwien.ac.at %K pollen forecast %K pollen information service %K mobile app %K pollen forecast quality %K allergen avoidance %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date. Objective: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers. Methods: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today’s grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter. Results: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the “readiness to flower” for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps. Conclusions: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered. %M 28483740 %R 10.2196/jmir.7426 %U http://www.jmir.org/2017/5/e152/ %U https://doi.org/10.2196/jmir.7426 %U http://www.ncbi.nlm.nih.gov/pubmed/28483740 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e45 %T Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points %A Dayer,Lindsey E %A Shilling,Rebecca %A Van Valkenburg,Madalyn %A Martin,Bradley C %A Gubbins,Paul O %A Hadden,Kristie %A Heldenbrand,Seth %+ Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W Markham, Little Rock, AR, 72205, United States, 1 501 526 4211, ledayer@uams.edu %K smartphone %K apps %K adherence %K medication %K health literacy %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. Objective: The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Methods: Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. Results: A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). Conclusions: More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently. %M 28428169 %R 10.2196/mhealth.6582 %U http://mhealth.jmir.org/2017/4/e45/ %U https://doi.org/10.2196/mhealth.6582 %U http://www.ncbi.nlm.nih.gov/pubmed/28428169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e35 %T Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy %A Wu,Yuan %A Yao,Xun %A Vespasiani,Giacomo %A Nicolucci,Antonio %A Dong,Yajie %A Kwong,Joey %A Li,Ling %A Sun,Xin %A Tian,Haoming %A Li,Sheyu %+ Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guoxue Road, Wuhou District, Chengdu, 610041, China, 86 13194874843, lisheyu@gmail.com %K mobile health %K mHealth %K mobile applications %K mobile apps %K diabetes mellitus %K classification %D 2017 %7 14.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. Objective: The aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. Methods: We developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. Results: Across 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI –0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI –0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI –0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). Conclusions: The use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps. %M 28292740 %R 10.2196/mhealth.6522 %U http://mhealth.jmir.org/2017/3/e35/ %U https://doi.org/10.2196/mhealth.6522 %U http://www.ncbi.nlm.nih.gov/pubmed/28292740 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e20 %T Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis %A Ginossar,Tamar %A Shah,Sayyed Fawad Ali %A West,Andrew J %A Bentley,Joshua M %A Caburnay,Charlene A %A Kreuter,Matthew W %A Kinney,Anita Y %+ Department of Communication and Journalism, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87108, United States, 1 5052775305, ginossar@unm.edu %K mobile phones %K mobile apps %K breast cancer %K cancer-related content %D 2017 %7 13.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps. Objective: This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price. Methods: Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM). Results: The most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms. Conclusions: Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities. %M 28288954 %R 10.2196/mhealth.7073 %U http://mhealth.jmir.org/2017/3/e20/ %U https://doi.org/10.2196/mhealth.7073 %U http://www.ncbi.nlm.nih.gov/pubmed/28288954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e67 %T Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument %A Guo,Yi %A Bian,Jiang %A Leavitt,Trevor %A Vincent,Heather K %A Vander Zalm,Lindsey %A Teurlings,Tyler L %A Smith,Megan D %A Modave,François %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Suite 2251 PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5969, yiguo@ufl.edu %K mHealth %K mobile apps %K physical activity %K measures %D 2017 %7 07.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality. Objective: The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM). Methods: We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers’ scores to the criterion scores. Results: Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70. Conclusions: We have developed and presented valid and reliable scoring instruments for exercise program apps. Our instrument may be useful for consumers and health care providers who are looking for apps that provide safe, progressive general exercise programs for health and fitness. %M 28270378 %R 10.2196/jmir.6976 %U http://www.jmir.org/2017/3/e67/ %U https://doi.org/10.2196/jmir.6976 %U http://www.ncbi.nlm.nih.gov/pubmed/28270378 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e7 %T Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis %A Ferron,Joelle C %A Brunette,Mary F %A Geiger,Pamela %A Marsch,Lisa A %A Adachi-Mejia,Anna M %A Bartels,Stephen J %+ Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth Hitchcock Medical Center, 105 Pleasant Street, Hugh Gallon Office Park, Main Bldg, Concord, NH, 03301, United States, 1 603 271 5044, joelle.ferron@dartmouth.edu %K mHealth %K mobile apps %K smoking cessation %K schizophrenia %K psychotic disorders %D 2017 %7 03.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly—66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. %M 28258047 %R 10.2196/humanfactors.5933 %U http://humanfactors.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/humanfactors.5933 %U http://www.ncbi.nlm.nih.gov/pubmed/28258047 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e22 %T Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis %A Christmann,Corinna Anna %A Hoffmann,Alexandra %A Bleser,Gabriele %+ Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Building 48, Gottlieb-Daimler-Str, Kaiserslautern, 67663, Germany, 49 631 205 ext 3456, christmann@cs.uni-kl.de %K mHealth %K mobile health %K relaxation %D 2017 %7 23.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. Objective: The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. Methods: Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. Results: The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). Conclusions: The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types. %M 28232299 %R 10.2196/mhealth.6471 %U http://mhealth.jmir.org/2017/2/e22/ %U https://doi.org/10.2196/mhealth.6471 %U http://www.ncbi.nlm.nih.gov/pubmed/28232299 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e7 %T Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality %A Grainger,Rebecca %A Townsley,Hermaleigh %A White,Bonnie %A Langlotz,Tobias %A Taylor,William J %+ Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Wellington South, Wellington, 6242, New Zealand, 64 4 385 5541 ext 4031, rebecca.grainger@otago.ac.nz %K mHealth %K mobile applications %K telemedicine %K self-management %K rheumatoid arthritis %D 2017 %7 21.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with RA may wish to monitor their own disease activity with a smartphone app, it is important to understand the functions and quality of apps for this purpose. Objective: The aim of our study was to assess the features and quality of apps to assist people to monitor their RA disease activity by (1) summarizing the available apps, particularly the instruments used for measurement of RA disease activity; (2) comparing the app features with American College of Rheumatology and European League against Rheumatism (ACR and EULAR) guidelines for monitoring of RA disease activity; and (3) rating app quality with the Mobile App Rating Scale (MARS). Methods: Systematic searches of the New Zealand iTunes and Google Play app stores were used to identify all apps for monitoring of RA disease activity that could be used by people with RA. The apps were described by both key metadata and app functionality. App adherence with recommendations for monitoring of RA disease activity in clinical practice was evaluated by identifying whether apps included calculation of a validated composite disease activity measure and recorded results for future retrieval. App quality was assessed by 2 independent reviewers using the MARS. Results: The search identified 721 apps in the Google Play store and 216 in the iTunes store, of which 19 unique apps met criteria for inclusion (8 from both app stores, 8 iTunes, and 3 Google Play). In total, 14 apps included at least one validated instrument measuring RA disease activity; 7 of 11 apps that allowed users to enter a joint count used the standard 28 swollen and tender joint count; 8 apps included at least one ACR and EULAR-recommended RA composite disease activity (CDA) measure; and 10 apps included data storage and retrieval. Only 1 app, Arthritis Power, included both an RA CDA measure and tracked data, but this app did not include the standard 28 tender and swollen joint count. The median overall MARS score for apps was 3.41/5. Of the 6 apps that scored ≥4/5 on the overall MARS rating, only 1 included a CDA score endorsed by ACR and EULAR; however, this app did not have a data tracking function. Conclusions: This review found a lack of high-quality apps for longitudinal assessment of RA disease activity. Current apps fall into two categories: simple calculators primarily for rheumatologists and data tracking tools for people with RA. The latter do not uniformly collect data using validated instruments or composite disease activity measures. There is a need for appropriate, high-quality apps for use by rheumatologists and patients together in co-management of RA. %M 28223263 %R 10.2196/mhealth.6956 %U http://mhealth.jmir.org/2017/2/e7/ %U https://doi.org/10.2196/mhealth.6956 %U http://www.ncbi.nlm.nih.gov/pubmed/28223263 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e13 %T Validated Smartphone-Based Apps for Ear and Hearing Assessments: A Review %A Bright,Tess %A Pallawela,Danuk %+ London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 (0)20 7636 8636, tess.bright1@lshtm.ac.uk %K hearing %K testing %K mobile %K audiometry %K smartphone %K applications %K app %K hearing loss %K hearing impairment %K surveys %K prevalence %D 2016 %7 23.12.2016 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: An estimated 360 million people have a disabling hearing impairment globally, the vast majority of whom live in low- and middle-income countries (LMICs). Early identification through screening is important to negate the negative effects of untreated hearing impairment. Substantial barriers exist in screening for hearing impairment in LMICs, such as the requirement for skilled hearing health care professionals and prohibitively expensive specialist equipment to measure hearing. These challenges may be overcome through utilization of increasingly available smartphone app technologies for ear and hearing assessments that are easy to use by unskilled professionals. Objective: Our objective was to identify and compare available apps for ear and hearing assessments and consider the incorporation of such apps into hearing screening programs Methods: In July 2015, the commercial app stores Google Play and Apple App Store were searched to identify apps for ear and hearing assessments. Thereafter, six databases (EMBASE, MEDLINE, Global Health, Web of Science, CINAHL, and mHealth Evidence) were searched to assess which of the apps identified in the commercial review had been validated against gold standard measures. A comparison was made between validated apps. Results: App store search queries returned 30 apps that could be used for ear and hearing assessments, the majority of which are for performing audiometry. The literature search identified 11 eligible validity studies that examined 6 different apps. uHear, an app for self-administered audiometry, was validated in the highest number of peer reviewed studies against gold standard pure tone audiometry (n=5). However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies. Of the apps that have been validated, further independent research is required to fully understand their accuracy at detecting ear and hearing conditions. %M 28582261 %R 10.2196/rehab.6074 %U http://rehab.jmir.org/2016/2/e13/ %U https://doi.org/10.2196/rehab.6074 %U http://www.ncbi.nlm.nih.gov/pubmed/28582261 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e135 %T Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps %A Sullivan,Rachel K %A Marsh,Samantha %A Halvarsson,Jakob %A Holdsworth,Michelle %A Waterlander,Wilma %A Poelman,Maartje P %A Salmond,Jennifer Ann %A Christian,Hayley %A Koh,Lenny SC %A Cade,Janet E %A Spence,John C %A Woodward,Alistair %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Geelong, Victoria,, Australia, 61 3 52271100, ralph.maddison@deakin.edu.au %K climate change %K noncommunicable diseases %K smartphone apps %K travel %K diet %K greenhouse gas emissions %K carbon footprint %K individual %K behavior change %D 2016 %7 19.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health. Objective: The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions. Methods: The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS). Results: Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC=0.94, 95% CI 0.87-0.97). Conclusions: Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits. %M 27993762 %R 10.2196/mhealth.5931 %U http://mhealth.jmir.org/2016/4/e135/ %U https://doi.org/10.2196/mhealth.5931 %U http://www.ncbi.nlm.nih.gov/pubmed/27993762 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e132 %T Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps %A Santo,Karla %A Richtering,Sarah S %A Chalmers,John %A Thiagalingam,Aravinda %A Chow,Clara K %A Redfern,Julie %+ The George Institute for Global Health, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, Sydney, 2050, Australia, 61 280524620, ksanto@georgeinstitute.org.au %K medication adherence %K medication compliance %K mobile phone %K smartphone %K mobile apps %K mobile applications %D 2016 %7 02.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are a growing number of mobile phone apps available to support people in taking their medications and to improve medication adherence. However, little is known about how these apps differ in terms of features, quality, and effectiveness. Objective: We aimed to systematically review the medication reminder apps available in the Australian iTunes store and Google Play to assess their features and their quality in order to identify high-quality apps. Methods: This review was conducted in a similar manner to a systematic review by using a stepwise approach that included (1) a search strategy; (2) eligibility assessment; (3) app selection process through an initial screening of all retrieved apps and full app review of the included apps; (4) data extraction using a predefined set of features considered important or desirable in medication reminder apps; (5) analysis by classifying the apps as basic and advanced medication reminder apps and scoring and ranking them; and (6) a quality assessment by using the Mobile App Rating Scale (MARS), a reliable tool to assess mobile health apps. Results: We identified 272 medication reminder apps, of which 152 were found only in Google Play, 87 only in iTunes, and 33 in both app stores. Apps found in Google Play had more customer reviews, higher star ratings, and lower cost compared with apps in iTunes. Only 109 apps were available for free and 124 were recently updated in 2015 or 2016. Overall, the median number of features per app was 3.0 (interquartile range 4.0) and only 18 apps had ≥9 of the 17 desirable features. The most common features were flexible scheduling that was present in 56.3% (153/272) of the included apps, medication tracking history in 54.8% (149/272), snooze option in 34.9% (95/272), and visual aids in 32.4% (88/272). We classified 54.8% (149/272) of the included apps as advanced medication reminder apps and 45.2% (123/272) as basic medication reminder apps. The advanced apps had a higher number of features per app compared with the basic apps. Using the MARS instrument, we were able to identify high-quality apps that were rated as being very interesting and entertaining, highly interactive and customizable, intuitive, and easy to use and to navigate as well as having a high level of visual appeal and good-quality information. Conclusions: Many medication reminder apps are available in the app stores; however, the majority of them did not have many of the desirable features and were, therefore, considered low quality. Through a systematic stepwise process, we were able to identify high-quality apps to be tested in a future study that will provide evidence on the use of medication reminder apps to improve medication adherence. %M 27913373 %R 10.2196/mhealth.6742 %U http://mhealth.jmir.org/2016/4/e132/ %U https://doi.org/10.2196/mhealth.6742 %U http://www.ncbi.nlm.nih.gov/pubmed/27913373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e233 %T Quality of Mobile Phone and Tablet Mobile Apps for Speech Sound Disorders: Protocol for an Evidence-Based Appraisal %A Furlong,Lisa M %A Morris,Meg E %A Erickson,Shane %A Serry,Tanya A %+ School of Allied Health, Discipline of Speech Pathology, La Trobe University, Kingsbury Drive, Bundoora, 3086, Australia, 61 457645539, l.furlong@latrobe.edu.au %K speech therapy %K medical informatics %K rehabilitation %K mHealth, speech sound disorders %D 2016 %7 29.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. %M 27899341 %R 10.2196/resprot.6505 %U http://www.researchprotocols.org/2016/4/e233/ %U https://doi.org/10.2196/resprot.6505 %U http://www.ncbi.nlm.nih.gov/pubmed/27899341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e122 %T A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) %A Chen,Elizabeth %A Mangone,Emily Rose %+ International Health Division, Abt Associates, 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD, 20814, United States, 1 650 919 3414, emilyrose.mangone@gmail.com %K mHealth %K eHealth %K smartphone %K mobile phone %K app %K teen %K adolescent %K young adult %K systematic review %K unintended pregnancy %K family planning %K pregnancy prevention %K contraception %D 2016 %7 10.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. %M 27833070 %R 10.2196/mhealth.6611 %U http://mhealth.jmir.org/2016/4/e122/ %U https://doi.org/10.2196/mhealth.6611 %U http://www.ncbi.nlm.nih.gov/pubmed/27833070 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e124 %T Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review %A Huang,Evelyn Tzu-Yen %A Williams,Henrietta %A Hocking,Jane S %A Lim,Megan SC %+ Austin Hospital, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia, 61 3 9496 5000, drevelynhuang@gmail.com %K mobile apps %K sexual health %K STDs %K sexually transmitted diseases %K mobile health %K mHealth %D 2016 %7 08.11.2016 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term “sexual” to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term “dating” to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. %M 27826133 %R 10.2196/mhealth.5760 %U http://mhealth.jmir.org/2016/4/e124/ %U https://doi.org/10.2196/mhealth.5760 %U http://www.ncbi.nlm.nih.gov/pubmed/27826133 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e204 %T App Chronic Disease Checklist: Protocol to Evaluate Mobile Apps for Chronic Disease Self-Management %A Anderson,Kevin %A Burford,Oksana %A Emmerton,Lynne %+ School of Pharmacy, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 892667352, lynne.emmerton@curtin.edu.au %K health %K mobile applications %K app %K smartphones %K self-management %K protocol %K usability checklist %K self-care %K chronic disease %D 2016 %7 04.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: The availability of mobile health apps for self-care continues to increase. While little evidence of their clinical impact has been published, there is general agreement among health authorities and authors that consumers’ use of health apps assist in self-management and potentially clinical decision making. A consumer’s sustained engagement with a health app is dependent on the usability and functionality of the app. While numerous studies have attempted to evaluate health apps, there is a paucity of published methods that adequately recognize client experiences in the academic evaluation of apps for chronic conditions. Objective: This paper reports (1) a protocol to shortlist health apps for academic evaluation, (2) synthesis of a checklist to screen health apps for quality and reliability, and (3) a proposed method to theoretically evaluate usability of health apps, with a view towards identifying one or more apps suitable for clinical assessment. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was developed to guide the selection of the apps to be assessed. The screening checklist was thematically synthesized with reference to recurring constructs in published checklists and related materials for the assessment of health apps. The checklist was evaluated by the authors for face and construct validity. The proposed method for evaluation of health apps required the design of procedures for raters of apps, dummy data entry to test the apps, and analysis of raters’ scores. Results: The PRISMA flow diagram comprises 5 steps: filtering of duplicate apps; eliminating non-English apps; removing apps requiring purchase, filtering apps not updated within the past year; and separation of apps into their core functionality. The screening checklist to evaluate the selected apps was named the App Chronic Disease Checklist, and comprises 4 sections with 6 questions in each section. The validity check verified classification of, and ambiguity in, wording of questions within constructs. The proposed method to evaluate shortlisted and downloaded apps comprises instructions to attempt set-up of a dummy user profile, and dummy data entry to represent in-range and out-of-range clinical measures simulating a range of user behaviors. A minimum score of 80% by consensus (using the Intraclass Correlation Coefficient) between raters is proposed to identify apps suitable for clinical trials. Conclusions: The flow diagram allows researchers to shortlist health apps that are potentially suitable for formal evaluation. The evaluation checklist enables quantitative comparison of shortlisted apps based on constructs reported in the literature. The use of multiple raters, and comparison of their scores, is proposed to manage inherent subjectivity in assessing user experiences. Initial trial of the combined protocol is planned for apps pertaining to the self-monitoring of asthma; these results will be reported elsewhere. %M 27815233 %R 10.2196/resprot.6194 %U http://www.researchprotocols.org/2016/4/e204/ %U https://doi.org/10.2196/resprot.6194 %U http://www.ncbi.nlm.nih.gov/pubmed/27815233 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e118 %T A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement %A Geuens,Jonas %A Swinnen,Thijs Willem %A Westhovens,Rene %A de Vlam,Kurt %A Geurts,Luc %A Vanden Abeele,Vero %+ e-Media Lab, KU Leuven, A. Vesaliusstraat 13, Leuven, 3000, Belgium, 32 472690740, jonas.geuens@kuleuven.be %K persuasive technology %K mobile applications %K chronic arthritis %D 2016 %7 13.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic arthritis (CA), an umbrella term for inflammatory rheumatic and other musculoskeletal diseases, is highly prevalent. Effective disease-modifying antirheumatic drugs for CA are available, with the exception of osteoarthritis, but require a long-term commitment of patients to comply with the medication regimen and management program as well as a tight follow-up by the treating physician and health professionals. Additionally, patients are advised to participate in physical exercise programs. Adherence to exercises and physical activity programs is often very low. Patients would benefit from support to increase medication compliance as well as compliance to the physical exercise programs. To address these shortcomings, health apps for CA patients have been created. These mobile apps assist patients in self-management of overall health measures, health prevention, and disease management. By including persuasive principles designed to reinforce, change, or shape attitudes or behaviors, health apps can transform into support tools that motivate and stimulate users to achieve or keep up with target behavior, also called persuasive systems. However, the extent to which health apps for CA patients consciously and successfully employ such persuasive principles remains unknown. Objective: The objective of this study was to evaluate the number and type of persuasive principles present in current health apps for CA patients. Methods: A review of apps for arthritis patients was conducted across the three major app stores (Google Play, Apple App Store, and Windows Phone Store). Collected apps were coded according to 37 persuasive principles, based on an altered version of the Persuasive System Design taxonomy of Oinas-Kukkonen and Harjuma and the taxonomy of Behavior Change Techniques of Michie and Abraham. In addition, user ratings, number of installs, and price of the apps were also coded. Results: We coded 28 apps. On average, 5.8 out of 37 persuasive principles were used in each app. The most used category of persuasive principles was System Credibility with an average of 2.6 principles. Task Support was the second most used, with an average of 2.3 persuasive principles. Next was Dialogue Support with an average of 0.5 principles. Social Support was last with an average of 0.01 persuasive principles only. Conclusions: Current health apps for CA patients would benefit from adding Social Support techniques (eg, social media, user fora) and extending Dialogue Support techniques (eg, rewards, praise). The addition of automated tracking of health-related parameters (eg, physical activity, step count) could further reduce the effort for CA patients to manage their disease and thus increase Task Support. Finally, apps for health could benefit from a more evidence-based approach, both in developing the app as well as ensuring that content can be verified as scientifically proven, which will result in enhanced System Credibility. %M 27742604 %R 10.2196/mhealth.6286 %U http://mhealth.jmir.org/2016/4/e118/ %U https://doi.org/10.2196/mhealth.6286 %U http://www.ncbi.nlm.nih.gov/pubmed/27742604 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e117 %T Breadth of Coverage, Ease of Use, and Quality of Mobile Point-of-Care Tool Information Summaries: An Evaluation %A Johnson,Emily %A Emani,Vamsi K %A Ren,Jinma %+ University of Illinois at Chicago Library, Library of the Health Sciences - Peoria, University of Illinois at Chicago, One Illini Dr., PO Box 1649, Peoria, IL,, United States, 1 309 671 8491, emj11@uic.edu %K mHealth %K mobile health %K mobile app %K assessment %K internal medicine %K point-of-care tools %D 2016 %7 12.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With advances in mobile technology, accessibility of clinical resources at the point of care has increased. Objective: The objective of this research was to identify if six selected mobile point-of-care tools meet the needs of clinicians in internal medicine. Point-of-care tools were evaluated for breadth of coverage, ease of use, and quality. Methods: Six point-of-care tools were evaluated utilizing four different devices (two smartphones and two tablets). Breadth of coverage was measured using select International Classification of Diseases, Ninth Revision, codes if information on summary, etiology, pathophysiology, clinical manifestations, diagnosis, treatment, and prognosis was provided. Quality measures included treatment and diagnostic inline references and individual and application time stamping. Ease of use covered search within topic, table of contents, scrolling, affordance, connectivity, and personal accounts. Analysis of variance based on the rank of score was used. Results: Breadth of coverage was similar among Medscape (mean 6.88), Uptodate (mean 6.51), DynaMedPlus (mean 6.46), and EvidencePlus (mean 6.41) (P>.05) with DynaMed (mean 5.53) and Epocrates (mean 6.12) scoring significantly lower (P<.05). Ease of use had DynaMedPlus with the highest score, and EvidencePlus was lowest (6.0 vs 4.0, respectively, P<.05). For quality, reviewers rated the same score (4.00) for all tools except for Medscape, which was rated lower (P<.05). Conclusions: For breadth of coverage, most point-of-care tools were similar with the exception of DynaMed. For ease of use, only UpToDate and DynaMedPlus allow for search within a topic. All point-of-care tools have remote access with the exception of UpToDate and Essential Evidence Plus. All tools except Medscape covered criteria for quality evaluation. Overall, there was no significant difference between the point-of-care tools with regard to coverage on common topics used by internal medicine clinicians. Selection of point-of-care tools is highly dependent on individual preference based on ease of use and cost of the application. %M 27733328 %R 10.2196/mhealth.6189 %U http://mhealth.jmir.org/2016/4/e117/ %U https://doi.org/10.2196/mhealth.6189 %U http://www.ncbi.nlm.nih.gov/pubmed/27733328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e222 %T The Top Chinese Mobile Health Apps: A Systematic Investigation %A Hsu,Jeffrey %A Liu,Di %A Yu,Ya Min %A Zhao,Hui Tong %A Chen,Zhi Rou %A Li,Jiao %A Chen,Wei %+ Division of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China, 86 10 6915 5068, chenwei6@medmail.com.cn %K mobile health applications %K mHealth %K medical informatics %K China %D 2016 %7 29.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: China’s mHealth market is on track to become a global leader by industry size. The Chinese mobile app market and health care system have peculiarities that distinguish them from other app markets. To date, Chinese mHealth apps have not been systematically investigated. Objective: The objective of this study was to provide an overview of Chinese mHealth apps as of December 2015. Methods: We identified and investigated the most downloaded apps from the iOS and Android platforms. For each app, we analyzed and recorded its main service offered, mHealth initiative, disease and specialty focus, app cost, target user, Web app availability, and emphasis on information security. Standard descriptive statistics were used. Results: A total of 234 apps met the inclusion criteria and were investigated. The apps targeting nonhealth care professionals focused on providing telemedicine and appointment-making services. The apps targeting health care professionals focused on education and peer reviewed articles. The most common disease-specific apps focused primarily on diabetes, hypertension, and hepatitis management. Most apps were free and available on both iOS and Android platforms. Conclusions: The primary mHealth initiatives targeted by the apps reflect Chinese patients’ demand for access to medical care. Disease-specific apps are also representative of disease prevalence in China. Government press releases suggest that new policies on the horizon may shift the industry. %M 27573724 %R 10.2196/jmir.5955 %U http://www.jmir.org/2016/8/e222/ %U https://doi.org/10.2196/jmir.5955 %U http://www.ncbi.nlm.nih.gov/pubmed/27573724 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e96 %T Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps %A Larsen,Mark Erik %A Nicholas,Jennifer %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293828508, mark.larsen@blackdog.org.au %K mobile applications %K mobile apps %K mental health %K telemedicine %K depression %K bipolar disorder %K suicide %D 2016 %7 09.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For many mental health conditions, mobile health apps offer the ability to deliver information, support, and intervention outside the clinical setting. However, there are difficulties with the use of a commercial app store to distribute health care resources, including turnover of apps, irrelevance of apps, and discordance with evidence-based practice. Objective: The primary aim of this study was to quantify the longevity and rate of turnover of mental health apps within the official Android and iOS app stores. The secondary aim was to quantify the proportion of apps that were clinically relevant and assess whether the longevity of these apps differed from clinically nonrelevant apps. The tertiary aim was to establish the proportion of clinically relevant apps that included claims of clinical effectiveness. We performed additional subgroup analyses using additional data from the app stores, including search result ranking, user ratings, and number of downloads. Methods: We searched iTunes (iOS) and the Google Play (Android) app stores each day over a 9-month period for apps related to depression, bipolar disorder, and suicide. We performed additional app-specific searches if an app no longer appeared within the main search Results: On the Android platform, 50% of the search results changed after 130 days (depression), 195 days (bipolar disorder), and 115 days (suicide). Search results were more stable on the iOS platform, with 50% of the search results remaining at the end of the study period. Approximately 75% of Android and 90% of iOS apps were still available to download at the end of the study. We identified only 35.3% (347/982) of apps as being clinically relevant for depression, of which 9 (2.6%) claimed clinical effectiveness. Only 3 included a full citation to a published study. Conclusions: The mental health app environment is volatile, with a clinically relevant app for depression becoming unavailable to download every 2.9 days. This poses challenges for consumers and clinicians seeking relevant and long-term apps, as well as for researchers seeking to evaluate the evidence base for publicly available apps. %M 27507641 %R 10.2196/mhealth.6020 %U http://mhealth.jmir.org/2016/3/e96/ %U https://doi.org/10.2196/mhealth.6020 %U http://www.ncbi.nlm.nih.gov/pubmed/27507641 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e98 %T The Quality and Accuracy of Mobile Apps to Prevent Driving After Drinking Alcohol %A Wilson,Hollie %A Stoyanov,Stoyan R %A Gandabhai,Shailen %A Baldwin,Alexander %+ Centre for Accident Research & Road Safety - Queensland (CARRS-Q), Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia, 61 731380394, hollie.wilson@qut.edu.au %K drink driving %K alcohol %K mobile apps %K calculator %K Mobile Application Rating Scale %K blood alcohol content %D 2016 %7 08.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Driving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile apps aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps. Objective: This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps. Methods: A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter “calculators”) were reviewed against current alcohol advice for accuracy. Results: A total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors. Conclusions: This novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps. %M 27502956 %R 10.2196/mhealth.5961 %U http://mhealth.jmir.org/2016/3/e98/ %U https://doi.org/10.2196/mhealth.5961 %U http://www.ncbi.nlm.nih.gov/pubmed/27502956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e85 %T Popular Nutrition-Related Mobile Apps: A Feature Assessment %A Franco,Rodrigo Zenun %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ School of Systems Engineering, University of Reading, Whiteknights Campus, Reading, RG6 6UR, United Kingdom, 44 1183787668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition apps %K diet apps %K food diary %K nutritional assessment %K mHealth %K eHealth %K mobile phone %K mobile technology %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A key challenge in human nutrition is the assessment of usual food intake. This is of particular interest given recent proposals of eHealth personalized interventions. The adoption of mobile phones has created an opportunity for assessing and improving nutrient intake as they can be used for digitalizing dietary assessments and providing feedback. In the last few years, hundreds of nutrition-related mobile apps have been launched and installed by millions of users. Objective: This study aims to analyze the main features of the most popular nutrition apps and to compare their strategies and technologies for dietary assessment and user feedback. Methods: Apps were selected from the two largest online stores of the most popular mobile operating systems—the Google Play Store for Android and the iTunes App Store for iOS—based on popularity as measured by the number of installs and reviews. The keywords used in the search were as follows: calorie(s), diet, diet tracker, dietician, dietitian, eating, fit, fitness, food, food diary, food tracker, health, lose weight, nutrition, nutritionist, weight, weight loss, weight management, weight watcher, and ww calculator. The inclusion criteria were as follows: English language, minimum number of installs (1 million for Google Play Store) or reviews (7500 for iTunes App Store), relation to nutrition (ie, diet monitoring or recommendation), and independence from any device (eg, wearable) or subscription. Results: A total of 13 apps were classified as popular for inclusion in the analysis. Nine apps offered prospective recording of food intake using a food diary feature. Food selection was available via text search or barcode scanner technologies. Portion size selection was only textual (ie, without images or icons). All nine of these apps were also capable of collecting physical activity (PA) information using self-report, the global positioning system (GPS), or wearable integrations. Their outputs focused predominantly on energy balance between dietary intake and PA. None of these nine apps offered features directly related to diet plans and motivational coaching. In contrast, the remaining four of the 13 apps focused on these opportunities, but without food diaries. One app—FatSecret—also had an innovative feature for connecting users with health professionals, and another—S Health—provided a nutrient balance score. Conclusions: The high number of installs indicates that there is a clear interest and opportunity for diet monitoring and recommendation using mobile apps. All the apps collecting dietary intake used the same nutrition assessment method (ie, food diary record) and technologies for data input (ie, text search and barcode scanner). Emerging technologies, such as image recognition, natural language processing, and artificial intelligence, were not identified. None of the apps had a decision engine capable of providing personalized diet advice. %M 27480144 %R 10.2196/mhealth.5846 %U http://mhealth.jmir.org/2016/3/e85/ %U https://doi.org/10.2196/mhealth.5846 %U http://www.ncbi.nlm.nih.gov/pubmed/27480144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e87 %T Mobile Apps for Weight Management: A Scoping Review %A Rivera,Jordan %A McPherson,Amy %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Iyer,Sindoora %A Agarwal,Arnav %A Lalloo,Chitra %A Stinson,Jennifer %+ Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K weight loss %K obesity %K mobile apps %K smartphones %K mHealth %D 2016 %7 26.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for ‘weight loss apps’ has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective: To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods: An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results: A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions: Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps’ claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets. %M 27460502 %R 10.2196/mhealth.5115 %U http://mhealth.jmir.org/2016/3/e87/ %U https://doi.org/10.2196/mhealth.5115 %U http://www.ncbi.nlm.nih.gov/pubmed/27460502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e80 %T Popular Mobile Phone Apps for Diet and Weight Loss: A Content Analysis %A Zaidan,Sarah %A Roehrer,Erin %+ School of Computing and Information Systems, Faculty of Science, Engineering and Technology, University of Tasmania, Sandy Bay, Hobart,, Australia, 61 416961498, sarahbzaidan@gmail.com %K applications %K diet %K monitoring %K obesity %K weight loss %D 2016 %7 11.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A review of the literature has revealed that the rates of overweight and obesity have been increasing in Australia over the last two decades and that wellness mobile phone apps play a significant role in monitoring and managing individuals’ weight. Although mobile phone app markets (iTunes and Google Play) list thousands of mobile phone health apps, it is not always clear whether those apps are supported by credible sources. Likewise, despite the prevailing use of mobile phone apps to aid with weight management, the usability features of these apps are not well characterized. Objective: The research explored how usability taxonomy could inform the popularity of downloaded, socially focused wellness mobile phone apps, in particular weight loss and diet apps. The aim of the study was to investigate the Australian mobile phone app stores (iTunes and Google Play) in order to examine the usability features of the most popular (ie, most downloaded) wellness apps. Methods: The design of this study comprises 3 main stages: stage 1, identifying apps; stage 2, development of weight loss and diet evaluation framework; and stage 3, application of the evaluation framework. Each stage includes specific data collection, analysis tools, and techniques. Results: The study has resulted in the development of a justified evaluation framework for weight loss and diet mobile phone apps. Applying the evaluation framework to the identified apps has shown that the most downloaded iTunes and Google Play apps are not necessarily the most usable or effective. In addition, the research found that search algorithms for iTunes and Google Play are biased toward apps’ titles and keywords that do not accurately define the real functionality of the app. Moreover, the study has also analyzed the apps’ user reviews, which served as justification for the developed evaluation framework. Conclusions: The analysis has shown that ease of use, reminder, bar code scanning, motivation, usable for all, and synchronization are significant attributes that should be included in weight loss and diet mobile phone apps and ultimately in potential weight loss and diet evaluation frameworks. %M 27400806 %R 10.2196/mhealth.5406 %U http://mhealth.jmir.org/2016/3/e80/ %U https://doi.org/10.2196/mhealth.5406 %U http://www.ncbi.nlm.nih.gov/pubmed/27400806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e74 %T Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS) %A Masterson Creber,Ruth M %A Maurer,Mathew S %A Reading,Meghan %A Hiraldo,Grenny %A Hickey,Kathleen T %A Iribarren,Sarah %+ Columbia University, School of Nursing, 617 W 168th St, New York, NY, 10032, United States, 1 2123050391, rm3284@cumc.columbia.edu %K mobile apps %K mobile health %K heart failure %K self-care %K self-management %K review %K symptom assessment %K nursing informatics %D 2016 %7 14.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, “heart failure,” “cardiology,” “heart failure and self-management”). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps. %M 27302310 %R 10.2196/mhealth.5882 %U http://mhealth.jmir.org/2016/2/e74/ %U https://doi.org/10.2196/mhealth.5882 %U http://www.ncbi.nlm.nih.gov/pubmed/27302310 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e25 %T Smartphone Applications to Support Tuberculosis Prevention and Treatment: Review and Evaluation %A Iribarren,Sarah J %A Schnall,Rebecca %A Stone,Patricia W %A Carballo-Diéguez,Alex %+ Columbia University, School of Nursing, 617 West 168th Street, New York, NY, United States, 1 212 342 3754, si2277@columbia.edu %K mobile apps %K mobile health %K tuberculosis %K review %D 2016 %7 13.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Tuberculosis (TB) remains a major global health problem and is the leading killer due to a single infectious disease. Mobile health (mHealth)–based tools such as smartphone apps have been suggested as tools to support TB control efforts (eg, identification, contact tracing, case management including patient support). Objective: The purpose of this review was to identify and assess the functionalities of mobile apps focused on prevention and treatment of TB. Methods: We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (eg, inform, instruct, record), and searches were conducted to identify peer-review publications of rigorous testing of the available apps. Results: A total of 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n=17); few (n=4) apps were patient focused. Most apps (n=17) had 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Of more concern, some apps provided potentially harmful information to patients, such as links to natural remedies for TB and natural healers. One-third of the apps (8/24) had not been updated for more than a year and may no longer be supported. Peer-reviewed publications were identified for only two of the included apps. In the gray literature (not found in the app stores), three TB-related apps were identified as in progress, being launched, or tested. Conclusions: Apps identified for TB prevention and treatment had minimal functionality, primarily targeted frontline health care workers, and focused on TB information (eg, general information, guidelines, and news) or data collection (eg, replace paper-based notification or tracking). Few apps were developed for use by patients and none were developed to support TB patient involvement and management in their care (eg, follow-up alerts/reminders, side effects monitoring) or improve interaction with their health care providers, limiting the potential of these apps to facilitate patient-centered care. Our evaluation shows that more refined work is needed to be done in the area of apps to support patients with active TB. Involving TB patients in treatment in the design of these apps is recommended. %M 27177591 %R 10.2196/mhealth.5022 %U http://mhealth.jmir.org/2016/2/e25/ %U https://doi.org/10.2196/mhealth.5022 %U http://www.ncbi.nlm.nih.gov/pubmed/27177591 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e34 %T Characterization of Apps and Other e-Tools for Medication Use: Insights Into Possible Benefits and Risks %A van Kerkhof,Linda Wilhelmina Maria %A van der Laar,Catharina Walthera Egbertha %A de Jong,Charlie %A Weda,Marjolein %A Hegger,Ingrid %+ National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, PO Box 1, Bilthoven, 3720 BA, Netherlands, 31 302748688, linda.van.kerkhof@rivm.nl %K mobile apps %K drugs %K eHealth %K mHealth %K medication use %D 2016 %7 06.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In the past years, an enormous increase in the number of available health-related applications (apps) has occurred, from approximately 5800 in 2011 to over 23,000 in 2013, in the iTunes store. However, little is still known regarding the use, possible effectiveness, and risks of these applications. In this study, we focused on apps and other e-tools related to medicine use. A large subset of the general population uses medicines and might benefit from tools that aid in the use of medicine. Objective: The aim of the present study was to gain more insight into the characteristics, possible risks, and possible benefits of health apps and e-tools related to medication use. Methods: We first made an inventory of apps and other e-tools for medication use (n=116). Tools were coded by two independent researchers, based on the information available in the app stores and websites. Subsequently, for one type of often downloaded apps (aimed at people with diabetes), we investigated users’ experiences using an online questionnaire. Results: Results of the inventory show that many apps for medication use are available and that they mainly offer simple functionalities. In line with this, the most experienced benefit by users of apps for regulating blood glucose levels in the online questionnaire was “information quick and conveniently available”. Other often experienced benefits were improving health and self-reliance. Results of the inventory show that a minority of the apps for medication use has potentially high risks and for many of the apps it is unclear whether and how personal data are stored. In contrast, online questionnaire among users of apps for blood glucose regulation indicates that they hardly ever experience problems or doubts considering reliability and/or privacy. Although, respondents do mention to experience disadvantages of use due to incomplete apps and apps with poor ease of use. Respondents not using app(s) indicate that they might use them in the future if reliability of the apps and instructions on how to use them are more clear. Conclusions: This study shows that for apps and e-tools related to medicine use a small subset of tools might involve relatively high risks. For the large group of nonmedical devices apps, risks are lower, but risks lie in the enormous availability and low levels of regulation. In addition, both users and nonusers indicated that overall quality of apps (ease of use, completeness, good functionalities) is an issue. Considering that important benefits (eg, improving health and self-reliance) are experienced by many of the respondents using apps for regulating blood glucose levels, improving reliability and quality of apps is likely to have many profits. In addition, creating better awareness regarding the existence and how to use apps will likely improve proper use by more people, enhancing the profits of these tools. %M 27052946 %R 10.2196/mhealth.4149 %U http://mhealth.jmir.org/2016/2/e34/ %U https://doi.org/10.2196/mhealth.4149 %U http://www.ncbi.nlm.nih.gov/pubmed/27052946 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e19 %T Health Behavior Theory in Popular Calorie Counting Apps: A Content Analysis %A Davis,Siena F %A Ellsworth,Marisa A %A Payne,Hannah E %A Hall,Shelby M %A West,Joshua H %A Nordhagen,Amber L %+ Department of Health Science, Brigham Young University, 4103 Life Sciences Building, Provo, UT, , United States, 1 801 422 3386, josh.west@byu.edu %K cell phones %K mobile applications %K telemedicine %K weight loss %K caloric restriction %D 2016 %7 02.03.2016 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. Objective: This study evaluates the presence of health behavior theory in calorie counting apps. Methods: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results: Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions: Most of the calorie counting apps in the sample contained minimal health behavior theory. %M 26935898 %R 10.2196/mhealth.4177 %U http://mhealth.jmir.org/2016/1/e19/ %U https://doi.org/10.2196/mhealth.4177 %U http://www.ncbi.nlm.nih.gov/pubmed/26935898 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e7 %T Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments %A Bakker,David %A Kazantzis,Nikolaos %A Rickwood,Debra %A Rickard,Nikki %+ School of Psychology and Monash Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, 3800, Australia, 61 3 9905 4301, david.bakker@monash.edu %K mobile phones %K mental health %K smartphones %K apps %K mobile apps %K depression %K anxiety %K cognitive behavior therapy %K cognitive behavioral therapy %K clinical psychology %D 2016 %7 01.03.2016 %9 Review %J JMIR Mental Health %G English %X Background: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. %M 26932350 %R 10.2196/mental.4984 %U http://mental.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/mental.4984 %U http://www.ncbi.nlm.nih.gov/pubmed/26932350 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e15 %T Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps %A Powell,Adam C %A Torous,John %A Chan,Steven %A Raynor,Geoffrey Stephen %A Shwarts,Erik %A Shanahan,Meghan %A Landman,Adam B %+ Payer+Provider Syndicate, 8 Garrison St Ste 101, Boston, MA, MA, United States, 1 6179399168, powell@payerprovider.com %K mobile applications %K mental health %K evaluation studies %K health apps %K ratings %D 2016 %7 10.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves. Objective: We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability. Methods: We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff’s alpha was calculated for each of the measures and reported by app category and in aggregate. Results: The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps. Conclusions: We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews. %M 26863986 %R 10.2196/mhealth.5176 %U http://mhealth.jmir.org/2016/1/e15/ %U https://doi.org/10.2196/mhealth.5176 %U http://www.ncbi.nlm.nih.gov/pubmed/26863986 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e13 %T Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools %A Con,Danny %A De Cruz,Peter %+ Department of Gastroenterology, Austin Hospital, 145 Studley Road, Melbourne, 3084, Australia, 61 3 9496 5353, ppdecruz@gmail.com %K IBD %K apps %K eHealth %K smartphone %K mhealth %D 2016 %7 01.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. Objective: The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. Methods: We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on “complete,” “partial,” or “absent” coverage of consensus statements derived from the European Crohn’s and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Results: Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54%) of the apps had diary functionalities; over a third (10/26, 39%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19%) had professional medical involvement in their design. Apps demonstrated “complete” coverage of only 38% of the international consensus statements explored. The average price of the apps was AUD$1.37. Conclusions: Apps may provide a useful adjunct to the management of IBD patients. However, a majority of current apps suffer from a lack of professional medical involvement and limited coverage of international consensus guidelines. Future studies and app design for IBD should include professional medical involvement, evidence-based guidelines, and functionalities with decision support that are specifically tailored to patient self-management. %M 26831935 %R 10.2196/mhealth.4874 %U http://mhealth.jmir.org/2016/1/e13/ %U https://doi.org/10.2196/mhealth.4874 %U http://www.ncbi.nlm.nih.gov/pubmed/26831935 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis %A Mangone,Emily Rose %A Lebrun,Victoria %A Muessig,Kathryn E %+ Gillings School of Global Public Health, Department of Health Policy and Management, UNC Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB Number 7411, Chapel Hill, NC, 27599-7411, United States, 1 650 919 3414, emilyrose.mangone@gmail.com %K mHealth %K eHealth %K mobile phone %K app %K systematic review %K unintended pregnancy %K family planning %K pregnancy prevention %K contraception %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective: To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods: We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results: Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions: This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. %M 26787311 %R 10.2196/mhealth.4846 %U http://mhealth.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/mhealth.4846 %U http://www.ncbi.nlm.nih.gov/pubmed/26787311 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e104 %T The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment %A Chen,Juliana %A Cade,Janet E %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Johns Hopkins Dr, Camperdown, 2050, Australia, 61 2 9036 7045, margaret.allman-farinelli@sydney.edu.au %K behavior change techniques %K evaluation %K obesity %K quality %K smartphone apps %K weight management %D 2015 %7 16.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Advancements in mobile phone technology have led to the development of smartphones with the capability to run apps. The availability of a plethora of health- and fitness-related smartphone apps has the potential, both on a clinical and public health level, to facilitate healthy behavior change and weight management. However, current top-rated apps in this area have not been extensively evaluated in terms of scientific quality and behavioral theory evidence base. Objective: The purpose of this study was to evaluate the quality of the most popular dietary weight-loss smartphone apps on the commercial market using comprehensive quality assessment criteria, and to quantify the behavior change techniques (BCTs) incorporated. Methods: The top 200-rated Health & Fitness category apps from the free and paid sections of Google Play and iTunes App Store in Australia (n=800) were screened in August 2014. To be included in further analysis, an app had to focus on weight management, include a facility to record diet intake (self-monitoring), and be in English. One researcher downloaded and used the eligible apps thoroughly for 5 days and assessed the apps against quality assessment criteria which included the following domains: accountability, scientific coverage and content accuracy of information relevant to weight management, technology-enhanced features, usability, and incorporation of BCTs. For inter-rater reliability purposes, a second assessor provided ratings on 30% of the apps. The accuracy of app energy intake calculations was further investigated by comparison with results from a 3-day weighed food record (WFR). Results: Across the eligible apps reviewed (n=28), only 1 app (4%) received full marks for accountability. Overall, apps included an average of 5.1 (SD 2.3) out of 14 technology-enhanced features, and received a mean score of 13.5 (SD 3.7) out of 20 for usability. The majority of apps provided estimated energy requirements (24/28, 86%) and used a food database to calculate energy intake (21/28, 75%). When compared against the WFR, the mean absolute energy difference of apps which featured energy intake calculations (23/28, 82%) was 127 kJ (95% CI -45 to 299). An average of 6.3 (SD 3.7) of 26 BCTs were included. Conclusions: Overall, the most popular commercial apps for weight management are suboptimal in quality, given the inadequate scientific coverage and accuracy of weight-related information, and the relative absence of BCTs across the apps reviewed. With the limited regulatory oversight around the quality of these types of apps, this evaluation provides clinicians and consumers an informed view of the highest-quality apps in the current popular app pool appropriate for recommendation and uptake. Further research is necessary to assess the effectiveness of apps for weight management. %M 26678569 %R 10.2196/mhealth.4334 %U http://mhealth.jmir.org/2015/4/e104/ %U https://doi.org/10.2196/mhealth.4334 %U http://www.ncbi.nlm.nih.gov/pubmed/26678569 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e18 %T Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content %A Taki,Sarah %A Campbell,Karen J %A Russell,Catherine G %A Elliott,Rosalind %A Laws,Rachel %A Denney-Wilson,Elizabeth %+ Faculty of Health, University of Technology Sydney, Building 10, 235 Jones Street, Sydney, , Australia, 61 2 9514 2000, sarah.b.taki@student.uts.edu.au %K applications %K Internet %K infant feeding %K health information %K quality %K suitability %K readability %D 2015 %7 29.09.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Internet websites and smartphone apps have become a popular resource to guide parents in their children’s feeding and nutrition. Given the diverse range of websites and apps on infant feeding, the quality of information in these resources should be assessed to identify whether consumers have access to credible and reliable information. Objective: This systematic analysis provides perspectives on the information available about infant feeding on websites and smartphone apps. Methods: A systematic analysis was conducted to assess the quality, comprehensibility, suitability, and readability of websites and apps on infant feeding using a developed tool. Google and Bing were used to search for websites from Australia, while the App Store for iOS and Google Play for Android were used to search for apps. Specified key words including baby feeding, breast feeding, formula feeding and introducing solids were used to assess websites and apps addressing feeding advice. Criteria for assessing the accuracy of the content were developed using the Australian Infant Feeding Guidelines. Results: A total of 600 websites and 2884 apps were screened, and 44 websites and 46 apps met the selection criteria and were analyzed. Most of the websites (26/44) and apps (43/46) were noncommercial, some websites (10/44) and 1 app were commercial and there were 8 government websites; 2 apps had university endorsement. The majority of the websites and apps were rated poor quality. There were two websites that had 100% coverage of information compared to those rated as fair or poor that had low coverage. Two-thirds of the websites (65%) and almost half of the apps (47%) had a readability level above the 8th grade level. Conclusions: The findings of this unique analysis highlight the potential for website and app developers to merge user requirements with evidence-based content to ensure that information on infant feeding is of high quality. There are currently no apps available to consumers that address a variety of infant feeding topics. To keep up with the rapid turnover of the evolving technology, health professionals need to consider developing an app that will provide consumers with a credible and reliable source of information about infant feeding, using quality assessment tools and evidence-based content. %M 26420339 %R 10.2196/ijmr.4323 %U http://www.i-jmr.org/2015/3/e18/ %U https://doi.org/10.2196/ijmr.4323 %U http://www.ncbi.nlm.nih.gov/pubmed/26420339 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e91 %T Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV %A Schnall,Rebecca %A Mosley,Jocelyn Patterson %A Iribarren,Sarah J %A Bakken,Suzanne %A Carballo-Diéguez,Alex %A Brown III,William %+ Columbia University, School of Nursing, 617 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mHealth %K HIV %K mobile apps %K user-centered design %D 2015 %7 18.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. Objective: The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. Methods: We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. Results: Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27%), medication reminders (6/15, 40%), medication logs (7/15, 47%), lab reports (5/15, 33%), pharmacy information (4/15, 27%), resources (7/15, 47%), settings (11/15, 73%), and search function (6/15, 40%). No apps included nutrition or fitness information. Conclusions: Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH’s desired functional specifications. %M 26385783 %R 10.2196/mhealth.4882 %U http://mhealth.jmir.org/2015/3/e91/ %U https://doi.org/10.2196/mhealth.4882 %U http://www.ncbi.nlm.nih.gov/pubmed/26385783 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e87 %T A Framework to Assist Health Professionals in Recommending High-Quality Apps for Supporting Chronic Disease Self-Management: Illustrative Assessment of Type 2 Diabetes Apps %A Hale,Kelli %A Capra,Sandra %A Bauer,Judith %+ Centre of Dietetics Research, School of Human Movement and Nutrition Sciences, University of Queensland, Building 26B, Cnr Blair & Union Rds, St Lucia, 4072, Australia, 61 7 3346 7703, k.hale@uq.edu.au %K mobile apps %K chronic disease %K patient-centered care %K technology %D 2015 %7 14.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: This paper presents an approach to assist health professionals in recommending high quality apps for supporting chronic disease self-management. Most app reviews focus on popularity, aesthetics, functionality, usability, and information quality. There is no doubt these factors are important in selecting trustworthy apps which are appealing to users, but behavioral theory may be also be useful in matching the apps to user needs. Objective: The framework developed aims to be methodologically sound, capable of selecting popular apps which include content covered by evidence-based programs, consistent with behavioral theory, as well as a patient-centered approach for matching apps to patients’ individual needs. Methods: A single disease—type 2 diabetes—was selected to illustrate how the framework can be applied as this was deemed to represent the types of strategies used in many chronic diseases. A systematic approach based on behavioral theory and recommendations from best practice guidelines was developed for matching apps to patients’ needs. In March 2014, a series of search strategies was used to identify top-rated iPhone and Android health apps, representing 29 topics from five categories of type 2 diabetes self-management strategies. The topics were chosen from published international guidelines for the management of diabetes. The senior author (KH) assessed the most popular apps found that addressed these topics using the Behavioral Theory Content Survey (BTS), which is based on traditional behavioral theory. A tool to assist decision making when using apps was developed and trialed with health professionals for ease of use and understanding. Results: A total of 14 apps were assessed representing all five topic categories of self-management. Total theoretical scores (BTS scores) were less than 50 on a 100-point scale for all apps. Each app scored less than 50% of the total possible BTS score for all four behavioral theories and for most of the 20 behavioral strategies; however, apps scored higher than 50% of the total possible BTS score for specific strategies related to their primary focus. Our findings suggest that the apps studied would be more effective when used in conjunction with therapy than as stand-alone apps. Apps were categorized according to topic and core intervention strategies. A framework for matching apps to identified patient needs was developed based on app categorization and principles of patient-centered care. The approach was well accepted and understood by a convenience sample of health practitioners. Conclusions: The framework presented can be used by health practitioners to better match apps with client needs. Some apps incorporate highly interactive strategies of behavioral theory, and when used as an adjunct may increase patient participation and the effectiveness of therapy. %M 26369346 %R 10.2196/mhealth.4532 %U http://mhealth.jmir.org/2015/3/e87/ %U https://doi.org/10.2196/mhealth.4532 %U http://www.ncbi.nlm.nih.gov/pubmed/26369346 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e84 %T Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review %A Williams,John Patrick %A Schroeder,Dirk %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 4595 LaSalle Court, Marietta, GA, 30062, United States, 1 770 649 0298, dschroeder@holadoctor.net %K diabetes mellitus %K mobile health %K mobile applications %K systematic review %K Hispanic %D 2015 %7 25.08.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. Objective: The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. Methods: Our study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents’ use of diabetes apps. Results: Approximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels. Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. Conclusions: Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish. %M 26307533 %R 10.2196/mhealth.3986 %U http://mhealth.jmir.org/2015/3/e84/ %U https://doi.org/10.2196/mhealth.3986 %U http://www.ncbi.nlm.nih.gov/pubmed/26307533 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e82 %T Review and Evaluation of Mindfulness-Based iPhone Apps %A Mani,Madhavan %A Kavanagh,David J %A Hides,Leanne %A Stoyanov,Stoyan R %+ Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia, 61 434190971, m.mani@qut.edu.au %K mindfulness %K mindfulness-based mobile apps %K mobile health (mHealth) %K mental health %D 2015 %7 19.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective: This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods: A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results: The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions: Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness. %M 26290327 %R 10.2196/mhealth.4328 %U http://mhealth.jmir.org/2015/3/e82/ %U https://doi.org/10.2196/mhealth.4328 %U http://www.ncbi.nlm.nih.gov/pubmed/26290327 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e198 %T Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality %A Nicholas,Jennifer %A Larsen,Mark Erik %A Proudfoot,Judith %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 293829260, j.nicholas@blackdog.org.au %K mobile applications %K bipolar disorder %K review %K telemedicine %D 2015 %7 17.08.2015 %9 Review %J J Med Internet Res %G English %X Background: With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. Objective: Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content. Methods: A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed. Results: Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%). Conclusions: In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public. %M 26283290 %R 10.2196/jmir.4581 %U http://www.jmir.org/2015/8/e198/ %U https://doi.org/10.2196/jmir.4581 %U http://www.ncbi.nlm.nih.gov/pubmed/26283290 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e81 %T Cannabis Mobile Apps: A Content Analysis %A Ramo,Danielle E %A Popova,Lucy %A Grana,Rachel %A Zhao,Shirley %A Chavez,Kathryn %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box TRC 0984, San Francisco, CA, 94143, United States, 1 415 476 7695, danielle.ramo@ucsf.edu %K cell phones %K mobile apps %K cannabis %D 2015 %7 12.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms “cannabis” and “marijuana.” Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated “17+” years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated “high maturity” (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations. %M 26268634 %R 10.2196/mhealth.4405 %U http://mhealth.jmir.org/2015/3/e81/ %U https://doi.org/10.2196/mhealth.4405 %U http://www.ncbi.nlm.nih.gov/pubmed/26268634 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e77 %T Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps %A Modave,François %A Bian,Jiang %A Leavitt,Trevor %A Bromwell,Jennifer %A Harris III,Charles %A Vincent,Heather %+ University of Florida, Department of Health Outcomes and Policy, CTRB 2243 PO Box 100177, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 352 294 5984, modavefp@ufl.edu %K apps %K fitness %K mHealth %K mobile coaching %K obesity %K quality %K weight loss %D 2015 %7 24.07.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Objective: Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. Methods: A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Results: Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4.1094), and no app scored above 50% on the flexibility component (mean 0.1118, SD 0.2679, maximum 0.9816). Finally, only 1 app had an overall score (64.3%) above 50% (mean 2.3158, SD 1.911, maximum 9.0072). Conclusions: There are over 100,000 health-related apps. When looking at popular free apps related to physical activity, we observe that very few of them are evidence based, and respect the guidelines for aerobic activity, strength/resistance training, and flexibility, set forth by the ACSM. Users should exercise caution when adopting a new app for physical activity purposes. This study also clearly identifies a gap in evidence-based apps that can be used safely and effectively to start a physical routine program, develop fitness, and lose weight. App developers have an exciting opportunity to improve mobile coaching app quality by addressing these gaps. %M 26209109 %R 10.2196/mhealth.4669 %U http://mhealth.jmir.org/2015/3/e77/ %U https://doi.org/10.2196/mhealth.4669 %U http://www.ncbi.nlm.nih.gov/pubmed/26209109 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 2 %P e4 %T Health Behavior Theory in Physical Activity Game Apps: A Content Analysis %A Payne,Hannah E %A Moxley,Victor BA %A MacDonald,Elizabeth %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 3024 LSB, Provo, UT, 84604, United States, 1 530 919 5100, hannahp413@gmail.com %K health and fitness apps %K mobile phone %K behavioral health %K theory %K content analysis %K physical activity %D 2015 %7 13.07.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: Physical activity games developed for a mobile phone platform are becoming increasingly popular, yet little is known about their content or inclusion of health behavior theory (HBT). Objective: The objective of our study was to quantify elements of HBT in physical activity games developed for mobile phones and to assess the relationship between theoretical constructs and various app features. Methods: We conducted an analysis of exercise and physical activity game apps in the Apple App Store in the fall of 2014. A total of 52 apps were identified and rated for inclusion of health behavior theoretical constructs using an established theory-based rubric. Each app was coded for 100 theoretical items, containing 5 questions for 20 different constructs. Possible total theory scores ranged from 0 to 100. Descriptive statistics and Spearman correlations were used to describe the HBT score and association with selected app features, respectively. Results: The average HBT score in the sample was 14.98 out of 100. One outlier, SuperBetter, scored higher than the other apps with a score of 76. Goal setting, self-monitoring, and self-reward were the most-reported constructs found in the sample. There was no association between either app price and theory score (P=.5074), or number of gamification elements and theory score (P=.5010). However, Superbetter, with the highest HBT score, was also the most expensive app. Conclusions: There are few content analyses of serious games for health, but a comparison between these findings and previous content analyses of non-game health apps indicates that physical activity mobile phone games demonstrate higher levels of behavior theory. The most common theoretical constructs found in this sample are known to be efficacious elements in physical activity interventions. It is unclear, however, whether app designers consciously design physical activity mobile phone games with specific constructs in mind; it may be that games lend themselves well to inclusion of theory and any constructs found in significant levels are coincidental. Health games developed for mobile phones could be potentially used in health interventions, but collaboration between app designers and behavioral specialists is crucial. Additionally, further research is needed to better characterize mobile phone health games and the relative importance of educational elements versus gamification elements in long-term behavior change. %M 26168926 %R 10.2196/games.4187 %U http://games.jmir.org/2015/2/e4/ %U https://doi.org/10.2196/games.4187 %U http://www.ncbi.nlm.nih.gov/pubmed/26168926 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e43 %T Public Health Guidelines for Physical Activity: Is There an App for That? A Review of Android and Apple App Stores %A Knight,Emily %A Stuckey,Melanie I %A Prapavessis,Harry %A Petrella,Robert J %+ University of Western Ontario, Centre for Studies in Family Medicine, 1151 Richmond Street, Rm 2117, London, ON, N6A 3K7, Canada, 1 519 933 8455, petrella@uwo.ca %K Mobile applications %K Exercise %K Public Health %D 2015 %7 21.05.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Physical activity participation is an important behavior for modifying lifestyle-related disease risk. Mobile health apps for chronic disease management and prevention are being developed at a rapid rate. However, it is unclear whether these apps are evidence-based. Current public health recommendations for physical activity participation for adults highlight the importance of engaging in 150 minutes weekly of purposeful exercise, and muscle strengthening activities on at least 2 days of the week. Objective: The aims of the present review were to (1) identify available evidence-based physical activity apps, and (2) identify technological features that could be leveraged to improve health outcomes. Methods: iTunes and Google Play mobile app stores were searched using keyword and category searching during a single day (February 18, 2014) for physical activity apps available in English. The description pages of eligible apps were reviewed by 4 independent reviewers for evidence-based content, technological, and descriptive features. An a priori subset of apps was downloaded for further review (n=6 affiliated with a non-commercial agency; n=10 top rated; n=10 random selection), and developers were contacted for information regarding evidence-informed content. Results: The initial search yielded 2400 apps, of which 379 apps (n=206 iTunes; n=173 Google Play) were eligible. Primary results demonstrated no apps (n=0) adhering to evidence-based guidelines for aerobic physical activity, and 7 out of 379 implementing evidence-based guidelines for resistance training physical activity. Technological features of apps included social networking (n=207), pairing with a peripheral health device (n=61), and measuring additional health parameters (n=139). Secondary results revealed 1 app that referenced physical activity guidelines (150 minutes/weekly of exercise), and demonstrated that apps were based on various physical activity reports (n=4) or personal expertise (n=2). Conclusions: The present study demonstrated a shortage of evidence-based physical activity apps. This gap underscores the need for development of evidence-informed mobile apps. Results highlight the opportunity to develop evidence-informed mobile apps that can be used clinically to enhance health outcomes. %M 25998158 %R 10.2196/mhealth.4003 %U http://mhealth.jmir.org/2015/2/e43/ %U https://doi.org/10.2196/mhealth.4003 %U http://www.ncbi.nlm.nih.gov/pubmed/25998158 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e118 %T Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis %A Crane,David %A Garnett,Claire %A Brown,James %A West,Robert %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7687 0723, david.crane.13@ucl.ac.uk %K alcohol %K behaviour change %K mHealth %K smartphone %K iPhone %K android %K apps %K digital %K intervention %D 2015 %7 14.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content. %M 25977135 %R 10.2196/jmir.4060 %U http://www.jmir.org/2015/5/e118/ %U https://doi.org/10.2196/jmir.4060 %U http://www.ncbi.nlm.nih.gov/pubmed/25977135 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e40 %T Valuable Features in Mobile Health Apps for Patients and Consumers: Content Analysis of Apps and User Ratings %A Mendiola,Martin F %A Kalnicki,Miriam %A Lindenauer,Sarah %+ SocialWellth, Inc, 231 S. 3rd Street, Suite 100, Las Vegas, NV, 89101, United States, 1 702 821 0818, mfmmdmph@gmail.com %K mHealth %K mobile apps %K consumer preference %K Affordable Care Act %D 2015 %7 13.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The explosion of mobile phones with app capabilities coupled with increased expectations of the patient-consumers’ role in managing their care presents a unique opportunity to use mobile health (mHealth) apps. Objectives: The aim of this paper is to identify the features and characteristics most-valued by patient-consumers (“users”) that contribute positively to the rating of an app. Methods: A collection of 234 apps associated with reputable health organizations found in the medical, health, and fitness categories of the Apple iTunes store and Google Play marketplace was assessed manually for the presence of 12 app features and characteristics. Regression analysis was used to determine which, if any, contributed positively to a user’s rating of the app. Results: Analysis of these 12 features explained 9.3% (R2=.093 n=234, P<.001) of the variation in an app’s rating, with only 5 reaching statistical significance. Of the 5 reaching statistical significance, plan or orders, export of data, usability, and cost contributed positively to a user’s rating, while the tracker feature detracted from it. Conclusions: These findings suggest that users appreciate features that save time over current methods and identify an app as valuable when it is simple and intuitive to use, provides specific instructions to better manage a condition, and shares data with designated individuals. Although tracking is a core function of most health apps, this feature may detract from a user’s experience when not executed properly. Further investigation into mHealth app features is worthwhile given the inability of the most common features to explain a large portion of an app’s rating. In the future, studies should focus on one category in the app store, specific diseases, or desired behavior change, and methods should include measuring the quality of each feature, both through manual assessment and evaluation of user reviews. Additional investigations into understanding the impact of synergistic features, incentives, social media, and gamification are also warranted to identify possible future trends. %M 25972309 %R 10.2196/mhealth.4283 %U http://mhealth.jmir.org/2015/2/e40/ %U https://doi.org/10.2196/mhealth.4283 %U http://www.ncbi.nlm.nih.gov/pubmed/25972309 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e31 %T Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps %A Vollmer Dahlke,Deborah %A Fair,Kayla %A Hong,Y Alicia %A Beaudoin,Christopher E %A Pulczinski,Jairus %A Ory,Marcia G %+ Texas A&M School of Public Health, Health Promotion and Community Health Sciences, Texas A&M University, 1266 TAMU, College Station, TX, TX, 77843, United States, 1 512 699 4493, Deborahvd@gmail.com %K mobile apps %K health behavior %K survivorship %K health promotion %K eHealth %K mobile health %D 2015 %7 27.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice. %M 25830810 %R 10.2196/mhealth.3861 %U http://mhealth.jmir.org/2015/1/e31/ %U https://doi.org/10.2196/mhealth.3861 %U http://www.ncbi.nlm.nih.gov/pubmed/25830810 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e28 %T mHealthApps: A Repository and Database of Mobile Health Apps %A Xu,Wenlong %A Liu,Yin %+ Department of Neurobiology and Anatomy, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, , United States, 1 713 500 5632, yin.liu@uth.tmc.edu %K mobile healtlh %K app repository %K app database %D 2015 %7 18.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The market of mobile health (mHealth) apps has rapidly evolved in the past decade. With more than 100,000 mHealth apps currently available, there is no centralized resource that collects information on these health-related apps for researchers in this field to effectively evaluate the strength and weakness of these apps. Objective: The objective of this study was to create a centralized mHealth app repository. We expect the analysis of information in this repository to provide insights for future mHealth research developments. Methods: We focused on apps from the two most established app stores, the Apple App Store and the Google Play Store. We extracted detailed information of each health-related app from these two app stores via our python crawling program, and then stored the information in both a user-friendly array format and a standard JavaScript Object Notation (JSON) format. Results: We have developed a centralized resource that provides detailed information of more than 60,000 health-related apps from the Apple App Store and the Google Play Store. Using this information resource, we analyzed thousands of apps systematically and provide an overview of the trends for mHealth apps. Conclusions: This unique database allows the meta-analysis of health-related apps and provides guidance for research designs of future apps in the mHealth field. %M 25786060 %R 10.2196/mhealth.4026 %U http://mhealth.jmir.org/2015/1/e28/ %U https://doi.org/10.2196/mhealth.4026 %U http://www.ncbi.nlm.nih.gov/pubmed/25786060 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e27 %T Mobile App Rating Scale: A New Tool for Assessing the Quality of Health Mobile Apps %A Stoyanov,Stoyan R %A Hides,Leanne %A Kavanagh,David J %A Zelenko,Oksana %A Tjondronegoro,Dian %A Mani,Madhavan %+ Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology (QUT), 60 Musk Avenue, Brisbane, QLD, , Australia, 61 731386144, leanne.hides@qut.edu.au %K well being %K mental health %K e-health %K mobile health (mhealth) %K mobile application %K assessment %K rating %K scale development %D 2015 %7 11.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The use of mobile apps for health and well being promotion has grown exponentially in recent years. Yet, there is currently no app-quality assessment tool beyond “star”-ratings. Objective: The objective of this study was to develop a reliable, multidimensional measure for trialling, classifying, and rating the quality of mobile health apps. Methods: A literature search was conducted to identify articles containing explicit Web or app quality rating criteria published between January 2000 and January 2013. Existing criteria for the assessment of app quality were categorized by an expert panel to develop the new Mobile App Rating Scale (MARS) subscales, items, descriptors, and anchors. There were sixty well being apps that were randomly selected using an iTunes search for MARS rating. There were ten that were used to pilot the rating procedure, and the remaining 50 provided data on interrater reliability. Results: There were 372 explicit criteria for assessing Web or app quality that were extracted from 25 published papers, conference proceedings, and Internet resources. There were five broad categories of criteria that were identified including four objective quality scales: engagement, functionality, aesthetics, and information quality; and one subjective quality scale; which were refined into the 23-item MARS. The MARS demonstrated excellent internal consistency (alpha = .90) and interrater reliability intraclass correlation coefficient (ICC = .79). Conclusions: The MARS is a simple, objective, and reliable tool for classifying and assessing the quality of mobile health apps. It can also be used to provide a checklist for the design and development of new high quality health apps. %M 25760773 %R 10.2196/mhealth.3422 %U http://mhealth.jmir.org/2015/1/e27/ %U https://doi.org/10.2196/mhealth.3422 %U http://www.ncbi.nlm.nih.gov/pubmed/25760773 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e16 %T Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace %A Shen,Nelson %A Levitan,Michael-Jane %A Johnson,Andrew %A Bender,Jacqueline Lorene %A Hamilton-Page,Michelle %A Jadad,Alejandro (Alex) R %A Wiljer,David %+ Centre for Addictions and Mental Health (CAMH), CAMH Education, 33 Russell St., Toronto, ON, M5S 2S1, Canada, 1 416 535 8501 ext 32178, david.wiljer@camh.ca %K mobile apps %K depression %K health information %K consumer %K mental health %D 2015 %7 16.02.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Mobile phone apps offer the potential to help close this treatment gap by confronting key barriers to accessing support for depression. Objectives: Our goal was to identify and characterize the different types of mobile phone depression apps available in the marketplace. Methods: A search for depression apps was conducted on the app stores of the five major mobile phone platforms: Android, iPhone, BlackBerry, Nokia, and Windows. Apps were included if they focused on depression and were available to people who self-identify as having depression. Data were extracted from the app descriptions found in the app stores. Results: Of the 1054 apps identified by the search strategy, nearly one-quarter (23.0%, 243/1054) unique depression apps met the inclusion criteria. Over one-quarter (27.7%, 210/758) of the excluded apps failed to mention depression in the title or description. Two-thirds of the apps had as their main purpose providing therapeutic treatment (33.7%, 82/243) or psychoeducation (32.1%, 78/243). The other main purpose categories were medical assessment (16.9%, 41/243), symptom management (8.2%, 20/243), and supportive resources (1.6%, 4/243). A majority of the apps failed to sufficiently describe their organizational affiliation (65.0%, 158/243) and content source (61.7%, 150/243). There was a significant relationship (χ25=50.5, P<.001) between the main purpose of the app and the reporting of content source, with most medical assessment apps reporting their content source (80.5%, 33/41). A fifth of the apps featured an e-book (20.6%, 50/243), audio therapy (16.9%, 41/243), or screening (16.9%, 41/243) function. Most apps had a dynamic user interface (72.4%, 176/243) and used text as the main type of media (51.9%, 126/243), and over a third (14.4%, 35/243) incorporated more than one form of media. Conclusion: Without guidance, finding an appropriate depression app may be challenging, as the search results yielded non-depression–specific apps to depression apps at a 3:1 ratio. Inadequate reporting of organization affiliation and content source increases the difficulty of assessing the credibility and reliability of the app. While certification and vetting initiatives are underway, this study demonstrates the need for standardized reporting in app stores to help consumers select appropriate tools, particularly among those classified as medical devices. %M 25689790 %R 10.2196/mhealth.3713 %U http://mhealth.jmir.org/2015/1/e16/ %U https://doi.org/10.2196/mhealth.3713 %U http://www.ncbi.nlm.nih.gov/pubmed/25689790 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e8 %T Exploring the Far Side of Mobile Health: Information Security and Privacy of Mobile Health Apps on iOS and Android %A Dehling,Tobias %A Gao,Fangjian %A Schneider,Stephan %A Sunyaev,Ali %+ Department of Information Systems, Faculty of Management, Economics and Social Sciences, University of Cologne, Albertus-Magnus-Platz, Cologne, D-50923, Germany, 49 221 4705397, sunyaev@wiso.uni-koeln.de %K mobile health %K mobile apps %K data security %K software and application security %K patient privacy %K health information technology %D 2015 %7 19.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile health (mHealth) apps aim at providing seamless access to tailored health information technology and have the potential to alleviate global health burdens. Yet, they bear risks to information security and privacy because users need to reveal private, sensitive medical information to redeem certain benefits. Due to the plethora and diversity of available mHealth apps, implications for information security and privacy are unclear and complex. Objective: The objective of this study was to establish an overview of mHealth apps offered on iOS and Android with a special focus on potential damage to users through information security and privacy infringements. Methods: We assessed apps available in English and offered in the categories “Medical” and “Health & Fitness” in the iOS and Android App Stores. Based on the information retrievable from the app stores, we established an overview of available mHealth apps, tagged apps to make offered information machine-readable, and clustered the discovered apps to identify and group similar apps. Subsequently, information security and privacy implications were assessed based on health specificity of information available to apps, potential damage through information leaks, potential damage through information manipulation, potential damage through information loss, and potential value of information to third parties. Results: We discovered 24,405 health-related apps (iOS; 21,953; Android; 2452). Absence or scarceness of ratings for 81.36% (17,860/21,953) of iOS and 76.14% (1867/2452) of Android apps indicates that less than a quarter of mHealth apps are in more or less widespread use. Clustering resulted in 245 distinct clusters, which were consolidated into 12 app archetypes grouping clusters with similar assessments of potential damage through information security and privacy infringements. There were 6426 apps that were excluded during clustering. The majority of apps (95.63%, 17,193/17,979; of apps) pose at least some potential damage through information security and privacy infringements. There were 11.67% (2098/17,979) of apps that scored the highest assessments of potential damages. Conclusions: Various kinds of mHealth apps collect and offer critical, sensitive, private medical information, calling for a special focus on information security and privacy of mHealth apps. In order to foster user acceptance and trust, appropriate security measures and processes need to be devised and employed so that users can benefit from seamlessly accessible, tailored mHealth apps without exposing themselves to the serious repercussions of information security and privacy infringements. %M 25599627 %R 10.2196/mhealth.3672 %U http://mhealth.jmir.org/2015/1/e8/ %U https://doi.org/10.2196/mhealth.3672 %U http://www.ncbi.nlm.nih.gov/pubmed/25599627 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e205 %T Facebook Apps for Smoking Cessation: A Review of Content and Adherence to Evidence-Based Guidelines %A Jacobs,Megan A %A Cobb,Caroline O %A Abroms,Lorien %A Graham,Amanda L %+ Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Avenue, NW, Washington, DC, 20036, United States, 1 202 454 5753, mjacobs@legacyforhealth.org %K Facebook %K smoking cessation/methods %K social media %K apps %D 2014 %7 09.09.2014 %9 Short Paper %J J Med Internet Res %G English %X Background: Facebook is the most popular social network site, with over 1 billion users globally. There are millions of apps available within Facebook, many of which address health and health behavior change. Facebook may represent a promising channel to reach smokers with cessation interventions via apps. To date, there have been no published reports about Facebook apps for smoking cessation. Objective: The purpose of this study was to review the features and functionality of Facebook apps for smoking cessation and to determine the extent to which they adhere to evidence-based guidelines for tobacco dependence treatment. Methods: In August 2013, we searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Results: We screened 22 apps for eligibility; of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date–based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date–based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app “community” feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest. Conclusions: There are few smoking cessation apps available within Facebook. Among those available, adherence to cessation treatment guidelines was low. Smoking cessation interventions provided via the Facebook platform are a unique and as yet untapped treatment strategy that can harness existing social support and social networks for quitting. Research is needed to examine whether apps that adhere to clinical practice guidelines for tobacco dependence treatment are more effective in promoting cessation than those that do not. %M 25205129 %R 10.2196/jmir.3491 %U http://www.jmir.org/2014/9/e205/ %U https://doi.org/10.2196/jmir.3491 %U http://www.ncbi.nlm.nih.gov/pubmed/25205129 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e36 %T Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review %A Hundert,Amos S %A Huguet,Anna %A McGrath,Patrick J %A Stinson,Jennifer N %A Wheaton,Mike %+ IWK Health Center, Room K8508, 8th Floor, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada, 1 902 470 8385, amos.hundert@iwk.nshealth.ca %K headache %K diary %K apps %K smartphone %K mobile phone %K technology %K mHealth %K review %D 2014 %7 19.08.2014 %9 Review %J JMIR mHealth uHealth %G English %X Background: Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective: This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods: The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results: Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions: Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps. %M 25138438 %R 10.2196/mhealth.3452 %U http://mhealth.jmir.org/2014/3/e36/ %U https://doi.org/10.2196/mhealth.3452 %U http://www.ncbi.nlm.nih.gov/pubmed/25138438 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e192 %T Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis %A Lyons,Elizabeth J %A Lewis,Zakkoyya H %A Mayrsohn,Brian G %A Rowland,Jennifer L %+ The University of Texas Medical Branch, Institute for Translational Sciences, 301 University Blvd, Galveston, TX, 77555-0342, United States, 1 409 772 1917, ellyons@utmb.edu %K electronic activity monitor %K mobile %K mhealth %K physical activity %K behavior change technique %D 2014 %7 15.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective: The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods: Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results: All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions: Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings. %M 25131661 %R 10.2196/jmir.3469 %U http://www.jmir.org/2014/8/e192/ %U https://doi.org/10.2196/jmir.3469 %U http://www.ncbi.nlm.nih.gov/pubmed/25131661 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 2 %N 2 %P e9 %T Just a Fad? Gamification in Health and Fitness Apps %A Lister,Cameron %A West,Joshua H %A Cannon,Ben %A Sax,Tyler %A Brodegard,David %+ LaughModel Health Communication Research Group, Department of Health Science, Brigham Young University, 213 RB, Provo, UT, 84604, United States, 1 9702316755, cameron@laughmodel.com %K gamification %K mobile phone %K behavioral health %K health and fitness apps %D 2014 %7 04.08.2014 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. Objective: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer’s health behavior. Methods: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. Results: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. Conclusions: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors. %M 25654660 %R 10.2196/games.3413 %U http://games.jmir.org/2014/2/e9/ %U https://doi.org/10.2196/games.3413 %U http://www.ncbi.nlm.nih.gov/pubmed/25654660 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e19 %T An Evaluation of Mobile Health Application Tools %A Sama,Preethi R %A Eapen,Zubin J %A Weinfurt,Kevin P %A Shah,Bimal R %A Schulman,Kevin A %+ Duke Clinical Research Institute, Duke University School of Medicine, PO Box 17969, Durham, NC, 27715, United States, 1 919 668 8101, kevin.schulman@duke.edu %K cellular phone %K Internet %K medical informatics applications %K social media %D 2014 %7 01.05.2014 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: The rapid growth in the number of mobile health applications could have profound significance in the prevention of disease or in the treatment of patients with chronic disease such as diabetes. Objective: The objective of this study was to describe the characteristics of the most common mobile health care applications available in the Apple iTunes marketplace. Methods: We undertook a descriptive analysis of a sample of applications in the “health and wellness” category of the Apple iTunes Store. We characterized each application in terms of its health factor and primary method of user engagement. The main outcome measures of the analysis were price, health factors, and methods of user engagement. Results: Among the 400 applications that met the inclusion criteria, the mean price of the most frequently downloaded paid applications was US $2.24 (SD $1.30), and the mean price of the most currently available paid applications was US $2.27 (SD $1.60). Fitness/training applications were the most popular (43.5%, 174/400). The next two most common categories were health resource (15.0%, 60/400) and diet/caloric intake (14.3%, 57/400). Applications in the health resource category constituted 5.5% (22/400) of the applications reviewed. Self-monitoring was the most common primary user engagement method (74.8%, 299/400). A total of 20.8% (83/400) of the applications used two or more user engagement approaches, with self-monitoring and progress tracking being the most frequent. Conclusions: Most of the popular mobile health applications focus on fitness and self-monitoring. The approaches to user engagement utilized by these applications are limited and present an opportunity to improve the effectiveness of the technology. %M 25099179 %R 10.2196/mhealth.3088 %U http://mhealth.jmir.org/2014/2/e19/ %U https://doi.org/10.2196/mhealth.3088 %U http://www.ncbi.nlm.nih.gov/pubmed/25099179 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e104 %T Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older %A Arnhold,Madlen %A Quade,Mandy %A Kirch,Wilhelm %+ Research Association Public Health Saxony and Saxony-Anhalt, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 33, Dresden, 01307, Germany, 49 351 458 13457, Madlen.Arnhold@tu-dresden.de %K mobile applications %K apps %K mobile health %K mHealth %K diabetes mellitus %K market analysis %K systematic review %K elderly %K usability test %K expert review %D 2014 %7 09.04.2014 %9 Review %J J Med Internet Res %G English %X Background: A multitude of mhealth (mobile health) apps have been developed in recent years to support effective self-management of patients with diabetes mellitus type 1 or 2. Objective: We carried out a systematic review of all currently available diabetes apps for the operating systems iOS and Android. We considered the number of newly released diabetes apps, range of functions, target user groups, languages, acquisition costs, user ratings, available interfaces, and the connection between acquisition costs and user ratings. Additionally, we examined whether the available applications serve the special needs of diabetes patients aged 50 or older by performing an expert-based usability evaluation. Methods: We identified relevant keywords, comparative categories, and their specifications. Subsequently, we performed the app review based on the information given in the Google Play Store, the Apple App Store, and the apps themselves. In addition, we carried out an expert-based usability evaluation based on a representative 10% sample of diabetes apps. Results: In total, we analyzed 656 apps finding that 355 (54.1%) offered just one function and 348 (53.0%) provided a documentation function. The dominating app language was English (85.4%, 560/656), patients represented the main user group (96.0%, 630/656), and the analysis of the costs revealed a trend toward free apps (53.7%, 352/656). The median price of paid apps was €1.90. The average user rating was 3.6 stars (maximum 5). Our analyses indicated no clear differences in the user rating between free and paid apps. Only 30 (4.6%) of the 656 available diabetes apps offered an interface to a measurement device. We evaluated 66 apps within the usability evaluation. On average, apps were rated best regarding the criterion “comprehensibility” (4.0 out of 5.0), while showing a lack of “fault tolerance” (2.8 out of 5.0). Of the 66 apps, 48 (72.7%) offered the ability to read the screen content aloud. The number of functions was significantly negative correlated with usability. The presence of documentation and analysis functions reduced the usability score significantly by 0.36 and 0.21 points. Conclusions: A vast number of diabetes apps already exist, but the majority offer similar functionalities and combine only one to two functions in one app. Patients and physicians alike should be involved in the app development process to a greater extent. We expect that the data transmission of health parameters to physicians will gain more importance in future applications. The usability of diabetes apps for patients aged 50 or older was moderate to good. But this result applied mainly to apps offering a small range of functions. Multifunctional apps performed considerably worse in terms of usability. Moreover, the presence of a documentation or analysis function resulted in significantly lower usability scores. The operability of accessibility features for diabetes apps was quite limited, except for the feature “screen reader”. %M 24718852 %R 10.2196/jmir.2968 %U http://www.jmir.org/2014/4/e104/ %U https://doi.org/10.2196/jmir.2968 %U http://www.ncbi.nlm.nih.gov/pubmed/24718852 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T A Classification Scheme for Analyzing Mobile Apps Used to Prevent and Manage Disease in Late Life %A Wang,Aiguo %A An,Ning %A Lu,Xin %A Chen,Hongtu %A Li,Changqun %A Levkoff,Sue %+ Gerontechnology Lab, Hefei University of Technology, Tunxi Road No. 193, Hefei, 230009, China, 86 18019956086, ning.g.an@acm.org %K mHealth %K app %K Precede-Proceed Model (PPM) %K health care process %K prevention %K management %K physical health %K mental health %D 2014 %7 17.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. Objective: The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the “Health & Fitness” category of the iTunes App Store. Methods: We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. Results: After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). Conclusions: The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the “Health and Fitness” category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily. %M 25098687 %R 10.2196/mhealth.2877 %U http://mhealth.jmir.org/2014/1/e6/ %U https://doi.org/10.2196/mhealth.2877 %U http://www.ncbi.nlm.nih.gov/pubmed/25098687 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e44 %T Smoking Cessation Apps for Smartphones: Content Analysis With the Self-Determination Theory %A Choi,Jounghwa %A Noh,Ghee-Young %A Park,Dong-Jin %+ Hallym University, 13406 Damheon Hall, 39 Hallymdaehak-gil, Chuncheon, , Korea, Republic Of, 82 33 248 1928, jhchoi@hallym.ac.kr %K medical informatics applications %K smoking cessation %K communication media %D 2014 %7 12.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones are increasingly receiving attention from public health scholars and practitioners as a means to assist individuals’ health management. A number of smartphone apps for smoking cessation are also available; however, little effort has been made to evaluate the content and functions of these apps employing a theoretical framework. Objective: The present study aims to analyze and evaluate the contents of smoking cessation apps available in South Korea employing the self-determination theory (SDT) as a theoretical framework for analysis. This study analyzes the extent to which smoking cessation apps have features that satisfy the basic needs identified in the SDT, which stimulate autonomous motivation. The type of motivational goal content manifested in the apps and how the goal content was framed are also explored. By assessing the features of smoking cessation apps based on the SDT, this study aims to offer direction for improvement for these apps. Methods: Out of 309 apps identified from the iTunes store and Google Play (excluding 27 duplications), 175 apps were randomly drawn and analyzed. The coding scheme was drafted by the authors based on the SDT and gain/loss framing theory and was further finely tuned through the process of coder training and by establishing intercoder reliability. Once the intercoder reliability was established, the coders divided up the rest of the sample and coded them independently. Results: The analysis revealed that most apps (94.3%, 165/175) had at least one feature that tapped at least 1 of the 3 basic needs. Only 18 of 175 apps (10.3%) addressed all 3 basic needs. For goal content, money (53.7%, 94/175) showed the highest frequency, followed by health (32.0%, 56/175), time (7.4%, 13/175), and appearance (1.1%, 2/175), suggesting that extrinsic goals are more dominantly presented in smoking cessation apps. For the framing of goal content, gain framing appeared more frequently (41.7%, 73/175). Conclusions: The results suggest that these smoking cessation apps may not sufficiently stimulate autonomous motivation; a small number of apps addressed all 3 basic needs suggested by the SDT (ie, autonomy, competence, and relatedness). The apps also tended to present extrinsic goal content (primarily in terms of money) over intrinsic ones (ie, health) by primarily adopting gain framing. Implications of these findings for public health practitioners and consumers are discussed. %M 24521881 %R 10.2196/jmir.3061 %U http://www.jmir.org/2014/2/e44/ %U https://doi.org/10.2196/jmir.3061 %U http://www.ncbi.nlm.nih.gov/pubmed/24521881 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Comparison of Mobile Apps for the Leading Causes of Death Among Different Income Zones: A Review of the Literature and App Stores %A Martínez-Pérez,Borja %A de la Torre-Díez,Isabel %A López-Coronado,Miguel %A Sainz-De-Abajo,Beatriz %+ University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, borja.martinez@uva.es %K apps %K different income zones %K leading causes of death %K mobile apps %K World Health Organization (WHO) %D 2014 %7 09.01.2014 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide. Objective: The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias. Methods: Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games. Results: Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps. Conclusions: Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected. %M 25099695 %R 10.2196/mhealth.2779 %U http://www.mhealth.jmir.org/2014/1/e1/ %U https://doi.org/10.2196/mhealth.2779 %U http://www.ncbi.nlm.nih.gov/pubmed/25099695 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e277 %T Transparency of Health-Apps for Trust and Decision Making %A Albrecht,Urs-Vito %+ PL Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, 49 5115323508, albrecht.urs-vito@mh-hannover.de %K smartphone %K technology %K education %K medicine %K app %K health care %K Android %K iPhone %K BlackBerry %K Windows Phone %K mobile phone %K standards %D 2013 %7 30.12.2013 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 24449711 %R 10.2196/jmir.2981 %U http://www.jmir.org/2013/12/e277/ %U https://doi.org/10.2196/jmir.2981 %U http://www.ncbi.nlm.nih.gov/pubmed/24449711 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e287 %T A Lot of Action, But Not in the Right Direction: Systematic Review and Content Analysis of Smartphone Applications for the Prevention, Detection, and Management of Cancer %A Bender,Jacqueline Lorene %A Yue,Rossini Ying Kwan %A To,Matthew Jason %A Deacken,Laetitia %A Jadad,Alejandro R %+ ELLICSR Health, Wellness and Cancer Survivorship Centre, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 581 8606, jackie.bender@rmp.uhn.on.ca %K mobile %K Internet %K cancer %K software applications %K apps %D 2013 %7 23.12.2013 %9 Review %J J Med Internet Res %G English %X Background: Mobile phones have become nearly ubiquitous, offering a promising means to deliver health interventions. However, little is known about smartphone applications (apps) for cancer. Objective: The purpose of this study was to characterize the purpose and content of cancer-focused smartphone apps available for use by the general public and the evidence on their utility or effectiveness. Methods: We conducted a systematic review of the official application stores for the four major smartphone platforms: iPhone, Android, Nokia, and BlackBerry. Apps were included in the review if they were focused on cancer and available for use by the general public. This was complemented by a systematic review of literature from MEDLINE, Embase, and the Cochrane Library to identify evaluations of cancer-related smartphone apps. Results: A total of 295 apps from the smartphone app stores met the inclusion criteria. The majority of apps targeted breast cancer (46.8%, 138/295) or cancer in general (28.5%, 84/295). The reported app purpose was predominantly to raise awareness about cancer (32.2%, 95/295) or to provide educational information about cancer (26.4%, 78/295), followed by apps to support fundraising efforts (12.9%, 38/295), assist in early detection (11.5%, 34/295), promote a charitable organization (10.2%, 30/295), support disease management (3.7%, 11/295), cancer prevention (2.0%, 6/295), or social support (1.0%, 3/295). The majority of the apps did not describe their organizational affiliation (64.1%, 189/295). Apps affiliated with non-profit organizations were more likely to be free of cost (χ21=16.3, P<.001) and have a fundraising or awareness purpose (χ22=13.3, P=.001). The review of the health literature yielded 594 articles, none of which reported an evaluation of a cancer-focused smartphone application. Conclusions: There are hundreds of cancer-focused apps with the potential to enhance efforts to promote behavior change, to monitor a host of symptoms and physiological indicators of disease, and to provide real-time supportive interventions, conveniently and at low cost. However, there is a lack of evidence on their utility, effectiveness, and safety. Future efforts should focus on improving and consolidating the evidence base into a whitelist for public consumption. %M 24366061 %R 10.2196/jmir.2661 %U http://www.jmir.org/2013/12/e287/ %U https://doi.org/10.2196/jmir.2661 %U http://www.ncbi.nlm.nih.gov/pubmed/24366061 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e24 %T Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features %A Plaza,Inmaculada %A Demarzo,Marcelo Marcos Piva %A Herrera-Mercadal,Paola %A García-Campayo,Javier %+ Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, Universidad de Zaragoza, Avda Isabel La Católica 1, Zaragoza, 50009, Spain, 34 976253621, jgarcamp@gmail.com %K mobile health %K mHealth %K mindfulness %K social networks %K personalized education %K health informatics %K evidence-based medicine %D 2013 %7 01.11.2013 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. %M 25099314 %R 10.2196/mhealth.2733 %U http://mhealth.jmir.org/2013/2/e24/ %U https://doi.org/10.2196/mhealth.2733 %U http://www.ncbi.nlm.nih.gov/pubmed/25099314 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e15 %T Mobile Apps in Cardiology: Review %A Martínez-Pérez,Borja %A de la Torre-Díez,Isabel %A López-Coronado,Miguel %A Herreros-González,Jesús %+ University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, borja.martinez@uva.es %K apps %K cardiology %K heart %K m-health %K mobile applications %D 2013 %7 24.07.2013 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective: The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Methods: Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple’s App Store for iOS. Results: Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the cardiac condition, and there were no apps that assist people who have undergone a heart transplant. Conclusions: The distribution of work in the field of cardiology apps is considerably disproportionate. Whereas some systems have significant research and apps are available, other important systems lack such research and lack apps, even though the contribution they could provide is significant. %M 25098320 %R 10.2196/mhealth.2737 %U http://mhealth.jmir.org/2013/2/e15/ %U https://doi.org/10.2196/mhealth.2737 %U http://www.ncbi.nlm.nih.gov/pubmed/25098320 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e9 %T “Let’s get Wasted!” and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications %A Weaver,Emma R %A Horyniak,Danielle R %A Jenkinson,Rebecca %A Dietze,Paul %A Lim,Megan SC %+ Burnet Institute, Centre for Population Health, 85 Commercial Rd, Melbourne, 3004, Australia, 61 383442403, lim@burnet.edu.au %K alcohol drinking %K young adult %K mobile phone %K applications %D 2013 %7 25.06.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone applications (“apps”) offer a number of possibilities for health promotion activities. However, young people may also be exposed to apps with incorrect or poor quality information, since, like the Internet, apps are mostly unregulated. Little is known about the quality of alcohol-related apps or what influence they may have on young people’s behavior. Objective: To critically review popular alcohol-related smartphone apps and to explore young people’s opinions of these apps, their acceptability, and use for alcohol-related health promotion. Methods: First, a content analysis of 500 smartphone apps available via Apple iTunes and Android Google Play stores was conducted. Second, all available blood alcohol concentration (BAC) apps were tested against four individual case profiles of known BAC from a previous study. Third, two focus group discussions explored how young people use alcohol-related apps, particularly BAC apps. Results: 384 apps were included; 50% (192) were entertainment apps, 39% (148) were BAC apps, and 11% (44) were health promotion and/or stop drinking–related apps. When testing the BAC apps, there was wide variation in results, with apps tending to overestimate BAC scores compared with recorded scores. Participants were skeptical of the accuracy of BAC apps, and there was an overall concern that these apps would be used as a form of entertainment, further encouraging young people to drink, rather than reduce their drinking and risk taking. Conclusions: The majority of popular alcohol-related apps encouraged alcohol consumption. Apps estimating blood alcohol concentration were widely available but were highly unreliable. Health departments and prominent health organizations need to endorse alcohol smartphone apps that are accurate and evidence-based to give specific apps credibility in the ever-expanding market of unregulated apps. %M 25100681 %R 10.2196/mhealth.2709 %U http://mhealth.jmir.org/2013/1/e9/ %U https://doi.org/10.2196/mhealth.2709 %U http://www.ncbi.nlm.nih.gov/pubmed/25100681 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e120 %T Mobile Health Applications for the Most Prevalent Conditions by the World Health Organization: Review and Analysis %A Martínez-Pérez,Borja %A de la Torre-Díez,Isabel %A López-Coronado,Miguel %+ University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, borja.martinez@uva.es %K apps %K mHealth %K mobile applications %K prevalent conditions %K World Health Organization (WHO) %D 2013 %7 14.06.2013 %9 Review %J J Med Internet Res %G English %X Background: New possibilities for mHealth have arisen by means of the latest advances in mobile communications and technologies. With more than 1 billion smartphones and 100 million tablets around the world, these devices can be a valuable tool in health care management. Every aid for health care is welcome and necessary as shown by the more than 50 million estimated deaths caused by illnesses or health conditions in 2008. Some of these conditions have additional importance depending on their prevalence. Objective: To study the existing applications for mobile devices exclusively dedicated to the eight most prevalent health conditions by the latest update (2004) of the Global Burden of Disease (GBD) of the World Health Organization (WHO): iron-deficiency anemia, hearing loss, migraine, low vision, asthma, diabetes mellitus, osteoarthritis (OA), and unipolar depressive disorders. Methods: Two reviews have been carried out. The first one is a review of mobile applications in published articles retrieved from the following systems: IEEE Xplore, Scopus, ScienceDirect, Web of Knowledge, and PubMed. The second review is carried out by searching the most important commercial app stores: Google play, iTunes, BlackBerry World, Windows Phone Apps+Games, and Nokia's Ovi store. Finally, two applications for each condition, one for each review, were selected for an in-depth analysis. Results: Search queries up to April 2013 located 247 papers and more than 3673 apps related to the most prevalent conditions. The conditions in descending order by the number of applications found in literature are diabetes, asthma, depression, hearing loss, low vision, OA, anemia, and migraine. However when ordered by the number of commercial apps found, the list is diabetes, depression, migraine, asthma, low vision, hearing loss, OA, and anemia. Excluding OA from the former list, the four most prevalent conditions have fewer apps and research than the final four. Several results are extracted from the in-depth analysis: most of the apps are designed for monitoring, assisting, or informing about the condition. Typically an Internet connection is not required, and most of the apps are aimed for the general public and for nonclinical use. The preferred type of data visualization is text followed by charts and pictures. Assistive and monitoring apps are shown to be frequently used, whereas informative and educational apps are only occasionally used. Conclusions: Distribution of work on mobile applications is not equal for the eight most prevalent conditions. Whereas some conditions such as diabetes and depression have an overwhelming number of apps and research, there is a lack of apps related to other conditions, such as anemia, hearing loss, or low vision, which must be filled. %M 23770578 %R 10.2196/jmir.2600 %U http://www.jmir.org/2013/6/e120/ %U https://doi.org/10.2196/jmir.2600 %U http://www.ncbi.nlm.nih.gov/pubmed/23770578 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e10 %T Growing Concerns With the Flow of Misinformation From Electronic Books %A Takahashi,Kenzo %A Kanda,Hideyuki %A Mizushima,Shunsaku %+ Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2610, kt_intl_@ja2.so-net.ne.jp %K misinformation %K e-book %K ethical guideline %K anti-vaccinists %K atopy business %K wellness maintenance %D 2013 %7 24.05.2013 %9 Viewpoint %J Interact J Med Res %G English %X In 2012, several kinds of electronic books (e-books) became available in Japan. Since several major book retailers launched e-book businesses, it is expected that e-books will become a popular source of information in the country. However, we are concerned that e-books may also be a source of misinformation. In examining 24 available materials published by anti-vaccinists, "atopy businesses", and "wellness maintenance" authors, each was found to contain inaccuracies or misinformation. Thus far, such information is only available in printed books. If these books are scanned and circulated, or published in e-book format, this misinformation may circulate rapidly as e-book devices are becoming popular, and, consequently, harm people’s health. We think that it is important for the government to formulate ethical guidelines for the publishing e-books with due consideration to freedom of expression. %M 23709125 %R 10.2196/ijmr.2541 %U http://www.i-jmr.org/2013/1/e10/ %U https://doi.org/10.2196/ijmr.2541 %U http://www.ncbi.nlm.nih.gov/pubmed/23709125 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e89 %T A Systematic Self-Certification Model for Mobile Medical Apps %A Lewis,Thomas Lorchan %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 7876453511, t.lewis@warwick.ac.uk %K smartphone %K technology %K education %K medicine %K app %K health care %K Android %K iPhone %K BlackBerry %K mobile phone %K standards %D 2013 %7 24.04.2013 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 23615332 %R 10.2196/jmir.2446 %U http://www.jmir.org/2013/4/e89/ %U https://doi.org/10.2196/jmir.2446 %U http://www.ncbi.nlm.nih.gov/pubmed/23615332 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 1 %P e1 %T Mobile Phone Applications for the Care and Prevention of HIV and Other Sexually Transmitted Diseases: A Review %A Muessig,Kathryn E %A Pike,Emily C %A LeGrand,Sara %A Hightow-Weidman,Lisa B %+ Department of Medicine, The University of North Carolina at Chapel Hill, Bioinformatics Bldg, CB #7030, 130 Mason Farm Rd, Chapel Hill, NC, 27599, United States, 1 443 320 3152, kmuessig@med.unc.edu %K HIV %K technology %K mobile phone applications %D 2013 %7 04.01.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone applications (apps) provide a new platform for delivering tailored human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention and care. Objective: To identify and evaluate currently available mobile phone apps related to the prevention and care of HIV and other STDs. Methods: We searched the Apple iTunes and Android Google Play stores for HIV/STD-related apps, excluding apps that exclusively targeted industry, providers, and researchers. Each eligible app was downloaded, tested, and assessed for user ratings and functionality as well as 6 broad content areas of HIV prevention and care: HIV/STD disease knowledge, risk reduction/safer sex, condom promotion, HIV/STD testing information, resources for HIV-positive persons, and focus on key populations. Results: Search queries up to May 2012 identified 1937 apps. Of these, 55 unique apps met the inclusion criteria (12 for Android, 29 for iPhone, and 14 for both platforms). Among these apps, 71% provided disease information about HIV/STDs, 36% provided HIV/STD testing information or resources, 29% included information about condom use or assistance locating condoms, and 24% promoted safer sex. Only 6 apps (11%) covered all 4 of these prevention areas. Eight apps (15%) provided tools or resources specifically for HIV/STD positive persons. Ten apps included information for a range of sexual orientations, 9 apps appeared to be designed for racially/ethnically diverse audiences, and 15 apps featured interactive components. Apps were infrequently downloaded (median 100-500 downloads) and not highly rated (average customer rating 3.7 out of 5 stars). Conclusions: Most available HIV/STD apps have failed to attract user attention and positive reviews. Public health practitioners should work with app developers to incorporate elements of evidence-based interventions for risk reduction and improve app inclusiveness and interactivity. %M 23291245 %R 10.2196/jmir.2301 %U http://www.jmir.org/2013/1/e1/ %U https://doi.org/10.2196/jmir.2301 %U http://www.ncbi.nlm.nih.gov/pubmed/23291245 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e72 %T There’s an App for That: Content Analysis of Paid Health and Fitness Apps %A West,Joshua H %A Hall,P. Cougar %A Hanson,Carl L %A Barnes,Michael D %A Giraud-Carrier,Christophe %A Barrett,James %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 221 Richards Building, Provo, UT, 84602, United States, 1 801 422 3444, josh.west@byu.edu %K mHealth %K iPhone %K app %D 2012 %7 14.05.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The introduction of Apple’s iPhone provided a platform for developers to design third-party apps, which greatly expanded the functionality and utility of mobile devices for public health. Objective: This study provides an overview of the developers’ written descriptions of health and fitness apps and appraises each app’s potential for influencing behavior change. Methods: Data for this study came from a content analysis of health and fitness app descriptions available on iTunes during February 2011. The Health Education Curriculum Analysis Tool (HECAT) and the Precede-Proceed Model (PPM) were used as frameworks to guide the coding of 3336 paid apps. Results: Compared to apps with a cost less than US $0.99, apps exceeding US $0.99 were more likely to be scored as intending to promote health or prevent disease (92.55%, 1925/3336 vs 83.59%, 1411/3336; P<.001), to be credible or trustworthy (91.11%, 1895/3336 vs 86.14%, 1454/3349; P<.001), and more likely to be used personally or recommended to a health care client (72.93%, 1517/2644 vs 66.77%, 1127/2644; P<.001). Apps related to healthy eating, physical activity, and personal health and wellness were more common than apps for substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health. Reinforcing apps were less common than predisposing and enabling apps. Only 1.86% (62/3336) of apps included all 3 factors (ie, predisposing, enabling, and reinforcing). Conclusions: Development efforts could target public health behaviors for which few apps currently exist. Furthermore, practitioners should be cautious when promoting the use of apps as it appears most provide health-related information (predisposing) or make attempts at enabling behavior, with almost none including all theoretical factors recommended for behavior change. %M 22584372 %R 10.2196/jmir.1977 %U http://www.jmir.org/2012/3/e72/ %U https://doi.org/10.2196/jmir.1977 %U http://www.ncbi.nlm.nih.gov/pubmed/22584372 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e65 %T Features of Mobile Diabetes Applications: Review of the Literature and Analysis of Current Applications Compared Against Evidence-Based Guidelines %A Chomutare,Taridzo %A Fernandez-Luque,Luis %A Årsand,Eirik %A Hartvigsen,Gunnar %+ Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Sykehusvn. 23, Tromsø, 9038, Norway, 47 47680032, taridzo.chomutare@telemed.no %K Mobile health (mHealth) %K diabetes mellitus %K blood glucose self-monitoring %K social networks %K personal health records (PHR) %K personalized education %K diabetes self-management %K health informatics %D 2011 %7 22.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in mobile health (mHealth) applications for self-management of diabetes is growing. In July 2009, we found 60 diabetes applications on iTunes for iPhone; by February 2011 the number had increased by more than 400% to 260. Other mobile platforms reflect a similar trend. Despite the growth, research on both the design and the use of diabetes mHealth applications is scarce. Furthermore, the potential influence of social media on diabetes mHealth applications is largely unexplored. Objective: Our objective was to study the salient features of mobile applications for diabetes care, in contrast to clinical guideline recommendations for diabetes self-management. These clinical guidelines are published by health authorities or associations such as the National Institute for Health and Clinical Excellence in the United Kingdom and the American Diabetes Association. Methods: We searched online vendor markets (online stores for Apple iPhone, Google Android, BlackBerry, and Nokia Symbian), journal databases, and gray literature related to diabetes mobile applications. We included applications that featured a component for self-monitoring of blood glucose and excluded applications without English-language user interfaces, as well as those intended exclusively for health care professionals. We surveyed the following features: (1) self-monitoring: (1.1) blood glucose, (1.2) weight, (1.3) physical activity, (1.4) diet, (1.5) insulin and medication, and (1.6) blood pressure, (2) education, (3) disease-related alerts and reminders, (4) integration of social media functions, (5) disease-related data export and communication, and (6) synchronization with personal health record (PHR) systems or patient portals. We then contrasted the prevalence of these features with guideline recommendations. Results: The search resulted in 973 matches, of which 137 met the selection criteria. The four most prevalent features of the applications available on the online markets (n = 101) were (1) insulin and medication recording, 63 (62%), (2) data export and communication, 61 (60%), (3) diet recording, 47 (47%), and (4) weight management, 43 (43%). From the literature search (n = 26), the most prevalent features were (1) PHR or Web server synchronization, 18 (69%), (2) insulin and medication recording, 17 (65%), (3) diet recording, 17 (65%), and (4) data export and communication, 16 (62%). Interestingly, although clinical guidelines widely refer to the importance of education, this is missing from the top functionalities in both cases. Conclusions: While a wide selection of mobile applications seems to be available for people with diabetes, this study shows there are obvious gaps between the evidence-based recommendations and the functionality used in study interventions or found in online markets. Current results confirm personalized education as an underrepresented feature in diabetes mobile applications. We found no studies evaluating social media concepts in diabetes self-management on mobile devices, and its potential remains largely unexplored. %M 21979293 %R 10.2196/jmir.1874 %U http://www.jmir.org/2011/3/e65/ %U https://doi.org/10.2196/jmir.1874 %U http://www.ncbi.nlm.nih.gov/pubmed/21979293