Background Mobile health (mHealth) apps have gained significant popularity over the last few years due to their tremendous benefits, such as lowering health care costs and increasing patient awareness. However, the sensitivity of health care data makes the security of mHealth apps a serious concern. Poor security practices and lack of security knowledge on the developers’ side can cause several vulnerabilities in mHealth apps. Objective In this review paper, we aimed to identify and analyze the reported challenges concerning security that developers of mHealth apps face. Additionally, our study aimed to develop a conceptual framework with the challenges for developing secure apps faced by mHealth app development organizations. The knowledge of such challenges can help to reduce the risk of developing insecure mHealth apps. Methods We followed the systematic literature review method for this review. We selected studies that were published between January 2008 and October 2020 since the major app stores launched in 2008. We selected 32 primary studies using predefined criteria and used a thematic analysis method for analyzing the extracted data. Results Of the 1867 articles obtained, 32 were included in this review based on the predefined criteria. We identified 9 challenges that can affect the development of secure mHealth apps. These challenges include lack of security guidelines and regulations for developing secure mHealth apps (20/32, 63%), developers’ lack of knowledge and expertise for secure mHealth app development (18/32, 56%), lack of stakeholders’ involvement during mHealth app development (6/32, 19%), no/little developer attention towards the security of mHealth apps (5/32, 16%), lack of resources for developing a secure mHealth app (4/32, 13%), project constraints during the mHealth app development process (4/32, 13%), lack of security testing during mHealth app development (4/32, 13%), developers’ lack of motivation and ethical considerations (3/32, 9%), and lack of security experts’ engagement during mHealth app development (2/32, 6%). Based on our analysis, we have presented a conceptual framework that highlights the correlation between the identified challenges. Conclusions While mHealth app development organizations might overlook security, we conclude that our findings can help them to identify the weaknesses and improve their security practices. Similarly, mHealth app developers can identify the challenges they face to develop mHealth apps that do not pose security risks for users. Our review is a step towards providing insights into the development of secure mHealth apps. Our proposed conceptual framework can act as a practice guideline for practitioners to enhance secure mHealth app development.

Mobile apps exploit embedded sensors and wireless connectivity of a device to empower users with portable computations, context-aware communication, and enhanced interaction. Specifically, mobile health apps (mHealth apps for short) are becoming integral part of mobile and pervasive computing to improve the availability and quality of healthcare services. Despite the offered benefits, mHealth apps face a critical challenge, i.e., security of health critical data that is produced and consumed by the app. Several studies have revealed that security specific issues of mHealth apps have not been adequately addressed. The objectives of this study are to empirically (a) investigate the challenges that hinder development of secure mHealth apps, (b) identify practices to develop secure apps, and (c) explore motivating factors that influence secure development. We conducted this study by collecting responses of 97 developers from 25 countriesacross 06 continentsworking in diverse teams and roles to develop mHealth apps for Android, iOS, and Windows platform. Qualitative analysis of the survey data is based on (i) 8 critical challenges, (ii) taxonomy of best practices to ensure security, and (iii) 6 motivating factors that impact secure mHealth apps. This research provides empirical evidence as practitioners' view and guidelines to develop emerging and next generation of secure mHealth apps.

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BACKGROUND Mobile health (mHealth) apps have gained significant popularity over the last few years due to their tremendous benefits, such as lowering health care costs and increasing patient awareness. However, the sensitivity of health care data makes the security of mHealth apps a serious concern. Poor security practices and lack of security knowledge on the developers’ side can cause several vulnerabilities in mHealth apps. OBJECTIVE In this review paper, we aimed to identify and analyze the reported challenges concerning security that developers of mHealth apps face. Additionally, our study aimed to develop a conceptual framework with the challenges for developing secure apps faced by mHealth app development organizations. The knowledge of such challenges can help to reduce the risk of developing insecure mHealth apps. METHODS We followed the systematic literature review method for this review. We selected studies that were published between January 2008 and October 2020 since the major app stores launched in 2008. We selected 32 primary studies using predefined criteria and used a thematic analysis method for analyzing the extracted data. RESULTS Of the 1867 articles obtained, 32 were included in this review based on the predefined criteria. We identified 9 challenges that can affect the development of secure mHealth apps. These challenges include lack of security guidelines and regulations for developing secure mHealth apps (20/32, 63%), developers’ lack of knowledge and expertise for secure mHealth app development (18/32, 56%), lack of stakeholders’ involvement during mHealth app development (6/32, 19%), no/little developer attention towards the security of mHealth apps (5/32, 16%), lack of resources for developing a secure mHealth app (4/32, 13%), project constraints during the mHealth app development process (4/32, 13%), lack of security testing during mHealth app development (4/32, 13%), developers’ lack of motivation and ethical considerations (3/32, 9%), and lack of security experts’ engagement during mHealth app development (2/32, 6%). Based on our analysis, we have presented a conceptual framework that highlights the correlation between the identified challenges. CONCLUSIONS While mHealth app development organizations might overlook security, we conclude that our findings can help them to identify the weaknesses and improve their security practices. Similarly, mHealth app developers can identify the challenges they face to develop mHealth apps that do not pose security risks for users. Our review is a step towards providing insights into the development of secure mHealth apps. Our proposed conceptual framework can act as a practice guideline for practitioners to enhance secure mHealth app development.