Apps and Adolescents: A Systematic Review of Adolescents’ Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions

Abstract

BackgroundThe prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely.ObjectiveTo systematically review the literature on the effectiveness of mobile apps designed to support adolescents’ management of their physical chronic or long-term conditions.MethodsWe conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools.ResultsThe search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants’ ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents’ personal management of their conditions.ConclusionsA key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps’ acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions.

Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research (Preprint)

“…Personal management of chronic physical conditions requires 5 main skills: problem solving, decision-making, resource utilization, patient-doctor relationships, and taking action. [42] The prototype mobile application can assist in aiding problem solving and decision making by providing disease-specific and lifestyle information, as well as create portable tools that adolescents can use to convey important disease information, including a portable medical summary and a CHD diagram of their disease.…”

“…A systematic review of adolescents' use of mobile applications that support management of chronic disease from 2015 revealed that the available four mobile apps that assisted youth with chronic disease that contained pre/post or randomized control data. [42] Two of these apps were focused on diabetes type 1, and the other two focused on asthma and cancer. Three out of the four studies reported some level of patient involvement in the design, development and/or evaluation of the app This study noted that the dearth of studies and overall small sample size emphasized the need for future studies on the development, use, and effectiveness of mobile apps to support adolescent personal management of their chronic disease.…”

“…Three out of the four studies reported some level of patient involvement in the design, development and/or evaluation of the app This study noted that the dearth of studies and overall small sample size emphasized the need for future studies on the development, use, and effectiveness of mobile apps to support adolescent personal management of their chronic disease. [42] There is currently, to our knowledge, no available mobile app for assisting patients with CHD in the transition process or in managing their disease. Thus our mobile application fills a gap in a high risk, heterogeneous population that requires lifelong management and care of their disease.…”

Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults (Preprint)

“…However, sustained mobile data collection is challenging due to lack of engagement and adherence [23,24]. Indeed, adherence is generally low for mHealth data collection apps [25], which is also true for substance use apps.…”

“…For example, a recent review of mHealth apps for substance use (including text messaging and apps) concluded that engagement is a critical limitation, with most use declining quickly over brief periods of time (2 weeks to 3 months) [26]; importantly, few studies included adolescents or emerging adults [27]. Similarly, research on behavioral health apps is also limited among youth, with engagement challenging, potentially because youth may habituate to apps [24] as well as competing demands due to frequent use of other apps (e.g., social media [22] or entertainment apps [28]). …”