Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review

Abstract

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

Quality assessment of mHealth apps: a scoping review

“…Our review only included articles up to mid-2021. However, a current review pointed out older assessment tools such as the SUS (1996) ( 20 ), the MARS (2015) ( 18 ), the PSSUQ (1995) ( 85 ), and the uMARS (2016) ( 63 ) are still among the most commonly used in mHealth assessment ( 99 ). Therefore, we are confident that our search strategy has enabled us to include a large proportion of quality assessment tools and quality assurance systems currently in use.…”

“…While we are not aware of a literature review specifically on quality assurance systems, at the time of our search several literature reviews on the quality assessment of mHealth apps had already been published (91,(94)(95)(96)(97)(98)(99). The most recent review of these included literature published up to December 2022 (99).…”

“…While we are not aware of a literature review specifically on quality assurance systems, at the time of our search several literature reviews on the quality assessment of mHealth apps had already been published (91,(94)(95)(96)(97)(98)(99). The most recent review of these included literature published up to December 2022 (99). The authors identified a set of 216 evaluation criteria and 6 relevant dimensions ("context", "stakeholder involvement", "development process", "evaluation", "implementation", and "features and requirements").…”