Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain

Abstract

With rising smartphone ownership, mobile health applications (mHealth apps) have the potential to support high-need, high-cost populations in managing their health. While the number of available mHealth apps has grown substantially, no clear strategy has emerged on how providers should evaluate and recommend such apps to patients. Key stakeholders, including medical professional societies, insurers, and policy makers, have largely avoided formally recommending apps, which forces patients to obtain recommendations from other sources. To help stakeholders overcome barriers to reviewing and recommending apps, we evaluated 137 patient-facing mHealth apps-those intended for use by patients to manage their health-that were highly rated by consumers and recommended by experts and that targeted high-need, high-cost populations. We found that there is a wide variety of apps in the marketplace but that few apps address the needs of the patients who could benefit the most. We also found that consumers' ratings were poor indications of apps' clinical utility or usability and that most apps did not respond appropriately when a user entered potentially dangerous health information. Going forward, data privacy and security will continue to be major concerns in the dissemination of mHealth apps.

Understanding the quality, effectiveness and attributes of top-rated smartphone health apps

“…While prior studies have used 10-point scales to assess quality,15 we felt that a simpler scheme of (a) ‘serious concerns regarding safety’, (b) ‘appears acceptable’ and (c) ‘may be useful or offer more features than other similar apps’ offers higher validity, though still subjective in nature. Any apps that raised concern about the safety of the user were rated as ‘serious concerns regarding safety’ (eg, apps that installed malware on the user’s phone, apps that promise brain changes after listening to music and so on).…”

“…Although there is some evidence that there is a correlation between star rating of an app and its number of downloads,14 generally little is known about why some health apps become popular and others not. Furthermore, researchers have demonstrated that the number of stars or number of downloads on app marketplaces does not correlate with clinical utility or validity for all apps including mental health apps 15. Ideally better features and functionality would drive popularity, but research on popular blood pressure apps suggests that those offering inaccurate and ‘falsely reassuring’ low numbers were top rated, presumably because people liked being told that they were healthy 16.…”

Privacy Issues in Smartphone Applications: An Analysis of Headache/Migraine Applications

“…Traditionally, there are on-line star ratings by users but a study of 137 patient-facing apps found that star-based ratings had low correlation with the apps’ clinical utility or usability. 50 Clinical ratings of individual features of mental health apps also show low interrater reliability 51 and the frequently updating nature of apps means any static score for them will be rapidly out of date. There may be utility in using smartphone app evaluation frameworks in future research whereby both doctors and patients have tools to weight the risks, evidence, usability, and data sharing potential of an app.…”

Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study

“…Presently, the mHealth field is at a crossroads: the cell phone medium is at risk of losing its utility for public health delivery due to the dearth of research evaluating the effectiveness of the over 100,000 available, predominantly consumer-facing mobile apps [27,28]. Sense Health has integrated health behavior theory into the development of its mobile communication platform from the outset, thus presenting an opportunity to assess the implications of using a theory-based approach.…”