Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review

Abstract

BackgroundSelf-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined.ObjectiveThe purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations.MethodsData sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement.ResultsOur final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app’s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome.ConclusionsMost apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others.

Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study (Preprint)

“…Previous studies identified the main factors of successful outcomes in mHealth interventions for older populations as independence, understanding, and confidence to access complex interventions [13,20]. Tracking features during periodic training and regular follow-ups are essential to provide positive feedback of progression based on objective data obtained during the mHealth intervention [11,35].…”

“…The iPad mini has some advantages regarding (1) proper size and weight to carry; (2) high pixel density in high quality images, which is key for older users to reduce burden due to limited visual difficulty; and (3) opportunities to use diverse types of apps developed internationally [23], as previous literature emphasizes [10,11,20].…”

“…In Phase 4, participants were instructed to use the selected apps for at least 30 minutes daily for a week to ensure feasibility [11]. All participants could still explore additional apps and downloaded some of them with interventionists as needed.…”

“…Computer-related questions were asked such as whether the participants had used computers, smart devices, or the Internet. We developed a self-reporting user evaluation and a proxy-report checklist of essential tasks based on previous literature [11,34]. After completing Phase 1, participants reported their confidence and a research assistant observed their basic skills in using mobile devices based on a standardized checklist.…”

“…Mobile health (mHealth) interventions are an emerging alternative to enhance selfmanagement of diseases [10][11][12]. mHealth is defined as medical and public eHealth approaches to improve health and wellbeing, which allows delivery of healthcare services via various solutions using mobile devices and associated technologies [10,12].…”