Problems and Barriers Related to the Use of Digital Health Applications: Protocol for a Scoping Review

Giebel, Godwin Denk; Speckemeier, Christian; Abels, Carina; Börchers, Kirstin; Wasem, Jürgen; Blase, Nikola; Neusser, Silke

doi:10.2196/32702

Cited by 8 publications

(9 citation statements)

References 24 publications

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“…The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist [ 12 ]. The corresponding research protocol was published in JMIR Research Protocols [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

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Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review

Giebel¹,

Speckemeier²,

Abels³

et al. 2023

J Med Internet Res

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Background The digitization of health care led to a steady increase in the adoption and use of mobile health (mHealth) apps. Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. Although the benefits of mHealth apps are discussed in detail, aspects of problems and barriers are rarely studied. Objective This scoping review aimed to map and categorize the evidence on problems and barriers related to the use of mHealth apps. Methods Systematic searches were conducted in the MEDLINE, Embase, and PsycINFO databases. Additional searches were conducted on JMIR Publications and on websites of relevant international organizations. The inclusion criteria were publications dealing with apps similar to those approved in the German health care system, publications addressing problems and barriers related to the use of mHealth apps, and articles published between January 1, 2015, and June 8, 2021. Study selection was performed by 2 reviewers. The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included publications and categorization of problems and hurdles were performed using MAXQDA (VERBI Software GmbH). Results The database search identified 1479 publications. Of the 1479 publications, 21 (1.42%) met the inclusion criteria. A further 8 publications were included from citation searching and searching in JMIR Publications. The identified publications were analyzed for problems and barriers. Problems and barriers were classified into 10 categories (“validity,” “usability,” “technology,” “use and adherence,” “data privacy and security,” “patient-physician relationship,” “knowledge and skills,” “individuality,” “implementation,” and “costs”). The most frequently mentioned categories were use and adherence (eg, incorporating the app into daily life or dropouts from use; n=22) and usability (eg, ease of use and design; n=19). Conclusions The search identified various problems and barriers in the context of mHealth apps. Although problems at the app level (such as usability) are studied frequently, problems at the system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers and policy makers should have a special focus on this issue to identify the needs for quality assurance. International Registered Report Identifier (IRRID) RR2-10.2196/32702

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Section: Methodsmentioning

confidence: 99%

“…If there were indexing terms (Medical Subject Headings and Emtree), the search string was extended accordingly. The final search strategy for each database can be found in the research protocol [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review

Giebel¹,

Speckemeier²,

Abels³

et al. 2023

J Med Internet Res

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“…This will also provide an overview on research gaps in the literature [ 10 ]. As part of our QuaSiApps project, the results will be used alongside those of another scoping reviews [ 16 ], focus groups, and stakeholder surveys to develop a continuous quality assurance system.…”

Section: Discussionmentioning

confidence: 99%

“…The language restriction was made because English and German were the only common languages of the reviewers. Regarding the search strategy of the proposed scoping review, it should be considered that there is still inconsistency regarding terminology [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Quality Assessment of Digital Health Applications: Protocol for a Scoping Review

Giebel¹,

Schrader²,

Speckemeier³

et al. 2022

JMIR Res Protoc

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Background All over the world, development and usage of mobile health (mHealth) apps is increasing. While apps offer numerous opportunities to improve health care, there are associated problems that differ significantly from those of traditional health care services. Further investigations on the quality of mHealth apps are needed to address these problems. Objective This study aims to identify and map research on quality assessment and quality assurance of mHealth apps and their transferability to continuous quality assurance of mHealth apps. Methods The scoping review will follow published methodological frameworks for scoping studies as well as Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria. Electronic databases (Medline, EMBASE, and PsycINFO), reference lists of relevant articles, and websites of relevant institutions will be searched. Two reviewers will independently assess eligibility of articles. Therefore, a 2-stage (title and abstract, followed by full text) screening process was conducted. Quality management systems and quality assessment tools will be analyzed and included in our review. Particular focus is placed on quality dimensions. Results This scoping review provides an overview of the available evidence and identifies research gaps regarding continuous quality assessment of mHealth apps. Thereby, relevant quality dimensions and criteria can be identified and their eligibility and relevance for the development of a continuous quality assurance system of mHealth apps can be determined. Our results are planned to be submitted to an indexed, peer-reviewed journal in the second half of 2022. Conclusions This is the first review in the context of continuous quality assurance of mHealth apps. Our results will be used within the research “Continuous quality assurance of Digital Health Applications” (“QuaSiApps”) project funded by the German Federal Joint Committee. International Registered Report Identifier (IRRID) DERR1-10.2196/36974

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“…Other countries, such as England, Denmark, the Netherlands, Norway, Sweden, and the USA, are still in the development process [ 1 ]. France has already announced its intention to adopt the German system [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence requirements of permanently listed digital health applications (DiGA) and their implementation in the German DiGA directory: an analysis

Mäder

Timpel²,

Schönfelder³

et al. 2023

BMC Health Serv Res

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Background With its digital health application (DiGA)-system, Germany is considered one of Europe's pioneers in the field of evidence-based digital health. Incorporating DiGA into standard medical care must be based on evidence-based success factors; however, a comprehensive overview of the evidence required of scientific studies for their approval is lacking. Objective The study aims to, (1) identify specific requirements defined by the Federal Institute for Drugs and Medical Devices (German: Bundesinstitut für Arzneimittel- und Medizinprodukte; BfArM) to design adequate studies, proving a positive healthcare effect, and (2) to assess the evidence given for applications permanently listed in the DiGA directory. Methods A multi-step approach was used: (1) identification of the evidence requirements for applications permanently listed in the DiGA directory, (2) identification of the evidence available supporting them. Results All DiGA permanently listed in the DiGA directory (13 applications) are included in the formal analysis. Most DiGA addressed mental health (n = 7), and can be prescribed for one or two indications (n = 10). All permanently listed DiGA have demonstrated their positive healthcare effect through a medical benefit, and most of them provide evidence for one defined primary endpoint. All DiGA manufacturers conducted a randomized controlled trial. Discussion It is striking that— although patient-relevant structural and procedural improvements show high potential for improving care, especially in terms of processes — all DiGA have provided a positive care effect via a medical benefit. Although BfArM accepts study designs with a lower level of evidence for the proof of a positive healthcare effect, all manufacturers conducted a study with a high level of evidence. Conclusion The results of this analysis indicate that permanently listed DiGA meet higher standards than required by the guideline.

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Problems and Barriers Related to the Use of Digital Health Applications: Protocol for a Scoping Review

Cited by 8 publications

References 24 publications

Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review

Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review

Quality Assessment of Digital Health Applications: Protocol for a Scoping Review

Evidence requirements of permanently listed digital health applications (DiGA) and their implementation in the German DiGA directory: an analysis

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