A research team led by Assistant Professor of Learning Health Sciences at the University of Michigan Medical School, Karandeep Singh, and Professor of Medicine at Harvard Medical School, David Bates, have developed a framework for evaluating mHealth apps for their patient engagement potential, quality and safety.

A review of more than 1,000 healthcare related-apps found that less than half appeared to be useful for their potential for patient engagement while also offering high quality and safety, according to the issue brief published by The Commonwealth Fund.

According to the issue brief, the researchers conducted a systematic search of Apple and Android app stores and an analysis of apps designed for those with chronic illnesses to assess which apps are likely to be useful in patient engagement efforts.

Usefulness was determined based on description of engagement; relevance to the targeted patient population; consumer ratings; and reviews and most recent app update.

The research team searched for apps using the following terms: alcohol; arthritis; asthma; bipolar;cancer; cirrhosis; cognitive impairment; chronic obstructive pulmonary disease; COPD; coronary artery disease; dementia; depression; diabetes; drug abuse; elderly; heart disease; heart failure; high blood pressure; hypertension; kidney disease; liver disease; lung disease; obesity; pain; smoking; and stroke.

Among the 1,046 health care–related, patient-facing apps identified by the search, the researchers found that 43 % of iOS apps and 27 % of Android apps appeared likely to be useful.

The research team also developed criteria for evaluating the patient engagement, quality and safety of mobile apps.

The researchers also constructed and used an engagement pyramid to determine how apps are meeting the needs of patients with differing levels of healthcare engagement. Those patients least engaged in their own care, for example, may face health literacy or social barriers to care, which can be addressed through health education, reminders and recording of health information.

“Moderately activated patients who are informed and able to keep track their health may benefit from being able to visualise and summarise their health information, receive guidance on next steps and communicate with family members and healthcare providers,” Singh and Bates wrote.

According to the authors, the most engaged patients may benefit from peer support delivered through social media or ongoing motivational challenges that can be delivered through gamification—that is, using elements of game design, like competition or point scoring, to make an activity more fun.

The researchers applied their evaluation framework to a sample of apps, including an app that anonymously connects users with trained ‘active listeners‘ for emotional support, counselling and therapy to help address depression, anxiety and stress; and a medication management app that provides users with medication reminders, refill alerts, drug interaction warnings and the ability to track medication side effects.

With the counselling and therapy services app, the researchers concluded that the app is designed to support highly engaged patients by connecting them to a private social network of active listeners.

“While the app does not provide functions to support patients with low or moderate engagement levels, both a clinician and a non-clinician scored the app highly on recommendability. This app demonstrates that health apps need not provide a wide array of functionalities or target patients across the engagement spectrum to be useful,” Singh and Bates wrote.

“App quality and safety do not necessarily align with functionality and must be considered separately. In developing this framework, we discovered several apps that sacrificed quality or safety in the pursuit of added functionality,” continued the authors.

With the medication management app, the researchers concluded that it is “an example of an app that appears to successfully meet the needs of patients with varying levels of engagement.”

In conclusion, the researchers noted that just as treatment needs to be tailored to the patient, the same applies to apps, as mHealth apps “appeal to different audiences by offering varied functionalities.”

“Using a framework that considers the engagement, quality and safety of mobile apps is critical for stakeholders to identify trustworthy apps that serve the needs of high-need, high-cost populations. While apps have tremendous potential to engage high-need, high-cost populations, a minority of patient-facing health applications on both the Apple and Android stores appear likely to be useful to patients.”

The research team is currently using its proposed framework to evaluate 143 apps targeting high-need, high-cost patients.

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