Evaluating mobile phone applications for health behaviour change: A systematic review

Introduction Increasing smartphones access has allowed for increasing development and use of smart phone applications (apps). Mobile health interventions have previously relied on voice or text-based short message services (SMS), however, the increasing availability and ease of use of apps has allowed for significant growth of smartphone apps that can be used for health behaviour change. This review considers the current body of knowledge relating to the evaluation of apps for health behaviour change. The aim of this review is to investigate approaches to the evaluation of health apps to identify any current best practice approaches. Method A systematic review was conducted. Data were collected and analysed in September 2016. Thirty-eight articles were identified and have been included in this review. Results Articles were published between 2011– 2016, and 36 were reviews or evaluations of apps related to one or more health conditions, the remaining two reported on an investigation of the usability of health apps. Studies investigated apps relating to the following areas: alcohol, asthma, breastfeeding, cancer, depression, diabetes, general health and fitness, headaches, heart disease, HIV, hypertension, iron deficiency/anaemia, low vision, mindfulness, obesity, pain, physical activity, smoking, weight management and women’s health. Conclusion In order to harness the potential of mobile health apps for behaviour change and health, we need better ways to assess the quality and effectiveness of apps. This review is unable to suggest a single best practice approach to evaluate mobile health apps. Few measures identified in this review included sufficient information or evaluation, leading to potentially incomplete and inaccurate information for consumers seeking the best app for their situation. This is further complicated by a lack of regulation in health promotion generally.

[1]  Amy M. Cohn,et al.  Promoting behavior change from alcohol use through mobile technology: the future of ecological momentary assessment. , 2011, Alcoholism, clinical and experimental research.

[2]  J. L. Bender,et al.  Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace , 2015, JMIR mHealth and uHealth.

[3]  Zhou-wen Chen,et al.  Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: A randomized controlled trial , 2008, Journal of Zhejiang University SCIENCE B.

[4]  Bettina B. Hoeppner,et al.  How Smart are Smartphone Apps for Smoking Cessation? A Content Analysis. , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[5]  J. L. Bender,et al.  A Lot of Action, But Not in the Right Direction: Systematic Review and Content Analysis of Smartphone Applications for the Prevention, Detection, and Management of Cancer , 2013, Journal of medical Internet research.

[6]  Charles Abraham,et al.  A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management , 2016, International Journal of Behavioral Nutrition and Physical Activity.

[7]  Lora E Burke,et al.  Mobile applications for weight management: theory-based content analysis. , 2013, American journal of preventive medicine.

[8]  Wilhelm Kirch,et al.  Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older , 2014, Journal of medical Internet research.

[9]  J. Emery,et al.  Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review , 2015, British Journal of Dermatology.

[10]  Russell A. McCann,et al.  mHealth for mental health: Integrating smartphone technology in behavioral healthcare. , 2011 .

[11]  Cecily Morrison,et al.  Apps for asthma self-management: a systematic assessment of content and tools , 2012, BMC Medicine.

[12]  Morwenna Kirwan,et al.  Using Smartphone Technology to Monitor Physical Activity in the 10,000 Steps Program: A Matched Case–Control Trial , 2012, Journal of medical Internet research.

[13]  Borja Martínez-Pérez,et al.  Mobile Health Applications for the Most Prevalent Conditions by the World Health Organization: Review and Analysis , 2013, Journal of medical Internet research.

[14]  Joyce M Lee,et al.  The Promise and Peril of Mobile Health Applications for Diabetes and Endocrinology , 2013, Pediatric diabetes.

[15]  A. Haines,et al.  The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review , 2013, PLoS medicine.

[16]  Oksana Zelenko,et al.  Mobile App Rating Scale: A New Tool for Assessing the Quality of Health Mobile Apps , 2015, JMIR mHealth and uHealth.

[17]  Nick Wilson,et al.  Smartphone apps for weight loss and smoking cessation: Quality ranking of 120 apps. , 2015, The New Zealand medical journal.

[18]  H. Christensen,et al.  Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review , 2013, Journal of medical Internet research.

[19]  Charmian Reynoldson,et al.  Assessing the quality and usability of smartphone apps for pain self-management. , 2014, Pain medicine.

[20]  Inmaculada Plaza,et al.  Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features , 2013, JMIR mHealth and uHealth.

[21]  Ali Idri,et al.  Empirical Studies on Usability of mHealth Apps: A Systematic Literature Review , 2015, Journal of Medical Systems.

[22]  杨琤 Promoting Health Literacy for Health Benefits , 2009 .

[23]  Miguel López-Coronado,et al.  Mobile Apps in Cardiology: Review , 2013, JMIR mHealth and uHealth.

[24]  Joel J. P. C. Rodrigues,et al.  Analysis of mobile health applications for a broad spectrum of consumers: A user experience approach , 2014, Health Informatics J..

[25]  Ambarish Pandey,et al.  Smartphone Apps as a Source of Cancer Information: Changing Trends in Health Information-Seeking Behavior , 2012, Journal of Cancer Education.

[26]  S. Michie,et al.  A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy , 2011, Psychology & health.

[27]  J. Bernhardt,et al.  Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature , 2015, JMIR mHealth and uHealth.

[28]  J. Brug,et al.  Apps to promote physical activity among adults: a review and content analysis , 2014, International Journal of Behavioral Nutrition and Physical Activity.

[29]  T. Volsko,et al.  Readability assessment of internet-based consumer health information. , 2008, Respiratory care.

[30]  C. Abraham,et al.  A taxonomy of behavior change techniques used in interventions. , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[31]  Helen Keleher,et al.  Health Literacy in Primary Health Care , 2007 .

[32]  Lyndal Trevena,et al.  A systematic review of quality assessment methods for smartphone health apps. , 2015, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[33]  Christopher E. Beaudoin,et al.  Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps , 2015, JMIR mHealth and uHealth.

[34]  K. Weinfurt,et al.  An Evaluation of Mobile Health Application Tools , 2014, JMIR mHealth and uHealth.

[35]  Jakob Nielsen,et al.  Heuristic evaluation of user interfaces , 1990, CHI '90.

[36]  Jounghwa Choi,et al.  Smoking Cessation Apps for Smartphones: Content Analysis With the Self-Determination Theory , 2014, Journal of medical Internet research.

[37]  Matthew Dunn,et al.  Health literacy and the Internet: a study on the readability of Australian online health information , 2015, Australian and New Zealand journal of public health.

[38]  Lorien C Abroms,et al.  A content analysis of popular smartphone apps for smoking cessation. , 2013, American journal of preventive medicine.

[39]  G. Hartvigsen,et al.  Features of Mobile Diabetes Applications: Review of the Literature and Analysis of Current Applications Compared Against Evidence-Based Guidelines , 2011, Journal of medical Internet research.

[40]  Neetika Garg,et al.  A content analysis of smartphone-based applications for hypertension management. , 2015, Journal of the American Society of Hypertension : JASH.

[41]  Robustillo CortésMaría de las Aguas,et al.  High Quantity But Limited Quality in Healthcare Applications Intended for HIV-Infected Patients , 2014 .

[42]  M. Lim,et al.  SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health , 2008, International journal of STD & AIDS.

[43]  C. Befort,et al.  iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention. , 2014, Childhood obesity.

[44]  Robert West,et al.  Comparative analysis of smoking cessation smartphone applications available in 2012 versus 2014 , 2016, Addictive behaviors.

[45]  Devin Mann,et al.  Evidence-based strategies in weight-loss mobile apps. , 2013, American journal of preventive medicine.

[46]  María de las Aguas Robustillo Cortés,et al.  High quantity but limited quality in healthcare applications intended for HIV-infected patients. , 2014 .

[47]  David Heaney,et al.  Patients’ experiences of using a smartphone application to increase physical activity: the SMART MOVE qualitative study in primary care , 2014, The British journal of general practice : the journal of the Royal College of General Practitioners.

[48]  Emma Derbyshire,et al.  Smartphone Medical Applications for Women's Health: What Is the Evidence-Base and Feedback? , 2013, International journal of telemedicine and applications.

[49]  Amos S Hundert,et al.  Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review , 2014, JMIR mHealth and uHealth.

[50]  T. Corbett,et al.  Behavior Change Techniques in Apps for Medication Adherence: A Content Analysis. , 2016, American journal of preventive medicine.

[51]  Ali Sunyaev,et al.  Availability and quality of mobile health app privacy policies , 2015, J. Am. Medical Informatics Assoc..

[52]  William Brown,et al.  Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology , 2013, J. Biomed. Informatics.

[53]  B. Fjeldsoe,et al.  Behavior change interventions delivered by mobile telephone short-message service. , 2009, American journal of preventive medicine.

[54]  J. Miller,et al.  Evaluating the Readability of Privacy Policies in Mobile Environments , 2011, Int. J. Mob. Hum. Comput. Interact..

[55]  C. Abraham,et al.  The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions , 2013, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[56]  David E Conroy,et al.  Implementation of behavior change techniques in mobile applications for physical activity. , 2015, American journal of preventive medicine.

[57]  L Suzanne Suggs,et al.  SMS for disease control in developing countries: a systematic review of mobile health applications , 2012, Journal of telemedicine and telecare.

[58]  Ara Darzi,et al.  Smartphone breast applications - what's the evidence? , 2014, Breast.

[59]  R. Whittaker,et al.  Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques? , 2014, BMC Public Health.

[60]  Helen Monkman,et al.  A Health Literacy and Usability Heuristic Evaluation of a Mobile Consumer Health Application , 2013, MedInfo.

[61]  Rebecca Jenkinson,et al.  “Let’s get Wasted!” and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications , 2013, JMIR mHealth and uHealth.

[62]  C. Eccleston,et al.  Smartphone applications for pain management , 2011, Journal of telemedicine and telecare.

[63]  W. Nilsen,et al.  Health behavior models in the age of mobile interventions: are our theories up to the task? , 2011, Translational behavioral medicine.

[64]  Dimitris Gritzalis,et al.  Delegate the smartphone user? Security awareness in smartphone platforms , 2013, Comput. Secur..

[65]  D. Conroy,et al.  Behavior change techniques in top-ranked mobile apps for physical activity. , 2014, American journal of preventive medicine.