How to choose a health app - a guide for clinicians

There are hundreds of thousands of health-related apps available from app stores. Currently the health app market is unregulated and as a result, there may be a number of healthcare apps that are helpful to users, but there is a growing number of apps that are untested and have the potential to be harmful.

Health professionals, as experts in their field, definitely have a role in helping determine whether an app is credible and safe for patients to use. The following are suggestions of what to consider when prescribing an app or helping a patient decide on a useful app for their condition.

There are three main things to keep in mind when considering a health app:

  1. Is it credible and safe?
  2. Is it user-friendly?
  3. Is it appealing and engaging?

Credibility: is the app credible and safe?

  • Evaluate the content quality
    • Does the app provide accurate information?
    • Does the app make suggestions about changing medication or treatment plans without consultation with the person’s health professional?
    • Is the medical content or advice offered by the app sound, safe and up-to-date?   
    • Does the app have the ability to handle 'dangerous' information entered by a patient such as a low blood glucose level, or suicidal thoughts?   
  • Assess the source
    (the most reliable health apps tend to result from collaborations among developers and health professionals)
    • Does the app come from a legitimate source?
    • Has it had input from health professionals? 
    • Is it sponsored or developed by a reputable organisation, university or health provider? 
  • Consider it's New Zealand relevance
    • Is the app suitable or relevant for New Zealanders?
    • Most apps available from app stores are developed overseas and do not have a New Zealand focus. It's important that the recommendations within these apps are in keeping with New Zealand practice. Other aspects to look for are things like the option for metric measurements (e.g. kilograms instead of pounds) and medications that may not be available in New Zealand.
  • Consider privacy and security concerns
    • Does the app have clear privacy guidelines on how data shared via the app will be stored and used?
    • Does the app ask for permission to access unrelated information that may be used for advertising or other commercial purposes?
    • Does the app require your credit card details, even before you begin using it.

User experience: is the app appealing and engaging?

Many health apps have low ongoing patient engagement. They may appeal to people initially, but fail to engage on a continued, ongoing basis and usage often drops off after a few weeks.

  • Is the app interactive?
    • Does it provide feedback and options like medication reminders, data syncing, user control, data visualisation and exportation?
    • Is it more of a glorified information pamphlet?
  • Is the app visually attractive and appealing?
  • Is it fun or entertaining?
  • How likely is it that the app may engage and motivate the user to change their health behaviour or attitudes or increase their knowledge or improve/maintain the management of their health condition? Does it use game strategies or appealing animations to keep you engaged?
  • When considering the appeal of an app, consider the app’s target audience, for example, an app viewed as easy by a teenager may seem fiddly and confusing to a smartphone novice. And what is appealing and engaging to one person could appear childish and patronising to another.
  • Is there evidence of patient involvement and co-design in app development such as collaboration with patient groups?   
Strategies to encourage patient engagement

  • providing educational information
  • reminders or alerts
  • recording and tracking health information
  • providing guidance based on information entered by the user 
  • enabling communication with clinicians, family members, and caregivers
  • providing support through social networks
  • supporting behaviour change through rewards.

It's important to note that health apps don't need to provide a wide array of functionalities to be useful. An app that addresses specific needs of patients  can be effective and worth recommending.

User experience: is the app user-friendly?

  • Is the layout simple, clear and well designed? Or cluttered and confusing?
  • Is it easy and intuitive to learn how to use? Does it have long lags or technical bugs?
  • Is the app’s language and information suitable for the target group your patient belongs to? If local does it include Māori and other language options?
  • How much data space will the app take up on a smartphone or tablet and/or how much mobile data will it require to run?
  • Does it require the internet to use its core features?
  • Does it have ongoing costs or charges?
  • Does it have advertising? Is the advertising intrusive and distracting?
  • What are the reviews and ratings of the app on sites that you trust? Generally in app stores, review scores are aggregated and used to determine an overall score for the app. Usually, the higher the score an app gets, its likely that more people liked it. This is often fuel for the thriving trade in fake reviews. 

Examples of app evaluation criteria

Credits: Selecting, appraising, recommending and using mobile applications (apps) in nursing. Journal of Clinical Nursing 2017

Other evaluation resources

Resource Description
Mobile App Rating Scale (MARS)
  • Developed by Queensland University of Technology 
  • Designed to score apps on a few comprehensive dimensions such as:
    • engagement
    • functionality
    • aesthetics
    • information quality
  • Read more about MARS
Evaluating mobile apps
  • Developed by National Library of Medicine (NLM) and National Institutes of Health (NIH)
  • Comprises a yes/no checklist of criteria to consider
  • Read more about evaluating mobile apps  
App evaluation model
  • Developed by American Psychiatric Association
  • Comprises a hierarchical rating system and rubric 
  • Read more about the app evaluation model
Evaluating and selecting mobile health apps

Outlines the following 7 strategies

  1. Review the scientific literature: Search the scientific literature for papers reviewing apps in a content domain or strong clinical trials
  2. Search app clearinghouse websites: Clearinghouses that review apps can help with identifying strengths and weaknesses
  3. Search app stores: App stores are challenging to navigate, so it is important to fine-tune and filter app searches with the most relevant and targeted key words, including words keyed to the pathological state or target behavior
  4. Review app descriptions, user ratings, and reviews: Publicized ratings and user reviews can offer evidence of app usability, functionality, and efficacy, which can help to narrow the pool of candidate apps
  5. Conduct a social media query within professional and, if available, patient networks: Social networks may reveal new app trends, likability by certain user groups, and other substantive data
  6. Pilot test the app: Apps may be piloted by the healthcare provider or a designee, including examinations of functionality, accuracy of content, and usability
  7. Elicit feedback from patients: Patients may be able to provide valuable insights after they have used the app a provider recommends
Read more 
Evaluating health apps
  • Online course (MOOC) by the University of Sydney
Learn more
Mobile medical apps for patient education 
  • Study evaluated dermatology apps for patient education
  • The final criteria were (1) educational objectives, (2) content, (3) accuracy, (4) design, and (5) conflict of interest. 

Read more

References

  1. Selecting a mobile app: evaluating the usability of medical applications mHiMSS, 2012
  2. PatientView What do people want from health apps? 2013 
  3. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, et al. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015 Mar 11;3(1):e27.
  4. Prescribing apps: helping patients to select a health app. Nursing Review Vol 18 Issue 1 2018 
  5. K. Singh, K. Drouin, L. P. Newmark et al., Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications, The Commonwealth Fund, February 2016. 
  6. Boudreaux ED, Waring ME, Hayes RB, Sadasivam RS, et al. Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Transl Behav Med. 2014 Dec;4(4):363-71.
Credits: Editorial team. Last reviewed: 07 Mar 2018