Background: Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered. Objective: We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change. Methods: We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change. Results: We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63%), weight and diet (apps: 25/60, 42%), or physical activity (apps: 22/60, 37%) and stress management (apps: 22/60, 37%). Only 8 out of the 60 apps (13%) were completely free. Conclusions: Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change.
Bibliographical noteFunding Information:
We would like to acknowledge Benedicte Lauge Hansen for conducting a pilot search of apps targeting patients with 1 or more chronic conditions as part of her internship. This study was funded by the European Research Council under the European Union’s Horizon 2020 research and innovation program (MOBILIZE; grant 801790); Næstved, Slagelse and Ringsted Hospitals’ Research Fund; and The Association of Danish Physiotherapists Research Fund and Region Zealand (Exercise First). The funding sources were not involved in any aspect of this work.
STS has received grants from The Lundbeck Foundation and personal fees from Munksgaard and TrustMe-Ed, of which all are outside the submitted work. STS is a cofounder of GLA:D (Good Life With osteoArthritis in Denmark), a not-for-profit initiative hosted at University of Southern Denmark that aims to implement clinical guidelines for osteoarthritis in clinical practice.
©Alessio Bricca, Alessandro Pellegrini, Graziella Zangger, Jonas Ahler, Madalina Jäger, Søren T Skou.