Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS)

Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation

BACKGROUND

The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones.

OBJECTIVE

This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms.

METHODS

A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting.

RESULTS

The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77%), while 31% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps.

CONCLUSIONS

Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise.

Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis

Background

Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy.

Objective

The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities.

Methods

We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated.

Results

Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads.

Conclusions

The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users.

Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment

BACKGROUND

In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies.

OBJECTIVE

This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores.

METHODS

A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale.

RESULTS

This study included 29 apps, of which 17 (59%) were developed by commercial organizations and 12 (41%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62%), eye exercises (16/29, 55%), and eye-care education (16/29, 55%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner.

CONCLUSIONS

In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users' needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control.

Development and Evaluation of a Web-Based Platform for Personalized Educational and Professional Assistance for Dementia Caregivers: Proposal for a Mixed Methods Study

BACKGROUND

Alzheimer disease (AD) and AD-related dementia are prevalent concerns for aging populations. With a growing older adult population living in the United States, the number of people living with dementia is expected to grow, posing significant challenges for informal caregivers. The mental and physical burdens associated with caregiving highlight the importance of developing novel and effective resources to support caregivers. However, technology solutions designed to address their needs often face low adoption rates due to usability issues and a lack of contextual relevance. This study focuses on developing a web-based platform providing financial and legal planning information and education for dementia caregivers and evaluating the platform's usability and adoptability.

OBJECTIVE

The goal of this project is to create a web-based platform that connects caregivers with personalized and easily accessible resources. This project involves industrial, academic, and community partners and focuses on two primary aims: (1) developing a digital platform using a Dementia Care Personalization Algorithm and assessing feasibility in a pilot group of caregivers, and (2) evaluating the acceptability and usability of the digital platform across different racial or ethnic populations. This work will aid in the development of technology-based interventions to reduce caregiver burden.

METHODS

The phase I study follows an iterative Design Thinking approach, involving at least 25 dementia caregivers as a user feedback panel to assess the platform's functionality, aesthetics, information, and overall quality using the adapted Mobile Application Rating Scale. Phase II is a usability study with 300 dementia caregivers in Texas (100 African American, 100 Hispanic or Latinx, and 100 non-Hispanic White). Participants will use the digital platform for about 4 weeks and evaluate its usefulness and ease of use through the Technology Acceptance Survey.

RESULTS

The study received funding from the National Institute on Aging on September 3, 2021. Ethical approval for phase I was obtained from the Texas A&M University Institutional Review Board on December 8, 2021, with data collection starting on January 1, 2022, and concluding on May 31, 2022. Phase I results were published on September 5, 2023, and April 17, 2024, respectively. On June 21, 2023, ethical approval for human subjects for phase II was granted, and participant recruitment began on July 1, 2023.

CONCLUSIONS

Upon completing these aims, we expect to deliver a widely accessible digital platform tailored to assist dementia caregivers with financial and legal challenges by connecting them to personalized, contextually relevant information and resources in Texas. If successful, we plan to work with caregiving organizations to scale and sustain the platform, addressing the needs of the growing population living with dementia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64127.

Evaluating the Quality and Comparative Validity of Manual Food Logging and Artificial Intelligence-Enabled Food Image Recognition in Apps for Nutrition Care

For artificial intelligence (AI) to support nutrition care, high quality and accuracy of its features within smartphone applications (apps) are essential. This study evaluated popular apps' features, quality, behaviour change potential, and comparative validity of dietary assessment via manual logging and AI. The top 200 free and paid nutrition-related apps from Australia's Apple App and Google Play stores were screened (n = 800). Apps were assessed using MARS (quality) and ABACUS (behaviour change potential). Nutritional outputs from manual food logging and AI-enabled food-image recognition apps were compared with food records for Western, Asian, and Recommended diets. Among 18 apps, Noom scored highest on MARS (mean = 4.44) and ABACUS (21/21). From 16 manual food-logging apps, energy was overestimated for Western (mean: 1040 kJ) but underestimated for Asian (mean: -1520 kJ) diets. MyFitnessPal and Fastic had the highest accuracy (97% and 92%, respectively) out of seven AI-enabled food image recognition apps. Apps with more AI integration demonstrated better functionality, but automatic energy estimations from AI-enabled food image recognition were inaccurate. To enhance the integration of apps into nutrition care, collaborating with dietitians is essential for improving their credibility and comparative validity by expanding food databases. Moreover, training AI models are needed to improve AI-enabled food recognition, especially for mixed dishes and culturally diverse foods.

Friends, Family, and Food: Development of a Food Allergy Intervention, F3-App, for Children

Objective

Despite a marked increase in the prevalence of pediatric IgE-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA.

Methods

Development of the "Friends, Family and Food Application (F3-App)" employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts. Phase 1 (Prototype Development/Pilot Evaluation) involved family input on key themes and educational messages, development of a prototype, and pilot testing. Phase 2 (Full F3-App Development/Open Trial) included refinement and expansion of the prototype per advisory panel and end-user recommendations, followed by an open trial with additional iterative refinement.

Results

Acceptability and credibility of the F3-App were rated highly by most participants. Relatively few technical challenges arose with F3-App installation or use. Follow up interviews with children and caregivers suggested that the F3-App was generally well-received, families found the content useful, and that it prompted family discussion about the child's FA management.

Conclusions

User input is critical to developing family-friendly software to support management of pediatric chronic conditions. Interactive educational software can be a useful channel for children to practice skills and build confidence in disease self-management and to facilitate family communication regarding the stresses of FA management.

Trial registration

ClinicalTrials.gov identifier: NCT05111938.

The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study

BACKGROUND

The increasing prevalence of Alzheimer disease and Alzheimer disease-related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care.

OBJECTIVE

This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers.

METHODS

For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics.

RESULTS

Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration.

CONCLUSIONS

The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population.

Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study

BACKGROUND

Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment.

OBJECTIVE

This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT.

METHODS

Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient's adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction.

RESULTS

Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%).

CONCLUSIONS

The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT.

Rural Health Disparities in Allergy, Asthma, and Immunologic Diseases: The Current State and Future Direction for Clinical Care and Research

Rural health disparities are well documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases. Furthermore, the intersection between rural health disparities and social determinants of health has not been fully explored. To achieve a more complete understanding of the factors that perpetuate rural health disparities, greater research efforts followed by improved practice and policy are needed that account for the complex social context within rural communities rather than a general comparison between urban and rural environments or focusing on biomedical factors. Moreover, research efforts must prioritize community inclusion throughout rural areas through meaningful engagement of stakeholders in both clinical care and research. In this review, we examine the scope of health disparities in the rural United States and the impact of social determinants of health. We then detail the current state of rural health disparities in the field of allergy, asthma, and immunology. To close, we offer future considerations to address knowledge gaps and unmet needs for both clinical care and research in addressing rural health disparities.

Design of mobile and website health application devices for drug tolerability in hereditary fructose intolerance

BACKGROUND

Hereditary fructose intolerance (HFI) is a rare metabolic disease caused by aldolase B deficiency. The aim of our study was to analyse excipient tolerability in patients with HFI and other related diseases and to design mobile and website health applications to facilitate the search for drugs according to their tolerance.

RESULTS

A total of 555 excipients listed in the Spanish Medicines Agency database (July 2023) were classified as suitable for HFI patients, suitable with considerations ((glucose and glucose syrup, intravenous sucrose, oral mannitol, polydextrose, gums and carrageenans, ethanol, sulfite caramel and vanilla), not recommended (intravenous mannitol) and contraindicated (fructose, oral sucrose, invert sugar, sorbitol, maltitol, lactitol, isomaltitol, fruit syrups, honey, sucrose esters and sorbitol esters). Glucose and glucose syrup were classified as suitable with considerations due to its possible fructose content and their potential endogenous fructose production. For other related intolerances, wheat starch was contraindicated and oatmeal was not recommended in celiac disease; oral lactose and lactose-based coprocessed excipient (Cellactose®) were not recommended in lactose intolerance; and glucose, invert sugar and oral sucrose were not recommended in diabetes mellitus. The applications were named IntoMed®. Results are listed in order of tolerability (suitable drugs appear first and contraindicated drugs at the end), and they are accompanied by a note detailing their classified excipients. If a drug contains excipients within different categories, the overall classification will be the most restrictive. The apps are also able to classify substances with the same criteria if they act as active ingredients. The tools exhibited good usability (82.07 ± 13.46 points on the System Usability Scale [range: 0-100]) on a sample of HFI patients, their families and health care professionals.

CONCLUSIONS

IntoMed® is a tool for finding information about the tolerability of drugs according to excipients for patients with HFI and other related intolerances, with good usability. It is a fast and reliable system that covers the current excipient legislation and expands on it with other specific information: HFI patients should be alert for excipients such as mannitol (especially in intravenous drugs), fruit syrups, honey, sulfite caramel or vanilla. Glucose might contain or produce fructose, and special precaution is needed because of potential errors in their composition.

Review and content analysis of mobile apps for inflammatory bowel disease management using the mobile application rating scale (MARS): Systematic search in app stores

BACKGROUND

People with inflammatory bowel disease (IBD) need tools for self-management of their disease with the ultimate goal of improving medication adherence and health outcomes. Mobile apps represent a novel opportunity to provide self-management for patients with IBD. Many mobile apps have been developed for IBD self-management, but more evidence is needed about the quality of these mobile apps.

OBJECTIVE

This study evaluated mobile apps developed for the IBD community and rated the quality of these apps to provide a roadmap for future development.

MATERIALS AND METHODS

The Apple App Store and Google Play Store were systematically searched to identify IBD mobile apps for patients and physicians based on the IBD-related keywords. We included mobile apps that focus on IBD, are in the English language, and are free. The related app quality was evaluated independently by two reviewers using the Mobile Application Rating Scale (MARS).

RESULTS

We identified 401 mobile apps. After removing duplicates and unrelated apps, 44 apps were included in the review. Overall, the mean MARS scores were 3.5 (SD = 0.5) on a scale from 1.00 to 5.00, which was the acceptable range.; 12 apps got scores ≥ 4.00. The highest mean domain score belonged to the functionality dimension (mean = 3.9, SD = 0.6) and the lowest belonged to the engagement dimension (mean = 3.2, SD = 0.8).

CONCLUSION

The MARS ratings showed that the IBD mobile apps quality meet acceptable criteria. However, more attention must be paid to design features that improve user interest and engagement, especially among children and adolescents. Healthcare professional involvement is crucial for designing mobile health apps.

The Most Popular Commercial Weight Management Apps in the Chinese App Store: Analysis of Quality, Features, and Behavior Change Techniques

BACKGROUND

Many smartphone apps designed to assist individuals in managing their weight are accessible, but the assessment of app quality and features has predominantly taken place in Western countries. Nevertheless, there is a scarcity of research evaluating weight management apps in China, which highlights the need for further investigation in this area.

OBJECTIVE

This study aims to conduct a comprehensive search for the most popular commercial Chinese smartphone apps focused on weight management and assess their quality, behavior change techniques (BCTs), and content-related features using appropriate evaluation scales. Additionally, the study sought to investigate the associations between the quality of various domains within weight management apps and the number of incorporated BCTs and app features.

METHODS

In April 2023, data on weight management apps from the iOS and Android app stores were downloaded from the Qimai Data platform. Subsequently, a total of 35 weight management apps were subjected to screening and analysis by 2 researchers. The features and quality of the apps were independently assessed by 6 professionals specializing in nutrition management and health behavioral change using the Mobile Application Rating Scale (MARS). Two registered dietitians, who had experience in app development and coding BCTs, applied the established 26-item BCT taxonomy to verify the presence of BCTs. Mean (SD) scores and their distributions were calculated for each section and item. Spearman correlations were used to assess the relationship between an app's quality and its technical features, as well as the number of incorporated BCTs.

RESULTS

The data set included a total of 35 apps, with 8 available in the Android Store, 10 in the Apple Store, and 17 in both. The overall quality, with a mean MARS score of 3.44 (SD 0.44), showed that functionality was the highest scoring domain (mean 4.18, SD 0.37), followed by aesthetics (mean 3.43, SD 0.42), engagement (mean 3.26, SD 0.64), and information (mean 2.91, SD 0.52), which had the lowest score. The mean number of BCTs in the analyzed apps was 9.17 (range 2-18 BCTs/app). The most common BCTs were "prompt review of behavioral goals" and "provide instruction," present in 31 apps (89%). This was followed by "prompt self-monitoring of behavior" in 30 apps (86%), "prompt specific goal setting" in 29 apps (83%), and "provide feedback on performance" in 27 apps (77%). The most prevalent features in the analyzed apps were the need for web access (35/35, 100%), monitoring/tracking (30/35, 86%), goal setting (29/35, 83%), and sending alerts (28/35, 80%). The study also revealed strong positive correlations among the number of BCTs incorporated, app quality, and app features. This suggests that apps with a higher number of BCTs tend to have better overall quality and more features.

CONCLUSIONS

The study found that the overall quality of weight management apps in China is moderate, with a particular weakness in the quality of information provided. The most prevalent BCTs in these apps were reviewing behavioral goals, providing guidance, self-monitoring of behavior, goal setting, and offering performance feedback. The most common features were the need for web access, monitoring and tracking, goal setting, and sending alerts. Notably, higher-quality weight management apps in China tended to incorporate more BCTs and features. These findings can be valuable for developers looking to improve weight management apps and enhance their potential to drive behavioral change in weight management.

Assessing the Usefulness of Mobile Apps for Noise Management in Occupational Health and Safety: Quantitative Measurement and Expert Elicitation Study

Background

Overexposure to occupational noise can lead to hearing loss. Occupational noise mapping is conventionally performed with a calibrated sound level meter (SLM). With the rise of mobile apps, there is a growing number of SLM apps available on mobile phones. However, few studies have evaluated such apps for accuracy and usefulness to guide those with occupational noise detection needs in selecting a quality app.

Objective

The purpose of this study was to evaluate the accuracy and usefulness of SLM mobile apps to guide workplace health and safety professionals in determining these apps' suitability for assessing occupational noise exposure.

Methods

The following three iOS apps were assessed: the NIOSH (National Institute for Occupational Safety and Health) Sound Level Meter, Decibel X, and SoundMeter X apps. The selected apps were evaluated for their accuracy in measuring sound levels in low-, moderate-, and high-noise settings within both simulated environments and real-world environments by comparing them to a conventional SLM. The usefulness of the apps was then assessed by occupational health specialists using the Mobile App Rating Scale (MARS).

Results

The NIOSH Sound Level Meter app accurately measured noise across a range of sound levels in both simulated settings and real-world settings. However, considerable variation was observed between readings. In comparison, the Decibel X and SoundMeter X apps showed more consistent readings but consistently underestimated noise levels, suggesting that they may pose a risk for workers. Nevertheless, none of the differences in sound measurements between the three apps and the conventional SLM were statistically significant (NIOSH Sound Level Meter: P=.78; Decibel X: P=.38; SoundMeter X: P=.40). The MARS scores for the three apps were all above 3.0, indicating the usefulness of these apps.

Conclusions

Under the conditions of this study, the NIOSH Sound Level Meter app had equivalent accuracy to the calibrated SLM and a degree of usefulness according to the MARS. This suggests that the NIOSH Sound Level Meter app may be suitable for mapping noise levels as part of a monitoring strategy in workplaces. However, it is important to understand its limitations. Mobile apps should complement but not replace conventional SLMs when trying to assess occupational noise exposure risk. Our outcomes also suggest that the MARS tool may have limited applicability to measurement-based apps and may be more suited to information-based apps that collect, record, and store information.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

BACKGROUND

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking.

OBJECTIVE

The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored.

METHODS

This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life.

RESULTS

Recruitment and data collection started in February 2022 and is still ongoing.

CONCLUSIONS

The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41436.

Mobile applications in the Philippines during the COVID-19 pandemic: systematic search, use case mapping, and quality assessment using the Mobile App Rating Scale (MARS)

Background

In the Philippines, various mobile health apps were implemented during the COVID-19 pandemic with very little knowledge in terms of their quality. The aims of this paper were 1) to systemically search for mobile apps with COVID-19 pandemic use case that are implemented in the Philippines; 2) to assess the apps using Mobile App Rating Scale (MARS); and 3) to identify the critical points for future improvements of these apps.

Methods

To identify existing mobile applications with COVID-19 pandemic use case employed in the Philippines, Google Play and Apple App Stores were systematically searched. Further search was conducted using the Google Search. Data were extracted from the app web store profile and apps were categorized according to use cases. Mobile apps that met the inclusion criteria were independently assessed and scored by two researchers using the MARS-a 23-item, expert-based rating scale for assessing the quality of mHealth applications.

Results

A total of 27 apps were identified and assessed using MARS. The majority of the apps are designed for managing exposure to COVID-19 and for promoting health monitoring. The overall MARS score of all the apps is 3.62 points (SD 0.7), with a maximum score of 4.7 for an app used for telehealth and a minimum of 2.3 for a COVID-19 health declaration app. The majority (n = 19, 70%) of the apps are equal to or exceeded the minimum "acceptable" MARS score of 3.0. Looking at the categories, the apps for raising awareness received the highest MARS score of 4.58 (SD 0.03) while those designed for managing exposure to COVID-19 received the lowest mean score of 3.06 (SD 0.6).

Conclusions

There is a heterogenous quality of mHealth apps implemented during the COVID-19 pandemic in the Philippines. The study also identified areas to better improve the tools. Considering that mHealth is expected to be an integral part of the healthcare system post-pandemic, the results warrant better policies and guidance in the development and implementation to ensure quality across the board and as a result, positively impact health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44247-023-00007-2.

Evaluation of overweight control applications with cognitive-behavioral therapy approach: A systematic review

Background and Aims

Overweight and obesity lead to the development of physical diseases. Cognitive factors play a vital role in controlling one's weight. Currently, cognitive-behavioral therapy (CBT) interventions are recognized as a subcategory of lifestyle modification programs that can be implemented to control weight and modify eating patterns as well as physical activity. Nowadays, smartphone-based applications are utilized to implement behavioral interventions. The main purpose of this study is to evaluate the quality of CBT-based smartphone applications available on Google Play and the App Store in the field of overweight control.

Methods

Smartphone-based utility applications available on Google Play and App Store were identified in March 2021. Weight control smartphone applications were obtained based on inclusion and exclusion criteria. The app name, platform, version, number of downloads, password protection, affiliations, and features of retrieved apps were tabulated. The Mobile Application Rating Scale was utilized to evaluate the quality of the identified apps.

Results

Seventeen CBT-based weight control smartphone apps were retrieved. The average engagement, functionality, aesthetics, and information quality scores were 3.65, 3.92, 3.80, and 3.91, respectively. Also, the average score in an aspect containing the usefulness of the app, frequency of using the application, cost, and user satisfaction was 3.5.

Conclusion

Future applications related to this field can be improved by providing a personalization program according to the needs of users and the possibility of online chatting with the therapist. Further improvements can be achieved by improving the areas of engagement, aesthetics, and subjective quality as well as having appropriate privacy policies.

Quality Assessment of the Road Traffic Health and Safety Apps with a Focus on the Five Rights of Information Management

Objective

The expansion of mobile applications as a tool for road traffic health and safety may develop several issues from the perspective of information management. Quality assessment of these apps, especially from an information system management perspective, appears inevitable, as their possible low quality may cause irreversible injury or fatal consequences. This study aimed to evaluate the quality of the apps in the three subcategories of road traffic safety apps (including Accident Record and Report (ARR), Distraction Management (DM), and Vehicle Operating, Fixing, and Maintenance (VOFM)) using the Mobile Application Rating Scale (MARS), which rates 23 evaluation criteria organized in five domains (Engagement, Esthetics, Information, and Subjective Quality) with particular attention to the five rights framework of health information system.

Method

The researchers retrieved road traffic health and safety mobile apps from Google Play. First, the domain expert panel (n= 7) (from disciplines of HIM and medical informatics) was formed. They scrutinized and discussed the MARS items and mapped them into the five rights framework of information quality. Moreover, the researchers assigned the apps to the information system or decision support system category. Two researchers independently reviewed the apps and conducted the qualitative content analysis to categorize them into ARR, DM, and VOFM classes. Finally, the quality of the apps was assessed using the MARS rating scale (max=5) in terms of 1) app classification category with a descriptive aim; 2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections; and 3) an optional app-specific section. The mean scores for the subjective quality, objective quality, and app-specific sections were calculated separately for each mobile app. A score ≥ 3.0 was considered acceptable.

Results

A total number of 42 apps met the criteria for the assessment. The average objective quality scores were computed as 2.6, 2.2, and 3.0 for the ARR, DM, and VOFM apps, respectively. Therefore, the quality of the apps in the ARR and DM subgroups was not acceptable. Moreover, the quality of the apps in the VOFM subcategory was considered moderate. Furthermore, the subjective quality and app-specific sections of apps in the ARR and DM categories were less than moderate. Most apps had the potential of an information system or decision support system. Also, the criteria measured by MARS could be mapped to the five rights framework of information management.

Conclusion

The findings of this study revealed the existing gaps in three subcategories of road traffic safety apps. Considering the multiple criteria of the MARS and having in mind the framework of five rights, developers of the apps may develop better products in road traffic health and safety.

Stance4Health Nutritional APP: A Path to Personalized Smart Nutrition

Access to good nutritional health is one of the principal objectives of current society. Several e-services offer dietary advice. However, multifactorial and more individualized nutritional recommendations should be developed to recommend healthy menus according to the specific user's needs. In this article, we present and validate a personalized nutrition system based on an application (APP) for smart devices with the capacity to offer an adaptable menu to the user. The APP was developed following a structured recommendation generation scheme, where the characteristics of the menus of 20 users were evaluated. Specific menus were generated for each user based on their preferences and nutritional requirements. These menus were evaluated by comparing their nutritional content versus the nutrient composition retrieved from dietary records. The generated menus showed great similarity to those obtained from the user dietary records. Furthermore, the generated menus showed less variability in micronutrient amounts and higher concentrations than the menus from the user records. The macronutrient deviations were also corrected in the generated menus, offering a better adaptation to the users. The presented system is a good tool for the generation of menus that are adapted to the user characteristics and a starting point to nutritional interventions.

Development and validation of the Turkish version of the Mobile App Rating Scale - MARS-TR

BACKGROUND

The number of mobile health apps (MHAs) is growing rapidly. MHAs have great potential to improve health and health care. However, the quality of available MHAs remains unknown due to the lack of quality assessment regulations and standards for MHAs. The Mobile Application Rating Scale (MARS) is the most widely used instrument to assess the quality of MHAs, and available in English, Italian, Spanish, German, French, Arabic and Japanese. However, the scale is currently not available in the Turkish language.

OBJECTIVE

This study aimed to cross-culturally adapt the MARS into Turkish and evaluate the validity and reliability of the scale.

METHODS

The MARS was translated and adapted into Turkish according to the international guidelines. A total of 52 pregnancy tracking apps were evaluated by two independent raters. Internal consistency (Cronbach's alpha), inter-rater reliability (Intraclass Correlation Coefficient [ICC]), convergent validity and concurrent validity were explored. Regarding convergent validity, MARS-TR scores were compared with the ENLIGHT scale.

RESULTS

The MARS-TR was highly aligned with the original MARS. The MARS-TR showed excellent internal consistency (Cronbach's alpha of 0.95 for both raters) and excellent inter-rater reliability (ICC = 0.94; SEM = 0.02), with a smallest detectable change (95 % confidence level) of 0.05 points for the total score. Cronbach's alphas for the subscales ranged from 0.76 to 0.94 for the two raters. Correlations between the MARS-TR and ENLIGHT demonstrated adequate convergent validity (P < 0.05). No ceiling or floor effects were observed.

CONCLUSION

The results provide evidence that the Turkish version of MARS is a valid and reliable tool for researchers and experts to assess the quality of MHAs in Turkey.

Mobile Apps for People With Rare Diseases: Review and Quality Assessment Using Mobile App Rating Scale

BACKGROUND

Mobile apps are becoming increasingly popular, with 5.70 million apps available in early 2021. Smartphones can provide portable and convenient access to health apps. Here, we consider apps for people with one of the estimated 7000 rare conditions, which are defined as having an incidence of <1 in 2000. The needs of people with rare conditions are known to be different from those of people with more common conditions. The former may be socially isolated (not knowing anyone else who has the condition) and may not be able to find reliable information about the disorder.

OBJECTIVE

The aim of this review is to search for apps developed specifically for people diagnosed with a rare disease and to assess them for quality using the Mobile App Rating Scale (MARS). We examine features that address 6 identified needs of people with a rare disorder and make recommendations for future developers.

METHODS

Google Play Store (Android) and Apple App Store (iOS) were searched for relevant health-related apps specifically for rare diseases. The search included the names of 10 rare disease groups. App quality was determined using MARS, assessing app engagement, functionality, aesthetics, and information.

RESULTS

We found 29 relevant apps (from a total of 2272) addressing 14 rare diseases or disease groups. The most common rare conditions addressed were cystic fibrosis (n=6), hemophilia (n=5), and thalassemia (n=5). The most common app features were web-based information and symptom trackers. The mean MARS score was 3.44 (SD 0.84). Lowest scores were for engagement.

CONCLUSIONS

Most apps provided factual and visual information, providing tools for self-monitoring and resources to help improve interactions during health consultations. App origin and quality varied greatly. Developers are recommended to consider ways to make appropriate apps more easily identifiable to consumers, to always include high-quality information, improve engagement, provide qualitative evaluations of the app, and include consumers and clinicians in the design.

Mental Health Mobile Apps in the French App Store: Assessment of Functionality and Quality (Preprint)

Background

Approximately 800 million people, representing 11% of the world’s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet.

Objective

This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale–French (MARS-F).

Methods

Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated.

Results

The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores.

Conclusions

Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

Oral-Hygiene-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality

Mobile health apps can contribute to increased quality of individual oral hygiene behaviors. This study provides an overview and an evaluation of quality of oral-hygiene-related mobile apps currently available in Google Play Store and the French Apple App. A shortlist of nine apps was assessed by 10 oral health professionals using the Mobile App Rating Scale. Intraclass correlation was used to evaluate interrater agreement. Best quality scores were obtained by Oral-B (3.4 ± 0.97), Colgate Connect (3.20 ± 0.63), and Preventeeth (3.10 ± 1.1) and worst ones by Mimizaur se brosse les dents (1.80 ± 0.79) and Kolibree (2.30 ± 0.82). The subjective quality scores ranged from 2.62 ± 0.61 (Oral-B) to 1.5 ± 0.61 (MSD). Specificity of the content ranged from 3.46 ± 0.84 (Preventeeth) to 1.78 ± 0.47 (Mimizaur se brosse les dents). Thus, even if oral health professionals positively evaluated the quality of oral-hygiene-related mobile apps, they are less assertive concerning their impact on the user's knowledge, attitudes, and intentions to change, as well as the likelihood of actual change in the oral hygiene behavior. Further investigations are needed to assess whether information from these apps is consistent with oral hygiene recommendations and to determine the long-term impacts of these apps.

Development and validation of the Japanese version of the uMARS (user version of the mobile app rating system)

BACKGROUND

Although the global market of Mobile Health Apps (mHealth apps) continues to grow dramatically, most mHealth apps still not only lack evidence base but have even not been evaluated for the basic usability or functionality. The User Version of the Mobile App Rating Scale (uMARS) was developed to allow end users to assess mHealth apps objectively and subjectively. However, there is no Japanese version of uMARS to date.

OBJECTIVE

The purpose of this study is (1) to develop a validated Japanese version of uMARS and (2) to assess the translated version's reliability and validity in evaluating mHealth apps.

METHODS

The original uMARS was adapted for Japanese use by four specialists using universalist cross-cultural methods. Translation/back-translation was reviewed by the author of the original version of uMARS, and confirmed. Its reliability and validity were further evaluated as part of a prospective cohort study of postoperative patients using a new mHealth app.

RESULTS

Conceptual equivalence was analyzed and all items in all subcategories of the original uMARS were included in the Japanese version. Internal consistency was deemed acceptable for all subscales of objective and subjective quality with a Cronbach's alpha of 0.75-0.85. Test-retest reliability of all subscales was also acceptable with intraclass correlation coefficients (ICCs) of 0.57-0.88. Convergent/divergent validity and concurrent validity were also considered acceptable.

CONCLUSION

A Japanese version of uMARS was cross-culturally validated and found to be as reliable as the original uMARS. This Japanese version of uMARS is expected to become a standard tool in assessing the quality of mHealth apps in Japan.

Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis

Background

Patients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality.

Objective

This study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS).

Methods

The German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user.

Results

In total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app “CED Dokumentation und Tipps” had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values.

Conclusions

The MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care.

Japanese Version of the Mobile App Rating Scale (MARS): Development and Validation

Background

The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date.

Objective

The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version’s reliability and validity in evaluating mHealth apps.

Methods

To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity.

Results

After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach α=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for “functionality,” which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the “information” subscale.

Conclusions

A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps.

Nutrition-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality

BACKGROUND

The global burden of disease attributes 20% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed.

OBJECTIVE

The aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality.

METHODS

We screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated.

RESULTS

The top scores for overall quality were obtained by Yazio - Régime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores.

CONCLUSIONS

Although prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users.

A Review of Smartphone Apps Used for Toric Intraocular Lens Calculation and Alignment

Smartphone apps are becoming increasingly popular in ophthalmology, one specific area of their application being toric intraocular lens (IOL) surgery for astigmatism correction. Our objective was to identify, review and objectively score smartphone apps applicable to toric IOL calculation and/or axis alignment. This review was divided into three phases. A review was conducted on four major app databases (phase I): National Health Service (NHS) Apps Library, Google Play Store, Apple App Store and Amazon Appstore. A systematic literature review (phase II) was conducted to identify studies for included apps in phase I of our study. Keywords used in both searches included: “toric lens”, “toric IOL”, “refraction”, “astigmatism”, “ophthalmology”, “eye calculator”, “ophthalmology calculator” and “refractive calculator”. Included apps were objectively scored (phase III) by three independent reviewers using the mobile app rating scale (MARS), a validated tool that ranks the quality of mobile health apps using a calculated mean app quality (MAQ) score. Phase I of our study screened 2428 smartphone apps, of which six apps for toric IOL calculation and four apps for axis marking were eligible and were selected for quantitative analysis. Phase II of our study screened 477 studies from PubMed, Medline and Google Scholar. Three studies validating two apps (toriCAM, iToric Patwardhan) in a clinical setting as adjunct tools for preoperative axis marking were identified. Phase III ranked Toric Calculator for iPhone (Apple iOS, MAQ 4.13; average MAQ 3.34 ± 0.54) as the highest-scoring toric IOL calculator, and iToric Patwardhan (Android OS, MAQ 4.13; average MAQ 3.41 ± 0.44) was the highest-scoring axis marker in our study. Our review identified and objectively scored ten smartphone apps available for toric IOL surgery adjuncts. Toric Calculator for iPhone and iToric Patwardhan were the highest-scoring toric IOL calculator and axis marker, respectively. Current literature, though limited, suggests that axis marking smartphone apps can achieve similar levels of misalignment reduction when compared to digital systems.

Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation

Background

Mental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness.

Objective

This study aims to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores.

Methods

A systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using the Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated.

Results

A total of 40 apps were analyzed, of which 35 (87.5%) were developed by companies and 33 (82.5%) provided links to access the privacy policy; 21 (52.5%) apps did not mention the involvement of relevant professionals or the guidance of a scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 82.5%). The overall quality average MARS score of the 40 apps was 3.54 (SD 0.39), and the total score was between 2.96 and 4.30. The total MARS score was significantly positively correlated with the scores of each subscale (r=0.62-0.88, P<.001). However, the user score of the app market was not significantly correlated with the total MARS score (r=0.17, P=.33).

Conclusions

The quality of multipurpose mental health apps in China’s main app market is generally good. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps.

The Sustainable Innovation Design in Catering Service

COVID-19 has impacted the whole world since 2019, especially the dietary patterns of customers. Before the pandemic, some companies had been monitoring the operation data for health and food safety situations. It has become a vital mission to improve the food production and service process if the companies wish to pursue the sustainability of their businesses due to the general environment being changed by the epidemic. The sustainability of food systems inherently implies not only customer satisfaction but also the saving of costs. The catering service must find new ways to increase customer loyalty and satisfaction while implementing improved practices for building their brand image and modern decoration. The objective of this article is to discuss the service innovation process in order to investigate the interrelationships of catering environmental policy and psychological effects in the service function. The data were collected from a DINESERV questionnaire, comprised service quality standards, to increase the customer satisfaction for a mobile dining car. Finally, the TRIZ or Kano is a standardized measure designed to improve the idealization of strategy for selecting the most appropriate service quality model. This study presents the results from the survey and discusses future perspectives of increasing the sustainability of service within a catering information system.

Tools for Evaluating the Content, Efficacy, and Usability of Mobile Health Apps According to the Consensus-Based Standards for the Selection of Health Measurement Instruments: Systematic Review

Background

There are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties.

Objective

This study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps.

Methods

From February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed.

Results

The initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ≥5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version.

Conclusions

The Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps.

Medical Apps and the Gray Zone in the COVID-19 Era: Between Evidence and New Needs for Cybersecurity Expansion

The study focuses on emerging problems caused by the spread of medical apps. Firstly, it reviews the current role of cybersecurity and identifies the potential need to widen the boundaries of cybersecurity in relation to these apps. Secondly, it focuses on the pivotal device behind the development of mHealth: the smartphone, and highlights its role and current potential for hosting wearable medical technology. Thirdly, it addresses emerging issues regarding these apps, which are in a gray zone. This is done through an analysis of the important positions of scholars, and by means of a survey report on the increased use of various categories of apps during the COVID-19 pandemic, highlighting an accentuation of the problem. The study ends by explaining the reflections and proposals that emerged after performing the analysis.

Comparing Smartphone Apps for Traditional Chinese Medicine and Modern Medicine in China: Systematic Search and Content Analysis

Background

Traditional Chinese medicine (TCM) is an integral part of mainstream medicine in China, with theories and practices that are completely different from modern medicine. TCM should not be ignored or confused with modern medicine in the analysis of the Chinese health care system, including the analysis of mobile health (mHealth) apps. To date, differences between TCM apps and modern medicine apps have not be systematically investigated.

Objective

The aim of this study was to systematically compare the quality of apps for TCM and modern medicine in China.

Methods

In December 2020, we searched iOS (iTunes) and Android (Tencent, Oppo, and Huawei app stores) platforms for all mHealth apps and then categorized them as TCM or modern medicine apps if they were included in the final analysis. The included apps were downloaded on smartphones and assessed by 2 reviewers on the following 4 aspects: (1) data in the app stores, including user ratings, download counts, cost, target users, and year of last update; (2) functionality; (3) quality of the app content as determined by the Mobile App Rating Scale (MARS); and (4) analysis of the app privacy and security.

Results

In total, 658 apps were analyzed, including 261 TCM medicine apps and 397 modern medicine apps. The average download count of modern medicine apps (approximately 5 million) was more than 10 times that of TCM apps (approximately 400,000). Regarding functionalities, 64.7% (257/397) of modern medicine apps provided telemedicine (74/261, 28.4% in TCM apps), 62.7% (249/397) provided registration (70/261, 26.8% in TCM apps), and 45.6% (181/397) provided communication (38/261, 14.6% in TCM apps). A larger proportion of TCM apps provided prescription and medication management (144/261, 55.2% in TCM apps versus 168/397, 42.3% in modern medicine apps). The majority of modern medicine apps (329/397, 82.9%) combined ≥3 functionalities compared with one-third of TCM apps (93/261, 34.6%). We then selected 81 top apps for quality and safety assessment (41 TCM apps and 40 modern medicine apps). Of these, the mean overall MARS score of TCM apps (2.7, SD 0.5) was significantly lower than modern medicine apps (3.6, SD 0.4). Almost all modern medicine apps (38/40, 95%) addressed privacy and security by providing a privacy policy and describing how to protect personal data, but less than half of the TCM apps (18/41, 44%) described this information (P<.001).

Conclusions

The different functionalities reflect the distinct innate characteristics of these two medical systems. Although great progress has been made and the Chinese mHealth market size is large, there still exist many opportunities for future development, especially for TCM.

Evaluation of two mobile health apps for patients with breast cancer using the Mobile Application Rating Scale

BACKGROUND

Breast cancer is one of the most frequently diagnosed cancers worldwide. Screening, education about signs and symptoms, and improved access to treatment has helped reduce mortality. An understanding of the informational needs of women with breast cancer can help identify areas where mobile apps can further improve the experience of this patient group.

METHODS

Personas are a commonly used tools in user centred design to help represent particular user archetypes. Knowledge of existing informational needs and prior research using personas in breast cancer app design were used to create two different personas through which to source apps for evaluation. The Mobile Application Rating Scale, a common evaluation framework, was used to evaluate the mobile apps across several important domains.

RESULTS

Becca and OWise, two apps for breast cancer, were found through a discovery process in line with the personas described. Overall, both apps scored highly on the Mobile Application Rating Scale. Both apps had limited or no research to support their use in this patient group, and had issues related to data privacy. Becca scored particularly highly in domains related to accessibility while OWise's extensive range of features scored highly for functionality.

CONCLUSIONS

Both apps demonstrate the ability to fill an informational needs gap as evidenced in the existing literature. As with many mobile health apps, more clinical evidence and improved data handling would help support the widespread recommendation of their use in women who are undergoing or have completed treatment for breast cancer.