Utilising Mobile Health Apps - A Comparison of GP Perceptions Across Australia and Germany

Germany became the first country to accept certain mobile health (mHealth) apps for prescription with costs covered by statutory health insurance. Yet, this option has only been used to a limited extent. To develop an international comparison, this study investigates GPs' perceptions of mHealth apps with a medical purpose in Germany and Australia. We conducted semi-structured interviews to examine their perspective on introducing and using mHealth apps and their awareness of their impact on patient adherence, empowerment, and health literacy. The results show that prescribing mHealth apps in general practice seems feasible in Australia and doctors are highly receptive to it.

Orthopaedic and trauma surgeons' prioritisation of app quality principles based on their demographic background

BACKGROUND

Although apps are becoming increasingly relevant in healthcare, there is limited knowledge about how healthcare professionals perceive "quality" in this context and how quality principles that can aid them in assessing health-related apps may be prioritised. The objective was to investigate physicians' views of predefined (general) quality principles for health apps and to determine whether a ranking algorithm applied to the acquired data can provide stable results against various demographic influences and may thus be appropriate for prioritisation.

METHODS

Participants of an online survey of members of two German professional orthopaedics associations conducted between 02/12/2019 and 02/01/2020 were asked about their perception of a set of quality principles for health apps (i.e., "practicality," "risk adequacy," "ethical soundness," "legal conformity," "content validity," "technical adequacy," "usability," "resource efficiency," and "transparency"). Structured as a Kano survey, for each principle, there were questions about its perceived relevance and opinions regarding the presence or absence of corresponding characteristics. The available data were evaluated descriptively, and a newly developed method for prioritisation of the principles was applied overall and to different demographic strata (for validation).

RESULTS

Three hundred eighty-two datasets from 9503 participants were evaluated. Legal conformity, content validity, and risk adequacy filled ranks one to three, followed by practicability, ethical soundness, and usability (ranks 4 to 6). Technical adequacy, transparency, and resource efficiency ranked last (ranks 7 to 9). The ranking based on the proposed method was relatively stable, irrespective of demographic factors. The principles were seen as essential, with one exception ("resource efficiency"). Only those with little to no interest in digitisation (22/382, 5.8%) rated the nine principles indifferently.

CONCLUSIONS

The specified quality principles and their prioritisation can lay a foundation for future assessments of apps in the medical field. Professional societies build upon this to highlight opportunities for digital transformations in medicine and encourage their members to participate.

Systematic evaluation of content and quality of English and German pain apps in European app stores

BACKGROUND AND OBJECTIVE

Pain spans a broad spectrum of diseases and types that are highly prevalent and cause substantial disease burden for individuals and society. Up to 40% of people affected by pain receive no or inadequate treatment. Providing a scalable, time-, and location-independent way for pain diagnostic, management, prevention and treatment mobile health applications (MHA) might be a promising approach to improve health care for pain. However, the commercial app market is rapidly growing and unregulated, resulting in an opaque market. Studies investigating the content, privacy and security features, quality and scientific evidence of the available apps are highly needed, to guide patients and clinicians to high quality MHA.Contributing to this challenge, the present study investigates the content, quality, and privacy features of pain apps available in the European app stores.

METHODS

An automated search engine was used to identify pain apps in the European Google Play and Apple App store. Pain apps were screened and checked for systematic criteria (pain-relatedness, functionality, availability, independent usability, English or German). Content, quality and privacy features were assessed by two independent reviewers using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality on four objectives (engagement, functionality, aesthetics, information quality) and two subjective scales (perceived impact, subjective quality).

RESULTS

Out of 1034 identified pain apps 218 were included. Pain apps covered eight different pain types. Content included basic information, advice, assessment and tracking, and stand-alone interventions. The overall quality of the pain apps was average M = 3.13 (SD = 0.56, min = 1, max = 4.69). The effectiveness of less than 1% of the included pain apps was evaluated in a randomized controlled trial. Major problems with data privacy were present: 59% provided no imprint, 70% had no visible privacy policy.

CONCLUSION

A multitude of pain apps is available. Most MHA lack scientific evaluation and have serious privacy issues, posing a potential threat to users. Further research on evidence and improvements privacy and security are needed. Overall, the potential of pain apps is not exploited.

Health intentions and behaviors of health app owners: a cross-sectional study

Mobile devices have become widely popular in recent years. This popularity has been accompanied by the adoption of technologies created for those devices such as mobile applications (apps), many of which have been designed to facilitate achieving health goals. This study examined health-related intentions and behaviors, and their associations with mobile health app ownership in a large, nationally representative sample. Data from the Health Information National Trends Survey (HINTS) from the 2014 collection wave were analyzed. Expressing greater intentions to lose weight and to exercise was associated with owning mobile health apps. However, health app owners did not significantly differ from non-owners in their reported health behaviors in the domains of eating, exercise, and sedentary time. Although we do not know that the health apps that the app owners in this sample possessed were related to altering diet and exercise, this finding could suggest that health app owners do not use them, or that the ones available to them may be insufficient at eliciting and maintaining behaviors supporting relevant health intentions, suggesting an opportunity to leverage the capacities of mHealth technologies to produce more effective interventions delivered by apps informed by health behavior change theories.

Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma

BACKGROUND

Mobile teledermoscopy may facilitate skin self-examinations (SSEs) and further improve monitoring and detection of melanoma.

OBJECTIVE

To assess consumer acceptability and expectations of a mobile health app used to: (i) instruct SSE and (ii) conduct consumer-performed mobile teledermoscopy.

METHODS

People aged 18 years and above were invited to participate in either (i) an online survey or (ii) focus group in Brisbane, Australia. Participants were asked about their SSE practices, mobile teledermoscopy acceptance, and app design and functionality. The online survey responses and focus group discussions were coded by two researchers who conducted thematic analysis.

RESULTS

Four focus groups were held with a total of 28 participants; 88 participants completed the online survey. The mean ages of participants in the focus group and online survey were 46 and 38 years, respectively. There were more males in the focus groups (61%, 17/28) compared to the online survey (19%, 17/88). Regular SSEs were conducted by 56 (64%) of the online survey participants. Barriers to SSE were forgetfulness (44%), low self-perceived risk of melanoma (25%) and low confidence in conducting SSEs (25%). The large majority of online survey participants (95%) would consider sending photos of their skin lesions to a medical practitioner via an app. Focus group participants reported that they would accept using mobile teledermoscopy; however, they would prefer to use it to monitor lesions between face-to-face consultations.

CONCLUSIONS

Overall, participants had positive views on using mobile teledermoscopy to send images of skin lesions to a dermatologist or other medical practitioner.

Potentials and Challenges of the Health Data Cooperative Model

INTRODUCTION

Currently, abundances of highly relevant health data are locked up in data silos due to decentralized storage and data protection laws. The health data cooperative (HDC) model is established to make this valuable data available for societal purposes. The aim of this study is to analyse the HDC model and its potentials and challenges.

RESULTS

An HDC is a health data bank. The HDC model has as core principles a cooperative approach, citizen-centredness, not-for-profit structure, data enquiry procedure, worldwide accessibility, cloud computing data storage, open source, and transparency about governance policy. HDC members have access to the HDC platform, which consists of the "core," the "app store," and the "big data." This, respectively, enables the users to collect, store, manage, and share health information, to analyse personal health data, and to conduct big data analytics. Identified potentials of the HDC model are digitization of healthcare information, citizen empowerment, knowledge benefit, patient empowerment, cloud computing data storage, and reduction in healthcare expenses. Nevertheless, there are also challenges linked with this approach, including privacy and data security, citizens' restraint, disclosure of clinical results, big data, and commercial interest. Limitations and Outlook: The results of this article are not generalizable because multiple studies with a limited number of study participants are included. Therefore, it is recommended to undertake further elaborate research on these topics among larger and various groups of individuals. Additionally, more pilots on the HDC model are required before it can be fully implemented. Moreover, when the HDC model becomes operational, further research on its performances should be undertaken.

Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps

OBJECTIVE

To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps.

METHODS

A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics.

RESULTS

Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (p<0.01).

CONCLUSION

Apps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions.

PRACTICE IMPLICATIONS

Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content.

Effect of Educating the Primary Care Physician About Headache to Help Reduce "Trivial" Referrals and Improve the Number and Quality of "Substantial" Referrals that Truly Need Subspecialty Headache Medicine Care

OPINION STATEMENT

Technology is likely to play an increasingly important role in the delivery of healthcare as the disparity between provider availability/expertise and patient numbers/needs increases. This article is intended to lend insight into the ways in which technology can facilitate the evaluation of patients with headache disorders and improve the ongoing monitoring of disease progression and response to therapy, following proper diagnosis. While it is not possible to prognosticate the impact of technologies not yet available, the article addresses potential novel usage of currently existing technology to standardize intake, expedite evaluations, ensure adequate history and documentation, and monitoring of patient care.