Orthodontic apps: an assessment of quality (using the Mobile App Rating Scale (MARS)) and behaviour change techniques (BCTs)

Abstract Background Apps have been shown to be an effective tool in changing patients’ behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published. Objectives To evaluate the quality of these apps aiming to change behaviour. To assess BCTs used in patient focused orthodontic apps. Methods The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors. Results BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly ‘prompts/cues’, and ‘information about health consequences’. All apps were shown to be of moderate quality (range 3.1–3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent. Conclusions The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients’ compliance with treatment.

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A content analysis of the quality and behaviour change techniques of smartphone apps promoting the Mediterranean diet

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002190 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Daniel McAleese ◽

Angeliki Papadaki

Keyword(s):

Content Analysis ◽

Mediterranean Diet ◽

Behaviour Change ◽

Rating Scale ◽

Mobile App ◽

Subjective Quality ◽

Behaviour Change Techniques ◽

Smartphone Apps ◽

The Mediterranean

AbstractThe popularity of smartphone apps is rising globally. However, the quality of widely available health apps and their effectiveness to promote behaviour change, by incorporating behavioural change techniques (BCTs) that have been suggested to result in behaviour change, is questionable. The aim of this study was to conduct a content analysis of smartphone apps that utilise the Mediterranean diet (MD), a dietary pattern linked to numerous health benefits, to promote healthy dietary behaviours. The specific objectives were to evaluate the quality of these apps and their use of BCTs. The iTunes Store and Google Play were searched for all available apps (free and requiring payment to download) promoting the MD. Apps were excluded if they were not available in English, did not focus only on the MD or the download process was corrupt. The Mobile App Rating Scale (MARS) was used to assess app engagement, functionality, aesthetics and information quality (the average of which represents a quality mean score (QMS)) and subjective quality. The Abraham & Michie behaviour change taxonomy was adapted to create a 20-item checklist to assess the presence of BCTs in the eligible apps. Thirty nine apps (64.1% of which were free to download) were analysed. The overall QMS was 2.96 ± 0.46. The lowest and highest scored QMS constructs were engagement (2.42 ± 0.62) and functionality (3.95 ± 0.45), respectively, whilst the overall mean subjective quality score was 1.71 ± 0.51 (scores’ range 1–5). Apps were scored higher for aesthetics if they required payment (3.14 vs. 2.78, p = 0.047). Apps incorporated an average of 3.10 ± 1.87 BCTs, with no difference in the number of BCTs present according to platform or cost. From the five BCTs that have been suggested to promote behaviour change, ‘self-monitoring’ was present in six apps, ‘intention formation’ in 15 and ‘goal setting’ in one. None of the apps incorporated the ‘review of behavioural goals’ and ‘feedback on performance’ BCTs. The total QMS score was positively associated with the presence of BCTs (r = 0.409, p = 0.008). Based on the MARS assessment, apps promoting the MD that are available in the public domain were of moderate quality. In contrast, the low presence, particularly of efficacious, BCTs and low subjective quality scores suggest that apps are actually of poor quality and potentially not effective in promoting behaviour change towards an MD diet. These findings provide important insights for the future development of high-quality apps to promote the MD at population level.

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The quality and potential of Apps to promote behaviour change in patients with a chronic condition or multimorbidity: A systematic search in App Store and Google Play (Preprint)

10.2196/preprints.33168 ◽

2021 ◽

Author(s):

Alessio Bricca ◽

Alessandro Pellegrini ◽

Graziella Zangger ◽

Jonas Ahler J ◽

Madalina Jäger ◽

...

Keyword(s):

Behaviour Change ◽

Chronic Conditions ◽

Chronic Condition ◽

Rating Scale ◽

Mobile App ◽

Systematic Search ◽

Chronic Obstructive ◽

App Store ◽

Google Play

BACKGROUND Mobile applications (Apps) offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for Apps to be recommended in clinical practice, their quality and potential for behaviour change are important. OBJECTIVE To investigate the quality and potential for behaviour change of health Apps for patients with a chronic condition or multimorbidity (defined as two or more chronic conditions). METHODS We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of Apps available in English or Danish on App Store and Google Play for patients with one or more of the following common and disabling conditions: osteoarthritis, heart condition (heart failure and ischaemic heart disease), hypertension, type 2 diabetes mellitus, depression and chronic obstructive pulmonary disease was conducted. The search strategy combined keywords related to these conditions. One author screened the title and content of the identified apps. Subsequently, three authors independently downloaded the Apps in a smartphone and assessed the quality of the Apps and their potential for behaviour change using the Mobile App Rating Scale (MARS-21 items, score ranging 0-5, higher is better) and the App Behavior Change Scale (ABACUS-21 items, score ranging 0-21, higher is better), respectively. We included the five highest-rated and the five most downloaded apps but only assessed the quality and potential for behaviour change of the free content. RESULTS We screened 453 Apps and ultimately included 60. Most of the Apps were available in both the App Store and Google Play (58%). The overall average quality of the Apps was 3.48 (SD 0.28) on the MARS scale, and the overall potential for behaviour change was 8.07 (SD 2.30) on the ABACUS scale. Apps for depression and patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common self-monitoring features presented in the Apps in support of behaviour change were physiological (e.g., blood pressure monitoring) in 64% of the Apps, weight/diet, or physical activity in 41% and 36%, respectively, and stress management in 37%. Only 14% of the Apps were completely free, while 86% had in-app-purchase for some content. CONCLUSIONS Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have a low-to-moderate potential for behaviour change. Our results provide a useful overview for patients and clinicians who would like to use Apps for managing chronic conditions and suggest the need to improve the Apps in terms of quality and potential for behaviour change. CLINICALTRIAL https://osf.io/nvhuy/

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Quality of Mobile Apps for Care Partners of People with Alzheimer’s Disease and Related Dementias: Mobile App Rating Scale Evaluation (Preprint)

10.2196/preprints.33863 ◽

2021 ◽

Author(s):

Nicole E Werner ◽

Janetta C Brown ◽

Priya Loganathar ◽

Richard J Holden

Keyword(s):

Rating Scale ◽

Mobile Apps ◽

Mobile App ◽

Future Research ◽

App Development ◽

Care Partners ◽

Acceptable Quality ◽

The Us ◽

Google Play

BACKGROUND The over 11 million care partners in the US who provide care to people living with Alzheimer’s disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to all aspects of their caregiving role. The proliferation of mobile applications (apps) for care partners has potential to meet the care partners’ needs, but the quality of apps is unknown. OBJECTIVE The present study aimed to 1) evaluate the quality of publicly available apps for care partners of people living with ADRD and 2) identify design features of low- and high-quality apps to guide future research and app development. METHODS We searched the US Apple and Google Play app stores with the criteria that the app needed to be 1) available in US Google play or Apple app stores, 2) directly accessible to users “out of the box”, 3) primarily intended for use by an informal (family, friend) caregiver or caregivers of a person with dementia. The included apps were then evaluated using the Mobile App Rating Scale (MARS), which includes descriptive app classification and rating using 23 items across five dimensions: engagement, functionality, aesthetics, information, and subjective quality. Next, we computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on the score driving factors for each item and what the app could have done to improve the score for that item. RESULTS We evaluated 17 apps (41% iOS only, 12% Android only, 47% both iOS and Android). We found that on average, the apps are of minimally acceptable quality. Although we identified apps above and below minimally acceptable quality, many apps had broken features and were rated as below acceptable for engagement and information. CONCLUSIONS Minimally acceptable quality is likely insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for mobile apps for care partners. The design features of high-quality apps we identified in this research can provide the foundation for benchmarking those standards.

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Mobile Applications in Otolaryngology: A Systematic Review of the Literature, Apple App Store and the Google Play Store

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420940350 ◽

2020 ◽

Vol 130 (1) ◽

pp. 78-91

Author(s):

Eleonora M. C. Trecca ◽

Antonio Lonigro ◽

Matteo Gelardi ◽

Brandon Kim ◽

Michele Cassano

Keyword(s):

Rating Scale ◽

Case Reports ◽

Mobile App ◽

App Store ◽

Literature Reviews ◽

Scientific Associations ◽

Conference Papers ◽

Further Development ◽

Google Play

Objectives: Although the last few years have seen an increased number of smartphone applications (apps) disseminated in the field of Otolaryngology (ORL), these apps vary widely in quality. The aim of this paper, therefore, is to systematically review ORL apps directed towards patients in mobile app stores and the current literature. Methods: The Google Play Store, Apple App Store and PubMed were searched for ORL apps for patients using various keywords pertaining to different ORL subspecialties. Apps not relevant to the scope of this research and/or duplicates, educational apps, apps promoting a business, apps requiring specific separate hardware, and apps in non-English were excluded. In PubMed, keywords pertaining to the subspecialties were combined with “mobile app” in a search query; literature reviews, editorials, case reports, conference papers, duplicate articles, and articles irrelevant to ORL apps were excluded. The quality of apps with the highest number of reviews was assessed using the “Mobile App Rating Scale” (MARS), while the quality of the articles was rated using “The Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) Statement. Results: After searching the app stores, 1074 apps were included and grouped according to their ORL subspecialties. The overall MARS score of the ten most popular apps in each category was 3.65 out of 5. A total of 636 articles were identified in the literature, and 193 were included. The mean adherence percentage of the articles to the STROBE checklist was of 84.37%. Conclusions: Although the apps currently available need further development, their application in ORL appears promising. Further dialogue between physicians and patients, as well as formal support from professional and scientific associations, should be encouraged.

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Can existing mobile apps support healthier food purchasing behaviour? Content analysis of nutrition content, behaviour change theory and user quality integration

Public Health Nutrition ◽

10.1017/s1368980017002889 ◽

2017 ◽

Vol 21 (2) ◽

pp. 288-298 ◽

Cited By ~ 24

Author(s):

Sarah-Jane Flaherty ◽

Mary McCarthy ◽

Alan Collins ◽

Fionnuala McAuliffe

Keyword(s):

Behaviour Change ◽

Mobile Apps ◽

Change Theory ◽

Mobile App ◽

Behaviour Change Techniques ◽

Food Purchasing ◽

Behaviour Change Theory ◽

User Acceptability ◽

Purchasing Behaviour

AbstractObjectiveTo assess the quality of nutrition content and the integration of user quality components and behaviour change theory relevant to food purchasing behaviour in a sample of existing mobile apps.DesignDescriptive comparative analysis of eleven mobile apps comprising an assessment of their alignment with existing evidence on nutrition, behaviour change and user quality, and their potential ability to support healthier food purchasing behaviour.SettingMobile apps freely available for public use in GoogePlay were assessed and scored according to agreed criteria to assess nutrition content quality and integration of behaviour change theory and user quality components.SubjectsA sample of eleven mobile apps that met predefined inclusion criteria to ensure relevance and good quality.ResultsThe quality of the nutrition content varied. Improvements to the accuracy and appropriateness of nutrition content are needed to ensure mobile apps support a healthy behaviour change process and are accessible to a wider population. There appears to be a narrow focus towards behaviour change with an overemphasis on behavioural outcomes and a small number of behaviour change techniques, which may limit effectiveness. A significant effort from the user was required to use the mobile apps appropriately which may negatively influence user acceptability and subsequent utilisation.ConclusionsExisting mobile apps may offer a potentially effective approach to supporting healthier food purchasing behaviour but improvements in mobile app design are required to maximise their potential effectiveness. Engagement of mobile app users and nutrition professionals is recommended to support effective design.

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Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality

JMIR mhealth and uhealth ◽

10.2196/18858 ◽

2020 ◽

Vol 8 (10) ◽

pp. e18858

Author(s):

Atiyeh Vaezipour ◽

Jessica Campbell ◽

Deborah Theodoros ◽

Trevor Russell

Keyword(s):

Rating Scale ◽

Mobile Apps ◽

Communication Disorders ◽

Mobile App ◽

Evidence Based ◽

Language Therapy ◽

Eligibility Criteria ◽

App Store ◽

Google Play

Background Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.

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A systematic review of the smartphone applications available for corona virus disease 2019 (COVID19) and their assessment using the mobile app rating scale (MARS)

10.1101/2020.07.02.20144964 ◽

2020 ◽

Cited By ~ 3

Author(s):

Samira Davalbhakta ◽

Shailesh Advani ◽

Shobhit Kumar ◽

Vishwesh Agarwal ◽

Samruddhi Bhoyar ◽

...

Keyword(s):

Systematic Review ◽

Mobile Applications ◽

Rating Scale ◽

Virus Disease ◽

Mobile App ◽

Assessment Tools ◽

Contact Tracing ◽

Mobile Platforms ◽

The Uk ◽

Google Play

AbstractThe global impact of COVID-19 pandemic has increased the need to rapidly develop and improve utilization of mobile applications across the healthcare continuum to address rising barriers of access to care due to social distancing challenges and allow continuity in sharing of health information, assist with COVID-19 activities including contact tracing, and providing useful information as needed. Here we provide an overview of mobile applications being currently utilized for COVID-19 related activities. We performed a systematic review of the literature and mobile platforms to assess mobile applications been currently utilized for COVID-19, and quality assessment of these applications using the Mobile Application Rating Scale (MARS) for overall quality, Engagement, Functionality, Aesthetics, and Information. Finally, we provide an overview of the key salient features that should be included in mobile applications being developed for future use. Our search identified 63 apps that are currently being used for COVID-19. Of these, 25 were selected from the Google play store and Apple App store in India, and 19 each from the UK and US. 18 apps were developed for sharing up to date information on COVID-19, and 8 were used for contact tracing while 9 apps showed features of both. On MARS Scale, overall scores ranged from 2.4 to 4.8 with apps scoring high in areas of functionality and lower in Engagement. Future steps should involve developing and testing of mobile applications using assessment tools like the MARS scale and the study of their impact on health behaviors and outcomes.

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Enabling women to access preferred methods of contraception: a rapid review and behavioural analysis

BMC Public Health ◽

10.1186/s12889-021-12212-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abimbola A. Ayorinde ◽

Felicity Boardman ◽

Majel McGranahan ◽

Lucy Porter ◽

Nwamaka A. Eze ◽

...

Keyword(s):

Behaviour Change ◽

Grey Literature ◽

Barriers And Facilitators ◽

Rapid Review ◽

Behaviour Change Techniques ◽

The United Kingdom ◽

Behaviour Change Wheel ◽

Behavioural Analysis ◽

Health And Social Care ◽

The Uk

Abstract Background Many pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally. Methods Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel. Results We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted. Conclusions This review highlights factors that influence women’s choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception. Registration Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156.

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Smartphone apps related to shoulder pain using the Mobile App Rating Scale (MARS): A Review (Preprint)

10.2196/preprints.34339 ◽

2021 ◽

Author(s):

Jonathon Agnew ◽

Christopher Nugent ◽

Catherine Hanratty ◽

Elizabeth Martin ◽

Daniel Kerr ◽

...

Keyword(s):

Shoulder Pain ◽

Rating Scale ◽

Scientific Literature ◽

Descriptive Analysis ◽

Evaluation Process ◽

Mobile App ◽

Mobile Technologies ◽

Face To Face ◽

Google Play

BACKGROUND Successful rehabilitation of musculoskeletal (MSK) pain requires more than medical input alone. Conservative treatment including physiotherapy and exercise therapy can be an effective way of decreasing pain associated with MSK pain. However, face-to-face appointments are currently not feasible. New mobile technologies such as mobile health (mHealth) in the form of an app on your smartphone can be a solution to this problem. In many cases, these apps are not backed by scientific literature, therefore it is important that they are reviewed and quality assessed. OBJECTIVE The aim is to evaluate and measure the quality of apps related to shoulder pain using the Mobile App Rating Scale (MARS). METHODS This study included 25 free and paid apps from the Apple Store and the Google Play Store. Five reviewers were involved in the evaluation process. A descriptive analysis of the MARS results provided a general overview of the quality of the apps. RESULTS Overall, app quality was generally low with an average star rating of 1.97 out of 5. The best scores were in the ‘Functionality’ and ‘Aesthetics’ sections, scoring poorer in the ‘Engagement’ and ‘Information’ sections. The apps were also rated poorly in the ‘Subjective Quality’ section. CONCLUSIONS In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to the user which led to a lack of engagement. Most of the apps weren’t backed by scientific literature and those that contained scientific references were vastly out of date. Future apps would need to address these concerns whilst taking simple measures to ensure quality control. CLINICALTRIAL N/A

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Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality (Preprint)

10.2196/preprints.18858 ◽

2020 ◽

Author(s):

Atiyeh Vaezipour ◽

Jessica Campbell ◽

Deborah Theodoros ◽

Trevor Russell

Keyword(s):

Rating Scale ◽

Mobile Apps ◽

Communication Disorders ◽

Mobile App ◽

Evidence Based ◽

Language Therapy ◽

Eligibility Criteria ◽

App Store ◽

Google Play

BACKGROUND Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. OBJECTIVE The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). METHODS Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. RESULTS From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). CONCLUSIONS To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.

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