Qualitative evaluation of lifestyle management apps using the Korean Mobile Application Rating Scale (MARS)

BACKGROUND Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Consequently, instruments of high psychometric quality for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA in various health domains. Only few validation studies investigating its psychometric quality exist with selected samples of MHAs. No study has evaluated the construct validity of the MARS and concurrent validity to other instruments. OBJECTIVE This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS. METHODS MARS scoring data was pooled from 15 international app quality reviews to evaluate the psychometric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. App quality is determined for each dimension and overall. Construct validity was evaluated by assessing related competing confirmatory models that were explored by confirmatory factor analysis (CFA). A combination of non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices was used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations between the MARS and 1) another quality assessment tool called ENLIGHT, and 2) user star-rating extracted from app stores were investigated. Reliability was determined using Omega. Objectivity was assessed in terms of intra-class correlation. RESULTS In total, MARS ratings from 1,299 MHA covering 15 different health domains were pooled for the analysis. Confirmatory factor analysis confirmed a bifactor model with a general quality factor and an additional factor for each subdimension (RMSEA=0.074, TLI=0.922, CFI=0.940, SRMR=0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC=0.82). The overall MARS rating was positively associated with ENLIGHT (r=0.91, P<0.01) and user-ratings (r=0.14, P<0.01). CONCLUSIONS he psychometric evaluation of the MARS demonstrated its suitability for the quality assessment of MHAs. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.

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An Analysis of Apps with a Medication List Functionality for Older People with Heart Failure: Evaluation using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics Functionality Score (Preprint)

10.2196/preprints.30674 ◽

2021 ◽

Author(s):

Yohanca Maria Diaz-Skeete ◽

David McQuaid ◽

Adewale Samuel Akinosun ◽

Idongesit Ekerete ◽

Natacha Carragher ◽

...

Keyword(s):

Heart Failure ◽

Mobile Application ◽

Rating Scale ◽

Scientific Evidence ◽

Medication List ◽

Healthcare Informatics ◽

Medication History ◽

Clinic Efficiency ◽

Google Play

BACKGROUND Managing the care of older patients with heart failure (HF) largely centres on medication management. Due to their frequent medication or dosing changes, an app supporting them to keep an up-to-date list of medication could be advantageous. During COVID-19 times, HF outpatients’ consultations are taking place virtually or by phone. An app with the capability to share the medication list with healthcare professionals before consultation could support the clinic efficiency, for example, reducing consultation time. However, the influence of apps on maintaining an up to date medication history for older adults with HF in Ireland remains largely unexplored. OBJECTIVE The objectives of this review are twofold: to review apps with a medication list functionality and to evaluate the quality of the apps included in the review using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. METHODS A systematic search of apps was conducted in June 2019 using the Google Play StoreTM and iTunes App StoreTM. The MARS was used independently by four researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. RESULTS Google play and iOS app stores searches identified 483 potential apps (292 from Android stores and 191 from Apple stores). Six apps met the inclusion criteria. Medisafe app had the highest overall MARS score (4/5) and the medication list & medical records app had the lowest overall score (2.5/5). Five out of the six apps achieved an acceptable quality MARS score (>3.0). Two apps scored the maximum number of features (n=11) according to the IMS Institute for Healthcare Informatics functionality score and two scored the lowest (n=5). The apps had on average 8 functions based on the IMS functionality criteria (range 5 to 11). CONCLUSIONS The quality of current apps with a medication list functionality varies regarding their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality. However, the subjective quality or satisfaction with the apps was poor. Only three apps are based on scientific evidence and have been previously tested. Two apps featured all the IMS Institute for Healthcare Informatics functionalities and half do not provide clear instructions on how to enter medication data, do not display vital parameters data in an easy to understand format and do not guide users on how or when to take their medication. CLINICALTRIAL N/A

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Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis (Preprint)

10.2196/preprints.17609 ◽

2019 ◽

Author(s):

Miguel Ángel Amor-García ◽

Roberto Collado-Borrell ◽

Vicente Escudero-Vilaplana ◽

Alejandra Melgarejo-Ortuño ◽

Ana Herranz-Alonso ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Health Professionals ◽

Health Care Professionals ◽

Mobile Application ◽

Rating Scale ◽

Cross Sectional ◽

Cancer Symptoms ◽

Genitourinary Cancers

BACKGROUND The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. OBJECTIVE The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. METHODS We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. RESULTS In total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: “Bladder cancer manager,” “Kidney cancer manager,” “My prostate cancer manager,” “Target Ovarian Cancer Symptoms Diary,” and “My Cancer Coach.” We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). CONCLUSIONS MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality.

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Preparing India to Leverage Power of Mobile Technology: Development of a Bilingual Mobile Health Tool for Heart Patients

Cardiovascular & Hematological Agents in Medicinal Chemistry ◽

10.2174/1871525717666190912152938 ◽

2019 ◽

Vol 17 (2) ◽

pp. 125-134 ◽

Cited By ~ 1

Author(s):

Yojna Sah Jain ◽

Arun Garg ◽

D.K. Jhamb ◽

Praful Jain ◽

Akash Karar

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Mobile Health ◽

User Satisfaction ◽

Mobile Application ◽

Rating Scale ◽

Tertiary Care ◽

Expert Assessment ◽

Heart Patients ◽

Artery Disease

Background: Mobile health technology offers promising means to implement public health strategies for the prevention and management of chronic conditions. However, at the moment, there is a dearth of both; specific mobile health tools tailored for the knowledge and language needs of Indian population; as well as enough systematic and scientific clinical data to analyse their impact in varied Indian socioeconomic and disease populations. Objective: To develop a smartphone-based bilingual educational mobile application for heart patients and pilot test in an Indian clinical setting. Methods: An Android™ based mobile application was developed according to a systematic instructional design model. Thereafter, expert assessment was done by 3 software engineers and 2 healthcare professionals using a peer-reviewed, objective and multidimensional Mobile Application Rating Scale (MARS). A pilot user satisfaction evaluation was done based on feedback from 35 Coronary Artery Disease patients visiting Cardiology outpatient Department of a North Indian tertiary care centre. Results: An Android™ based mobile application named as ‘Happy Heart’ was developed. The content was developed in both Hindi and English under professional supervision. For this mobile application, the Mean MARS score was 3.60 ± 0.86 and subjectivity score was 3.30 ± 1.03. The overall user satisfaction response for the mobile application was 4.09 ± 0.75 indicating that most of the testers found it useful. Conclusion: This mobile application is developed as a research tool to further conduct a clinical study in Coronary Artery Disease Patients. Current evaluation was a pilot testing wherein this application showed promising results.

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A Systematic Review of Smartphone Applications Available for Corona Virus Disease 2019 (COVID19) and the Assessment of their Quality Using the Mobile Application Rating Scale (MARS)

Journal of Medical Systems ◽

10.1007/s10916-020-01633-3 ◽

2020 ◽

Vol 44 (9) ◽

Cited By ~ 11

Author(s):

Samira Davalbhakta ◽

Shailesh Advani ◽

Shobhit Kumar ◽

Vishwesh Agarwal ◽

Samruddhi Bhoyar ◽

...

Keyword(s):

Systematic Review ◽

Mobile Application ◽

Rating Scale ◽

Virus Disease ◽

Smartphone Applications ◽

Corona Virus

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Patient preferences for patient participation: Psychometric evaluation of The 4Ps tool in patients with chronic heart or lung disorders

Nordic Journal of Nursing Research ◽

10.1177/2057158517713156 ◽

2017 ◽

Vol 38 (2) ◽

pp. 68-76 ◽

Cited By ~ 7

Author(s):

Kristina Luhr ◽

Ann Catrine Eldh ◽

Ulrica Nilsson ◽

Marie Holmefur

Keyword(s):

Patient Participation ◽

Patient Preferences ◽

Rasch Analysis ◽

Rating Scale ◽

Psychometric Evaluation ◽

Qualitative Evaluation ◽

Weighted Kappa ◽

General Knowledge ◽

Test Retest Reliability ◽

Internal Scale

The Patient Preferences for Patient Participation tool (The 4Ps) was developed to aid clinical dialogue and to help patients to 1) depict, 2) prioritise, and 3) evaluate patient participation with 12 pre-set items reiterated in the three sections. An earlier qualitative evaluation of The 4Ps showed promising results. The present study is a psychometric evaluation of The 4Ps in patients with chronic heart or lung disease ( n = 108) in primary and outpatient care. Internal scale validity was evaluated using Rasch analysis, and two weeks test–retest reliability of the three sections using kappa/weighted kappa and a prevalence- and bias-adjusted kappa. The 4Ps tool was found to be reasonably valid with a varied reliability. Proposed amendments are rephrasing of two items, and modifications of the rating scale in Section 2. The 4Ps is suggested for use to increase general knowledge of patient participation, but further studies are needed with regards to its implementation.

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Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study

JMIR Formative Research ◽

10.2196/13170 ◽

2020 ◽

Vol 4 (5) ◽

pp. e13170

Author(s):

Alexandra Hoffmann ◽

Corinna A Faust-Christmann ◽

Gregor Zolynski ◽

Gabriele Bleser

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Mobile Application ◽

Rating Scale ◽

Pain Treatment ◽

Semistructured Interview ◽

Content Quality ◽

Management Techniques ◽

Health Experts

Background The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor.

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Assessing the Quality of Mobile Apps Used by Occupational Therapists: Evaluation Using the User Version of the Mobile Application Rating Scale

JMIR mhealth and uhealth ◽

10.2196/13019 ◽

2019 ◽

Vol 7 (5) ◽

pp. e13019 ◽

Cited By ~ 3

Author(s):

Kelsea LeBeau ◽

Lauren G Huey ◽

Mark Hart

Keyword(s):

Mobile Application ◽

Rating Scale ◽

Mobile Apps ◽

Occupational Therapists

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Evaluation of Android and Apple Store Depression Applications Based on Mobile Application Rating Scale

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312505 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12505

Author(s):

Jaime Martín-Martín ◽

Antonio Muro-Culebras ◽

Cristina Roldán-Jiménez ◽

Adrian Escriche-Escuder ◽

Irene De-Torres ◽

...

Keyword(s):

Health Status ◽

Mobile Application ◽

Rating Scale ◽

Behavioral Changes ◽

Average Score ◽

App Store ◽

The United Kingdom ◽

Treatment Of Depression ◽

Mobile Health Applications

There are a large number of mobile applications that allow the monitoring of health status. The quality of the applications is only evaluated by users and not by standard criteria. This study aimed to examine depression-related applications in major mobile application stores and to analyze them using the rating scale tool Mobile Application Rating Scale (MARS). A search of digital applications for the control of symptoms and behavioral changes in depression was carried out in the two reference mobile operating systems, Apple (App Store) and Android (Play Store), by means of two reviewers with a blind methodology between September and October 2019 in stores from Spain and the United Kingdom. Eighteen applications from the Android Play Store and twelve from the App Store were included in this study. The quality of the applications was evaluated using the MARS scale from 1 (inadequate) to 5 (excellent). The average score of the applications based on the MARS was 3.67 ± 0.53. The sections with the highest scores were “Functionality” (4.51) and “Esthetics” (3.98) and the lowest “Application Subjective quality” (2.86) and “Information” (3.08). Mobile Health applications for the treatment of depression have great potential to influence the health status of users; however, applications come to the digital market without health control.

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