The efficiency of Developing Mobile Applications Support Diabetes Mellitus Type 2 Self-management: A Systematic Literature Review of Recent Articles, Meta-analysis and Qualitative Assessment (Preprint)

BACKGROUND Applying health technologies, such as mobile applications (apps), is considered as a means of promoting health management. This research aimed to examine the consideration of developing mobile applications (apps), support diabetes mellitus type 2 (DM-2) self-management, via investigating the outcome of original articles. OBJECTIVE (1) To indicate the extend which mobile app developers considered features and specifications defined by the health technology guidelines. (2) To identify the bottlenecks of health technology guidelines by assessing and comparing them. (3) To provide a list of evidence-based recommendations for manufacturers in order to design and develop as well as verify the health mobile apps. METHODS This research is a combination of systematic literature review and meta-analysis as well as qualitative assessment. The systematic literature review and meta-analysis included the articles published within the last six years, to indicate time-related reliability to the content, indexed on Ovid, Embase, Engendering Village, and PubMed. In order to conduct a meta-analysis, the information derived from included articles was adopted in a framework made of qualitative assessment of the well-known health technology guidelines. These guidelines were published by The National Institute for Health and Care Excellence (NICE), World Health Organisation (WHO), Public Health England and the U.S. Food and Drug Administration (FDA). RESULTS After filtering all articles via a PRISMA flowchart, 37 articles were selected for further investigations. The results of the systematic literature review and meta-analysis indicated that almost all articles reported the significant role of apps in improving the health status of the users. Majority of studies were clinical trials conducted to measure the outcomes of interventions using a known mobile app. Technology-related limitations were having access to a smartphone and mobile markets, technology literacy, and malfunction of the systems. Combination of recommendations provided by included articles was conducting further studies with larger sample size to determine barriers and facilitators of available technologies integrated with mobile apps, aimed to provide patient-centred services, in a longer duration of the intervention implementation. On the other hand, the majority of articles did not report the use of any particular guideline. However, by comparing their findings with the results of the qualitative assessment of selected health technology guidelines, evidence-based documents were scarcely reported. Likewise, only a few numbers of articles briefly discussed cost-effectiveness. Almost none of them used an approved tool for evaluating the economic effect of mobile apps. CONCLUSIONS The majority of publications indicated lack of proper adherence to guidelines in designing and examining mobile applications, developed for supporting DM-2 self-management. Furthermore, a comparison of four included guidelines indicated insufficiencies in some perspectives such as safety of recorded information. The list of recommendations, produced by the results of included articles and highlights of included guidelines, facilitates producing standard mobile health apps by manufacturers.