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)
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/