Healthcare apps are intended to help people better maintain their physical and mental health and help healthcare professionals facilitate and improve patient care. Health-related apps have an exciting potential to aid a wide range of target audiences with a variety of health issues (Zhao, Freeman & Li, 2016).
At least two-thirds of Americans own a smartphone, giving more people the opportunity to monitor and manage their health on the go (Dignity Health, 2016). Remember the first Fitbit? It was launched in 2009, and now wearables such as this can measure every aspect of our activity, physiology, and even mental health.
Many mHealth apps are available to download for free or at a minimal cost, and some allow users to set pill or appointment reminders, access their medical records in real time, or view post-visit instructions (Smith, 2015).
Today there are more than a million health and wellness apps that are available from the Apple and Google app stores, and this number grows daily! This can be so overwhelming; how can an individual decide which apps could be helpful?
I have found four broad categories of mhealth apps:
general health and wellness apps (examples: Health Pal, MyFitnessPal)
apps that help manage overall health or a particular chronic condition (examples: FlareDown, Manage my Pain)
telehealth and telemedicine apps, (examples: Mend, Healee)
digital therapeutics apps, (category is approved by the FDA, and can be used for the treatment of specific conditions, they are evidence-based, clinically evaluated according to the Digital Therapeutics Alliance, the industry's trade association. Examples include reSETO, Sleepio, and mental Health apps such as You’re Okay).
The Good:
Health management apps can assist individuals in monitoring their own health conditions, such as heart disease, diabetes, pregnancy, mental health, and more, and this can allow healthcare providers to share and report on a patient's personal health records remotely. There are Published reviews that support that mental health apps can be effective for reducing anxiety and depression with an overall effect size of small to moderate.
Do these mobile health apps have any impact on our health? According to many recent studies, the answer is a most likely “yes.” Research findings are not clear when it comes to health apps' effects on health, but some studies suggest they can have a positive impact on certain health-related behaviors (Iribarren et al., 2021). Also, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. (Ventola, 2014).
Beyond personal use, mHealth apps can be useful to facilitate engagement with medical providers regarding sharing health status between providers and patients. One of the apps that I like to share with my MS patient is through the Multiple Sclerosis Association of America (MSAA) that allows patients to track their ever-changing MS disease. (Multiple Sclerosis Association of American, 2022). The app can assist the patient with tracking their disease activity, storing their personal medical information, and generating charts with reports across various metrics like treatments, moods, symptoms, and more. Additional features that are HIPAA-compliant include optional private reminder settings, links to further educational materials from MSAA.
The Worrisome
There is discussion in the web that supports the use of consumer mobile health apps’ success in helping individuals; however, the majority are simply not evidence-based and can, in fact, “contain harmful content.” Most consumers use mHealth apps without any concrete information about their effectiveness or harm and evidence of the effectiveness of mHealth has been inconclusive and not fully understood, indicating the need for more research (Han,& Lee, 2018).
A recent study found that medical apps are far less accurate at making diagnoses than trained medical professionals. Physicians had the correct diagnosis 72% of the time, whereas the apps managed a correct diagnosis just 34% of the time (Iribarren, 2021).
Mental mHealth apps have had rapid growth in the mhealth app market. Researchers have analyzed the claims on seventy-three mental health apps related to depression, self-harm, substance use, anxiety, and schizophrenia. Of the mental health apps, 64% claimed effectiveness at diagnosing a mental health condition or improving symptoms or self-management. Yet none of the apps referenced certification or accreditation processes and just two apps offered “low-quality, primary evidence” from a study using that particular app. Only one app included a citation to published literature. mHealth apps do show a positive impact on health-related behaviors, such as physical activity, diet change, adherence to medication or therapy, and knowledge enhancement related to clinical procedures. Moreover, most apps promote better clinical health outcomes. Also, most app users are satisfied with the use of mHealth apps to manage their health in comparison to users of conventional care (Han, & Lee, 2018).
In terms of overall efficacy, the jury is still out on the use of mobile applications in mental health treatment. In a randomized control trial in the US, a chatbot called Woebot was compared to a control group who had access to an eBook on mental health. The clinical trial found that the programmed delivered measurable improvements on psychometric screening tools, the nine-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder scale and the Positive and Negative Affect Scale among college students. However, these students had not been officially diagnosed with depression or anxiety. Woebot, meanwhile, states 75% of users reported feeling better after using the tool for the first time and a 98.9% accuracy rate in detecting crisis language (Fitzpatrick, Darcy, Vierhile, 2017).
The Unknown
Data privacy. Many health apps raise data privacy concerns. One in-depth research study indicates that over 88% of mHealth apps have data sharing technology within the app (Tangari, et al., 2021). As wearable and home digital devices evolve (such as the apple watch or home devices like blood pressure cuffs, smart scales, thermometers), and since these devices communicate directly to your health apps on the phones, I am concerned about data security and breaching of personal information from the phone to outsiders without good intentions.
I am also concerned about inaccurate information that can be given to a patient and the lack of regulation in this industry.
A word about Telehealth and Telemedicine Apps. Apps like Doctor on Demand, Teladoc, GoodRx Care, Talkspace, and Zocdoc can connect you directly with a doctor for a virtual appointment or help a patient seek out and book local health care providers for in-person visits. More hospitals and health systems, like the Mayo Clinic and the Cleveland Clinic, are also including the ability to participate in virtual visits in their own apps. Apps they are secure can be confused with apps that are not secure.
References:
Dignity Health. (2016)The Pros and Cons of Mobile Health Apps. Reviewed October 5th 2022 from https://www.dignityhealth.org/articles/the-pros-and-cons-of-mobile-health-apps)
Fitzpatrick, K.K., Darcy, A., Vierhile, M.,( 2017). Delivering Cognitive Behavior Therapy to Young Adults with Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial. JMIR Ment Health. ;4(2):e19. doi: 10.2196/mental.7785
Han, M., & Lee, E. (2018). Effectiveness of Mobile Health Application Use to Improve Health Behavior Changes: A Systematic Review of Randomized Controlled Trials. (“Effectiveness of Mobile Health Application Use to Improve Health ...”) Healthcare informatics research, 24(3), 207–226. https://doi.org/10.4258/hir.2018.24.3.207
Iribarren, S. J., Akande, T. O., Kamp, K. J., Barry, D., Kader, Y. G., & Suelzer, E. (2021)." (“Nussbaum.docx - Nussbaum, R., Kelly, C., Quinby, E., Mac,”) "Effectiveness of Mobile Apps to Promote Health and Manage Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials." (“Effectiveness of Mobile Apps to Promote Health and Manage Disease ...”) JMIR mHealth and uHealth, 9(1), e21563. https://doi.org/10.2196/21563
Multiple Sclerosis Association of American (2022). My MS Manager™ Mobile App. https://mymsaa.org/msaa-community/mobile/
Smith, A., 2015. U.S. Smartphone Use in 2015. The Pros and Cons of Mobile Health Apps - Dignity Health. Pew Research Center. https://www.dignityhealth.org
Tangari, G., Ikram, M. Ijaz,K., Kaafar, M. A., Berkovsky, S., (2021). (“JMIR mHealth and uHealth - Exploring the Far Side of Mobile Health ...”) Mobile health and privacy: cross sectional study. BMJ 373:n1248. doi: https://doi.org/10.1136/bmj.n1248
Ventola C. L. (2014). Mobile devices and apps for health care professionals uses and benefits. P & T : a peer-reviewed journal for formulary management, 39(5), 356–364.
Wallace, S., Clark, M., White, J., (2012). ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. (“(PDF) ‘It's on My iPhone’: Attitudes to the Use of Mobile”) BMJ Open. 2:e001099.
Zhao J, Freeman B, Li M. Can mobile phone apps influence people's health behavior change? Evidence reviews. J Med Internet Res. 2016;18(11):e287.