Do Mobile Apps Improve Patient Care Outcomes?

They say there’s an app for everything these days, and the health care arena is no exception. A quick search of the app store on your smartphone will reveal an abundance of apps promising to help you measure, monitor and manage every possible facet of your health. There are apps to measure blood glucose levels, cardiac rhythms and apps to monitor the quality of your sleep. There are apps to improve medication adherence, apps to predict ovulation, and apps that assess whether a skin lesion might be melanoma. Others focus on physical activity, weight and diet control, mental health, memory and cognitive function, alcohol addiction, diabetes management, sun protection, hypertension management, cardiac rehabilitation, smoking cessation, family planning and pain management (Zhao, Freeman & Li, 2016). In fact, there are over 300,000 mobile health apps available to download on mobile devices running either Apple or Android operating systems, according to the IQVIA Institute for Human Data Sciences (Byambasuren, Sanders, Beller & Glasziou, 2018).

But is the proliferation of mobile health apps leading to improved health outcomes? With our ageing population and the rising incidence of chronic conditions such as Heart Disease and Type 2 Diabetes, enabling health consumers to independently manage their health is critical to reducing expenditure on health services. Mobile health apps typically offer consumers a means of documenting self-administered readings, or provide social and clinical support to assist the consumer to identify changes in their condition and take appropriate action (Anderson & Emmerton, 2015).  However, there is a disturbing lack of evidence to support the effectiveness of the vast majority of mobile health apps.

A recent study from Bond University found that only a tiny fraction of currently available mobile health apps had been subject to testing in randomised controlled trials (RCTs) (Byambasuren et al., 2018). The researchers were able to find just 23 RCTs evaluating 22 available apps (mostly addressing diabetes, mental health and obesity), and only half of those were able to demonstrate a positive health benefit from the app. Even then, most of the trials had a small sample size and a high risk of bias, so the overall quality of evidence for their reported outcomes was described as low.

Overseas, initiatives such as the NHS App Library have attempted to provide a framework for accreditation of quality mobile health apps, so that both consumers and health care professionals can readily identify apps that are safe and effective. But the App Library has attracted criticism too: a 2015 report found that of the 14 apps in the NHS library for depression and anxiety, only four were backed up by scientific evidence, and only two had been properly evaluated for clinical effectiveness (Leight & Flatt, 2015).

Aside from efficacy concerns, another potential issue with mobile health apps relates to data security practices. A 2015 analysis of 79 apps in the NHS library found that 66% of apps sending identifying information over the Internet did not use encryption, and 20% did not have a privacy policy. Four apps were found to have sent both identifying and health information without using encryption (Huckvale, Prieto, Tilney, Benghozi & Car, 2015). Similarly, a US study of over 200 diabetes management apps found that 81% did not have privacy policies, and nearly half of diabetes apps with privacy policies shared user information. (Blenner et al., 2016).  Consumers may believe that health information entered into an app is private, but often that is not the case. In downloading and installing an app, consumers often inadvertently give apps permission to collect personal information.

As Nurses, we know the importance of evidenced-based practice. The widespread adoption of mobile phones presents a significant opportunity to improve health behaviour, particularly in relation to prevention and management of chronic disease, but the evidence base for these interventions is currently lacking. The Bond University researchers referenced earlier in the article concluded their report by calling for the establishment of a recognised national body to evaluate apps for safety and efficacy – might we see an Australian version of the NHS App Library in the future? This could be a worthwhile initiative, though the sheer number of available health apps would provide a challenge for any regulatory agency. In the meantime, it is very much a case of ‘buyer beware’ – before downloading or using any mobile health app, consumers would be wise to look into how the app was developed or tested, check that it has  proper privacy and data safety policies in place, and to seek professional advice for any serious health concerns.

By Jennifer Hummelshoj MACN