Select, review, rate


There are plenty of them out there, but how do you know how effective they are? Barry Nguyen, APAM, provides some insight.

The number of health apps available to download from the Apple and Google app marketplaces has recently exploded, with more than 300,000 now developed.

This is not surprising given advances in technology and innovation, increased capital investment, the consumerisation of healthcare, and widespread community access to smartphones.

Amid claims that apps can successfully promote positive behavioural change, the range of app functionality is relatively broad and includes fitness, personal health data management, online bookings and chronic disease management.

Although there is a significant amount of research into validating and evaluating health apps for consumer use being conducted by universities across the globe, there is much less consensus on how health apps should be implemented into routine clinical practice.

A recent 2020 npj Digital Medicine review article suggests that the key areas that need to be addressed to integrate health apps into clinical practice include education and awareness, workflow and electronic health record integration, payment models and patient/ provider support.

So health apps are increasingly popular, but the key question frequently asked by clinicians is: are they actually effective?

The Victorian government organisation VicHealth uses a process of evaluating ‘healthy living’ apps, which aims to help users understand more about health and wellbeing apps available in app stores.

VicHealth has implemented a comprehensive six-step process that rates an app on functionality (user-friendliness) and whether it has an impact on changing behaviour and promoting a healthy lifestyle.

The following is a summary of their framework. It is by no means the only approach and should only be used as a guide for practitioners to assess the health apps encountered in clinical practice.

1. Search for apps using ‘health’ and ‘wellbeing’ in the title or description

  • Google and Apple app stores are searched over a specified timeframe.

2. Screen and select apps for the ‘healthy living’ categScreen ory

  • Filter apps according to English language, average three star or higher user rating with a minimum of 10 reviews, and updates in the last 18 months.
  • Categorise apps into VicHealth’s five focus areas: (1) promoting healthy eating, (2) encouraging regular physical activity, (3) preventing tobacco use, (4) preventing harm from alcohol, and (5) improving mental wellbeing.
  • Filter apps again according to conflicts of interest, specific clinical population, and relevance to the Australian user.

3. Select apps that encourage behavioural change

  • Two independent experts determine whether the apps are behavioural change apps—where behavioural change is defined as new activities or actions performed regularly to achieve a healthier lifestyle.
  • In this context, apps need to mention two of these four behavioural change elements: (1) personal goal-setting, tailoring or personalising, (3) sharing user progress with others, and (4) receiving rewards or acknowledgements for making progress towards or achieving goals. 

4. Rate apps for functionality

  • Use the Mobile App Rating Scale (MARS), developed by the University of Queensland and the Young and Well Cooperative Research Centre, to examine overall functionality with the following five criteria: (1) engagement, (2) functionality, utility, (4) aesthetics, and (5) information. A total score of five is derived.

5. Rate apps for potential to affect behavioural change

  • Use the App Behavior Change Scale (ABACUS), developed by Deakin University, to examine the potential to affect behavioural change in relation to 21 key criteria including goal-setting, rewarding and feedback. The score is converted into a total out of five.

6. Calculate the overall rating for the apps

  • Determine the overall score out of a total of five, using the average of the MARS and ABACUS scale scores.
  • Take into account further information provided, including key features, security, in-app purchases and advertising, social media integrations and pricing model.

>> Visit here to read ‘Beyond validation: getting health apps into clinical practice’ published in npj Digital Medicine. Visit here for more on VicHealth’s process of selecting, reviewing and rating healthy living apps.

Visit here to check out how to choose an app that will change behaviour, albeit in the context of weight loss.

Disclaimer: This material is intended for general information purposes only and does not constitute legal advice or meet the specific needs of your clinical context.


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