Which app should I use?BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4597 (Published 09 September 2015) Cite this as: BMJ 2015;351:h4597
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This is a timely article and addresses an issue which will become increasingly important as both patients and healthcare professionals become more dependent on health apps. It will be interesting to see how the NIB consultation on their proposed four-step assessment process impacts upon the current NHS Health Apps library.
At the Academic Unit of Primary Medical Care in Sheffield we are addressing the issue of quality assurance for health behaviour change apps by adapting the 2014 NICE Behaviour Change Guidance. This approach identified nine areas that are important to consider when examining the quality of health apps; purpose, planning and development, usability, assessment and tailoring, behaviour change technique, maintenance and relapse, evaluation, documentation, and data protection. We examined the behaviour change apps in the NHS Health Apps Library and found that while app purpose was usually clear, few showed strong evidence of thorough planning and development or of addressing behavioural maintenance and relapse. Few apps demonstrated a focus on usability, and evidence for evaluation of app efficacy was poor. Whilst adherence to data protection is a prerequisite, documentation varied, and only a third of apps showed evidence of initial assessment and tailoring.
While there appears to be a great deal of variation in app quality, the RCP advice to avoid apps that lack a CE mark seems rather extreme, considering widely used and respected apps such as the NICE BNF app does not carry one. Until such a time as a clear quality assurance scheme is widely adopted for health apps, common sense may be our best guide. Just as we might recommend a good book to a patient that we have read ourselves, we might also recommend a good app. And just as we need to take much information we read on the internet with a pinch of salt, we would do well to double check clinical information on apps with other sources to confirm its reliability. We look forward to a time when less vigilance is needed and there is a process in place to reassure healthcare professionals that the apps we are using or recommending are reliable and trustworthy.
1. National Institute for Health and Care Excellence (2014). Behavior Change: individual approaches. NICE, London. 2014. Available from; https://www.nice.org.uk/guidance/ph49
2. McMillan, B., Hickey, E., Patel, M. Mitchell, C. (2015). Mobile health apps: The emperor's new clothes? Poster presented at the Royal College of General Practitioners annual conference, 1-3 October 2015, Scottish Exhibition and Conference Centre, Glasgow.
Competing interests: No competing interests