What’s In An App?

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There’s no doubt that the health marketplace is overflowing with smart devices and apps all claiming to be better than sliced bread when it comes to making people healthier
…question is, which ones really work, and how safe are they?

Wearable devices are designed to provide instant feedback about behaviours such as physical activity, caloric intake, or sleep
patterns by recording physiological processes such as galvanic skin response (GSR), or self – reported data such as foods eaten. The assumption is that feedback will influence motivation to engage in better health behaviours, and herein lies the problem. The evidence supporting this assumption is slim at best.

Behaviour change is a complex science shaped by many variables including environmental factors (e.g. access to supportive facilities such as gyms or personal trainers, or social support from people we respect) and internal motivational factors (e.g. having a purpose to change, or being able to manage cognitive dissonance), and of course barriers to sustained change (e.g.having to recharge the device).

According to one survey of over 5000 people, at least one third of people who purchased a wearable device stop using it before 6 months, and only about half continue for longer.

The producers of apps that can be downloaded to smartphones address some of these issues, given that most people carry their phone with them most of the time. This addresses the barrier of having to put on a wearable device, but doesn’t resolve the motivational issue of having to log in to the app, and in many cases, remember to enter data. And again, the app depends on accurate data being entered – most of us know about our clients reporting just what they believe we want to hear when it comes to self-reporting!

Finally, the reliability and validity of “digital medicine” is raising concerns across the health industry, as well as lack of scrutiny regarding potential risks of these devices or apps. Many of these apps and devices have not been subjected to regulatory scrutiny or independent evidence -based evaluation, as we would expect from any “new”
game-changing psychotherapeutic approach or medicaltreatment. And risks associated with the quality of information provided to the public, along with potential hazards to health, can be viewed in this article http://www.jmir.org/2014/9/e210

In the United States, a regulatory framework to handle digital medicine products is emerging with the release of the FDA’s Mobile Medical Apps Guidance in 2013 and an updated Guidance in 2015. This has been extended by the FDA to address what has been termed “clinical decision support” (CDS) software, a category of software that interfaces between patient data and clinical decision making. Similar trends are emerging in Europe, the United Kingdom, and Sweden.

To address the issue of validity and reliability of “mHealth” (mobile apps for health and wellbeingpromotion), Stoyanovet al (2015) have developed the MARS (Mobile App Rating Scale), a tool to help practitionersrate the degree that mHealth apps satisfy quality criteria. It can be downloaded from their publication here. Australia’s stance on this issue can be found at https://www.tga.gov.au/regulation-medical-software-and-mobile-medical-apps