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      Availability, readability, and content of privacy policies and terms of agreements of mental health apps

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          Abstract

          Objective

          To assess the availability, readability, and privacy-related content of the privacy policies and terms of agreement of mental health apps available through popular digital stores.

          Materials and methods

          Popular smartphone app stores were searched using combinations of keywords “track” and “mood” and their synonyms. The first 100 apps from each search were evaluated for inclusion and exclusion criteria. Apps were assessed for availability of a privacy policy (PP) and terms of agreement (ToA) and if available, these documents were evaluated for both content and readability.

          Results

          Most of the apps collected in the sample did not include a PP or ToA. PPs could be accessed for 18% of iOS apps and 4% of Android apps; whereas ToAs were available for 15% of iOS and 3% of Android apps. Many PPs stated that users' information may be shared with third parties (71% iOS, 46% Android).

          Discussion

          Results demonstrate that information collection is occurring with the majority of apps that allow users to track the status of their mental health. Most of the apps collected in the initial sample did not include a PP or ToA despite this being a requirement by the store. The majority of PPs and ToAs that were evaluated are written at a post-secondary reading level and disclose that extensive data collection is occurring.

          Conclusion

          Our findings raise concerns about consent, transparency, and data sharing associated with mental health apps and highlight the importance of improved regulation in the mobile app environment.

          Highlights

          • Privacy policies and terms of agreement of mental health apps were analyzed for availability, content and readability.

          • Most mental health tracking apps did not include a PP or ToA.

          • A majority of PPs stated that users’ information may be shared with third parties.

          • The readability of mental health apps PPs and ToAs is too difficult for the general population.

          • Findings raise concerns about consent, transparency, and data sharing associated with mental health apps.

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          Most cited references18

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          mHealth for mental health: Integrating smartphone technology in behavioral healthcare.

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            Harnessing Context Sensing to Develop a Mobile Intervention for Depression

            Background Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder. Objective The purpose of this study was to investigate the technical feasibility, functional reliability, and patient satisfaction with Mobilyze!, a mobile phone- and Internet-based intervention including ecological momentary intervention and context sensing. Methods We developed a mobile phone application and supporting architecture, in which machine learning models (ie, learners) predicted patients’ mood, emotions, cognitive/motivational states, activities, environmental context, and social context based on at least 38 concurrent phone sensor values (eg, global positioning system, ambient light, recent calls). The website included feedback graphs illustrating correlations between patients’ self-reported states, as well as didactics and tools teaching patients behavioral activation concepts. Brief telephone calls and emails with a clinician were used to promote adherence. We enrolled 8 adults with major depressive disorder in a single-arm pilot study to receive Mobilyze! and complete clinical assessments for 8 weeks. Results Promising accuracy rates (60% to 91%) were achieved by learners predicting categorical contextual states (eg, location). For states rated on scales (eg, mood), predictive capability was poor. Participants were satisfied with the phone application and improved significantly on self-reported depressive symptoms (betaweek = –.82, P < .001, per-protocol Cohen d = 3.43) and interview measures of depressive symptoms (betaweek = –.81, P < .001, per-protocol Cohen d = 3.55). Participants also became less likely to meet criteria for major depressive disorder diagnosis (bweek = –.65, P = .03, per-protocol remission rate = 85.71%). Comorbid anxiety symptoms also decreased (betaweek = –.71, P < .001, per-protocol Cohen d = 2.58). Conclusions Mobilyze! is a scalable, feasible intervention with preliminary evidence of efficacy. To our knowledge, it is the first ecological momentary intervention for unipolar depression, as well as one of the first attempts to use context sensing to identify mental health-related states. Several lessons learned regarding technical functionality, data mining, and software development process are discussed. Trial Registration Clinicaltrials.gov NCT01107041; http://clinicaltrials.gov/ct2/show/NCT01107041 (Archived by WebCite at http://www.webcitation.org/60CVjPH0n)
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              Mobile medical and health apps: state of the art, concerns, regulatory control and certification

              This paper examines the state of the art in mobile clinical and health-related apps. A 2012 estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals and consumers continue to express concerns about the quality of many apps, calling for some form of app regulatory control or certification to be put in place. We describe the range of apps on offer as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps that have been conducted to date, covering a range of clinical disciplines and topics. Our survey includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps. We discuss the concept of ‘apps as a medical device’ and the relevant regulatory controls that apply in USA and Europe, offering examples of apps that have been formally approved using these mechanisms. We describe the online Health Apps Library run by the National Health Service in England and the calls for a vetted medical and health app store. We discuss the ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical device’. These ingredients cover app content quality, usability, the need to match apps to consumers’ general and health literacy levels, device connectivity standards (for apps that connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy. ‘Happtique Health App Certification Program’ (HACP), a voluntary app certification scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many “similar” quality benchmarking tools and codes of conduct for information publishers were proposed to appraise and rate online medical and health information. It is probably impossible to rate and police every app on offer today, much like in those early days of the Web, when people quickly realised the same regarding informational Web pages. The best first line of defence was, is, and will always be to educate consumers regarding the potentially harmful content of (some) apps.
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                Author and article information

                Contributors
                Journal
                Internet Interv
                Internet Interv
                Internet Interventions
                Elsevier
                2214-7829
                06 March 2019
                September 2019
                06 March 2019
                : 17
                : 100243
                Affiliations
                [a ]Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
                [b ]University of Ottawa Centre for Health Law, Policy and Ethics, Common Law Section, Faculty of Law, University of Ottawa, 57 Louis Pasteur (Fauteux Hall), Ottawa, ON K1N 6N5, Canada
                Author notes
                [* ]Corresponding author at: BC Children's and Women's Hospital, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada. jrobilla@ 123456mail.ubc.ca
                Article
                S2214-7829(18)30016-2 100243
                10.1016/j.invent.2019.100243
                6430038
                30949436
                751d0fac-1f77-42a8-abdc-9f0de6ab1ef7
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 2 March 2018
                : 18 February 2019
                Categories
                Article

                apps,mental health,smartphone,mobile health,privacy
                apps, mental health, smartphone, mobile health, privacy

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