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      Mobile medical and health apps: state of the art, concerns, regulatory control and certification

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          Abstract

          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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          Most cited references 74

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          Behavior change interventions delivered by mobile telephone short-message service.

          The expansion and adoption of new methods of communication provide new opportunities for delivering health behavior change interventions. This paper reviews the current research examining mobile telephone short-message service (SMS) for delivering health behavior change interventions via text messages. This service has wide population reach, can be individually tailored, and allows instant delivery with asynchronous receipt, suggesting potential as a delivery channel for health behavior interventions. An electronic database search was conducted for studies published between January 1990 and March 2008. Studies were included in the review if they (1) evaluated an intervention delivered primarily via SMS, (2) assessed change in health behavior using pre-post assessment, and (3) were published in English in a peer-reviewed scientific journal. Of 33 studies identified, 14 met the inclusion criteria. Four of the 14 studies reviewed targeted preventive health behaviors (e.g., smoking cessation), and ten focused on clinical care (e.g., diabetes self-management). Positive behavior change outcomes were observed in 13 of the 14 reviewed studies. Intervention initiation (researcher or participant), SMS dialogue initiation, tailoring of SMS content, and interactivity were found to be important features of SMS-delivered interventions. Methodologic issues with current SMS research were also identified. This review suggests that SMS-delivered interventions have positive short-term behavioral outcomes. Further research is required to evaluate interventions for preventive health behaviors that incorporate features found to affect behavioral outcomes and participant acceptance. The quality of studies in this emerging field of research needs to improve to allow the full potential of this medium to be explored.
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            Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments.

            Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.
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              Health behavior models in the age of mobile interventions: are our theories up to the task?

              Mobile technologies are being used to deliver health behavior interventions. The study aims to determine how health behavior theories are applied to mobile interventions. This is a review of the theoretical basis and interactivity of mobile health behavior interventions. Many of the mobile health behavior interventions reviewed were predominately one way (i.e., mostly data input or informational output), but some have leveraged mobile technologies to provide just-in-time, interactive, and adaptive interventions. Most smoking and weight loss studies reported a theoretical basis for the mobile intervention, but most of the adherence and disease management studies did not. Mobile health behavior intervention development could benefit from greater application of health behavior theories. Current theories, however, appear inadequate to inform mobile intervention development as these interventions become more interactive and adaptive. Dynamic feedback system theories of health behavior can be developed utilizing longitudinal data from mobile devices and control systems engineering models.
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                Author and article information

                Journal
                Online J Public Health Inform
                Online J Public Health Inform
                OJPHI
                Online Journal of Public Health Informatics
                University of Illinois at Chicago Library
                1947-2579
                05 February 2014
                2014
                : 5
                : 3
                : 229
                Affiliations
                [1 ]Faculty of Health & Human Sciences, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK
                [2 ]Dermatology Residency Program, Mayo Clinic in Arizona, Scottsdale, AZ 85259, USA
                [3 ]Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
                [4 ]Klein Buendel, Inc, Golden, CO 80401, USA
                [5 ]Dermatology Service, Denver VA Medical Center, Denver, CO 80220, USA
                Author notes
                ojphi-05-e229
                10.5210/ojphi.v5i3.4814
                3959919
                This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics.
                Categories
                Research Article

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