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      Apps and Adolescents: A Systematic Review of Adolescents’ Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions

      , BSc (Hons), MSc, PhD 1 , , MB, ChB, FRCPCH 2 , , BSc (Hons), MSc, PhD 3 , , MBCHB, MSc, MRCPaed 4 , , BSc, MA, PhD 3 , , BA (Hons), MEd, FHEA 3 , , MBBS, MD, FRCP 5 , 6 , 7 , , BSc, PhD 5 , 6 , , BSc (Hons), MMedSc, PhD , 8

      (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications Inc.

      adolescents, asthma, mobile or tablet apps, arthritis, cancer, chronic disease or condition, diabetes, long-term condition, personal or self-management, review, young people

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          Abstract

          Background

          The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely.

          Objective

          To systematically review the literature on the effectiveness of mobile apps designed to support adolescents’ management of their physical chronic or long-term conditions.

          Methods

          We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools.

          Results

          The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants’ ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents’ personal management of their conditions.

          Conclusions

          A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps’ acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions.

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          Most cited references 78

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          Self-management education: history, definition, outcomes, and mechanisms.

          Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks--medical management, role management, and emotional management--and six self-management skills--problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
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            Practical statistics for medical researched

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              Cochrane Handbook for Systematic Reviews of Interventions

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                December 2015
                23 December 2015
                : 17
                : 12
                Affiliations
                1University of Manchester School of Psychological Sciences ManchesterUnited Kingdom
                2Alder Hey Children’s Foundation National Health Service (NHS) Foundation Trust Department of Rheumatology LiverpoolUnited Kingdom
                3University of Manchester School of Nursing, Midwifery, and Social Work ManchesterUnited Kingdom
                4Royal Manchester Children’s Hospital Department of Rheumatology ManchesterUnited Kingdom
                5Arthritis Research UK Centre for Epidemiology Centre for Musculoskeletal Research University of Manchester ManchesterUnited Kingdom
                6National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit Manchester Academic Health Science Centre University of Manchester ManchesterUnited Kingdom
                7The University of Manchester Faculty of Life Sciences ManchesterUnited Kingdom
                8University of Leeds LeedsUnited Kingdom
                Author notes
                Corresponding Author: Veronica Swallow v.m.swallow@ 123456leeds.ac.uk
                Article
                v17i12e287
                10.2196/jmir.5043
                4704897
                26701961
                ©Rabiya Majeed-Ariss, Eileen Baildam, Malcolm Campbell, Alice Chieng, Debbie Fallon, Andrew Hall, Janet E McDonagh, Simon R Stones, Wendy Thomson, Veronica Swallow. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.12.2015.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

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