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How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment.

ABSTRACT: BACKGROUND:Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. OBJECTIVE:We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers' perceptions on apps' quality and usability. METHODS:We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. RESULTS:A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization's infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. CONCLUSIONS:The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies.

SUBMITTER: Zhao J

PROVIDER: S-EPMC5738546 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment.

Zhao Jing J Freeman Becky B Li Mu M

JMIR mHealth and uHealth 20171206 12

<h4>Background</h4>Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed.<h4>Objective</h4>We aimed to assess the quality of Chinese infant feeding apps us ...[more]

PMID: 29212627

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Project description:BACKGROUND:Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. OBJECTIVE:This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. METHODS:The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. RESULTS:A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps' engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. CONCLUSIONS:The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council's Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.

Project description:BackgroundThe number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required.ObjectiveThe purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians.MethodsBased on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords "breast cancer" in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively.ResultsThe initial search identified 1148 apps, 69 (6%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001).ConclusionsThe quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes.

Project description:BackgroundTinnitus is the perception of a sound without any outside source. It affects 6 million people in the United Kingdom. Sound therapy is a core component of many tinnitus management programs. Potential mechanisms of benefit include making tinnitus less noticeable, habituation, distracting attention from tinnitus, relaxation, and promoting neuroplastic changes within the brain. In recent years, there has been a substantial increase in the use of mobile technology. This provided an additional medium through which people with tinnitus can access different tinnitus management options, including sound therapy.ObjectiveThe aim of this study was to (1) generate the list of apps that people use for management of their tinnitus, (2) explore reasons for app use and nonuse, (3) perform quality assessment of the most cited apps, and (4) perform content analysis to explore and describe options and management techniques available in the most cited apps.MethodsA Web-based survey consisting of 33 open and closed questions captured (1) demographic information, information about tinnitus, and hearing loss and (2) mobile app-specific information about the motivation to use an app, the apps which respondents used for tinnitus, important factors when choosing an app, devices used to access apps, and reasons for not using apps. The quality of the most cited apps was assessed using the Mobile Apps Rating Scale (MARS). Content and features of the most cited apps were analyzed.ResultsData from 643 respondents were analyzed. The majority of respondents (482/643, 75.0%) had never used an app for management of tinnitus mainly because of lack of awareness (381/643, 59.3%). The list of the 55 apps that people use for their tinnitus was generated. These included apps that were developed specifically for the management of tinnitus; however, the majority of cited apps were developed for other problems (eg, sleep, depression or anxiety, and relaxation). Quality assessment of the 18 most popular apps using MARS resulted in a range of mean scores from 1.6 to 4.2 (out of 5). In line with the current model of tinnitus management, sound was the main focus of the majority of the apps. Other components included relaxation exercises, elements of cognitive behavioral therapy, information and education, and hypnosis.ConclusionsPeople used apps for the management of their tinnitus; however, this was done mostly as a self-help option, without conjunction with management provided by hearing health care professionals. Further research should consider the place for apps in tinnitus management (stand-alone self-management intervention vs part of the management by a hearing professional). As the content of the apps varies with respect to sound options, information, and management strategies, it seems that the choice of the best management app should be guided by individual patient's needs and preferences.

Project description:BACKGROUND:With the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed. OBJECTIVE:Our objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users' perspectives and experiences with mobile phone medication adherence apps. METHODS:We searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes. RESULTS:We identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features-specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability). CONCLUSIONS:A large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps.

Project description:BackgroundDespite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives.ObjectiveThis study aims to assess users' self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores-Apple App Store and Google Play Store.MethodsWe conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach.ResultsThe three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team.ConclusionsUsers generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment.

Project description:BackgroundAs the Chinese society ages and the concern for health and quality of life grows, the demand for care services in China is increasing. The widespread use of internet technology has greatly improved the convenience and efficiency of web-based services. As a result, the Chinese government has been implementing "Internet+Nursing Services" since 2019, with mobile apps being the primary tools for users to access these services. The quality of these apps is closely related to user experience and the smooth use of services.ObjectiveThis study aims to evaluate the functionality, services, and quality of "Internet+Nursing Service" apps; identify weaknesses; and provide suggestions for improving service programs and the research, development, improvement, and maintenance of similar apps.MethodsIn December 2022, two researchers searched for "Internet+Nursing Service" apps by applying the search criteria on the Kuchuan mobile app monitoring platform. After identifying the apps to be included based on ranking criteria, they collected information such as the app developer, app size, version number, number of downloads, user ratings, and number and names of services. Afterward, 5 trained researchers independently evaluated the quality of the apps by using the Chinese version of the user version of the Mobile App Rating Scale (uMARS-C). The total uMARS-C score was based on the average of the five evaluators' ratings.ResultsA total of 17 "Internet+Nursing Service" apps were included. Among these, 12 (71%) had been downloaded more than 10,000 times, 11 (65%) had user ratings of 4 or higher, the median app size was 62.67 (range 22.71-103; IQR 37.51-73.47) MB, 16 (94%) apps provided surgical wound dressing change services, 4 (24%) covered first-tier cities, and only 1 (6%) covered fourth-tier cities. The median total uMARS-C score was 3.88 (range 1.92-4.92; IQR 3.71-4.05), which did not correlate with app store user ratings (r=0.003; P=.99). The quality of most apps (11/17, 65%) was average. Most apps (12/17, 71%) were rated as "good" or above (≥4 points) in terms of information quality, layout, graphics, performance, and ease of use; however, the vast majority of apps were rated as "fair" or even "poor" (<4 points) in terms of credibility (14/17, 82%) and demand (16/17, 94%).Conclusions"Internet+Nursing Service" apps need to broaden their service coverage, increase service variety, and further optimize their service structure. The overall quality of these apps is generally poor. App developers should collaborate with medical professionals and communicate with target users before launching their products to ensure accurate content, complete functionality, and good operation that meets user needs.

Project description:BackgroundInfant feeding categories, often referred to as breastfeeding definitions, form the basis to describe infant feeding patterns; especially, breastfeeding duration and degree of breastfeeding exclusivity. Researchers use a variety of algorithms and no validated tool exists to measure feeding patterns for research purposes. The goal of this research project was to develop and test a tool to measure patterns of infant feeding for breastfeeding and lactation research.MethodsWe used a literature review, survey methods, and statistical analysis to develop and test this health measurement tool. The work was completed in three phases: 1) development of the tool; 2) assessment of content validity with a panel of experts; and 3) testing for inter-rater reliability by comparing the conclusions of 2 independent research assistants (RAs) and by comparing mothers' feeding diaries with the RAs' findings. For the third phase, an a priori analysis determined we needed to recruit 75 participants. Inclusion criteria were women who had given birth to a single healthy newborn, planned to breastfeed and were able to breastfeed freely, were able to read and write in English or French, were willing and able to maintain a weekly feeding diary for 6 weeks and to answer 6 English telephone questionnaires (twice within 24 hrs x 3 times over 6 months. To measure inter-rater reliability, we used intraclass correlation coefficient.ResultsTHE FINAL TOOL, THE FEEDCAT TOOL, CONTAINS TWO PARTS: 1) questions asked to determine what and how the baby was fed and 2) a chart to indicate the feeding category for each time point and recall period. We recruited 75 breastfeeding mothers to measure inter-rater reliability. Inter-rater reliability for classification of feeding categories by the two RAs and for agreement between the RAs' findings at 1 month and mothers' diaries at 4 weeks indicated excellent agreement.ConclusionWe produced a feeding categories tool that can be used by researchers to describe the type, amount, and mode of feeding, and we tested the tool for content validity and reliability. Researchers should consider The FeedCat Tool for lactation and research projects requiring data about infant feeding patterns.

Project description:BACKGROUND: Apps have been enthusiastically adopted by the general public. They are increasingly recognized by policy-makers as a potential medium for supporting self-management of long-term conditions. We assessed the degree to which current smartphone and tablet apps for people with asthma offer content and tools of appropriate quality to support asthma self-management. METHODS: We adapted systematic review methodology to the assessment of apps. We identified English-language asthma apps for all ages through a systematic search of official app stores. We systematically assessed app content using criteria derived from international guidelines and systematic review of strategies for asthma self-management. We covered three domains: comprehensiveness of asthma information, consistency of advice with evidence and compliance with health information best practice principles. RESULTS: We identified 103 apps for asthma in English, of which 56 were sources of information about the condition and 47 provided tools for the management of asthma. No apps offered both types of functionality. Only three information apps approached our definition of comprehensiveness of information about asthma. No apps provided advice on lay management of acute asthma that included details of appropriate reliever medication use. In 32 of 72 instances, apps made unequivocal recommendations about strategies for asthma control or prophylaxis that were unsupported by current evidence. Although 90% of apps stated a clear purpose, compliance with other best practice principles for health information was variable. Contact details were located for 55%, funding source for 18% and confidentiality policy for 17%. CONCLUSIONS: No apps for people with asthma combined reliable, comprehensive information about the condition with supportive tools for self-management. Healthcare professionals considering recommending apps to patients as part of asthma self-management should exercise caution, recognizing that some apps like calculators may be unsafe; that no current app will meet the need of every patient; and that ways of working must be adapted if apps are to be introduced, supported and sustained in routine care. Policy-makers need to consider the potential role for assurance mechanisms in relation to apps. There remains much to be done if apps are to find broad use in clinical practice; clinicians cannot recommend tools that are inaccurate, unsafe or lack an evidence base.

Project description:BackgroundMaternal feeding anxiety (FA) was prevalent during puerperium and might affect infant feeding practices. This study was aimed to investigate the FA status in Chinese postpartum women and its relationship with infant feeding practices (FPs).MethodsParticipants were from the Mother-Infant Cohort Study of China, in which the dietary and feeding practices, physical and psychiatric health for both mothers and infants were followed up from childbirth to next 2 years. In this study the maternal feeding anxiety (FA) status at 0-3 months postpartum was assessed by Li's Self-rating Feeding Anxiety Scale (SFAS). Infant feeding practices (FPs) at 0-3 months, including breastfeeding-related behaviors, responsive feeding and infant food refusal were investigated by self-designed questionnaire.ResultsIn total 456 mothers the average feeding anxiety scores (FAS) was 41.02 ± 8.02 (mean ± SD), and maternal FA prevalence were 61.4% (FAS>38) with severe FA being 8.6% (FAS>52) at 0-3 months postpartum. The FAS was related with infant FPs, and lower maternal FAS was significantly related with infant colostrum feeding (40.86 ± 8.02 vs 44.74 ± 11.33, P < 0.05), but higher FAS was related with bottle feeding (41.95 ± 8.28 vs 39.69 ± 7.92, P < 0.05). The mothers with severe feeding anxiety (FAS > 53) were more likely to feed infants with bottle (ORs, 95%CI: 2.41, 1.11 ~ 5.19). There were not significant association between FAS and exclusive breastfeeding and responsive feeding practices (P > 0.05). The higher FAS was associated with infant food refusal behaviors, the maternal scores whose infant "never", "rarely", "sometimes" and "often" spat out food when feeding were 39.86 ± 8.02, 41.47 ± 8.18, 41.36 ± 7.44 and 42.14 ± 12.03 increasingly (P > 0.05), and the FA prevalence was significantly different among groups (P < 0.05). The infants whose mother was identified as feeding anxiety were more likely to refuse opening the mouth when feeding (P < 0.05). Multivariate analysis indicated maternal FAS was positively related to infant bottle feeding (βi = 2.487, P < 0.05) and outdoor sunshine exposure practice (βi = 1.787, P < 0.05), and negatively related to household income level (βi = - 0.118, P < 0.05).ConclusionsMaternal postpartum feeding anxiety was associated with some infant feeding practices, including bottle feeding and infant food refusal behaviors.

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How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment.

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How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment.

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