Dataset Information

Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review.

ABSTRACT:

Background

The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual's burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively.

Objective

The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression.

Methods

We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app's website, information on the app's website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed.

Results

None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms.

Conclusions

Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps.

SUBMITTER: Teepe GW

PROVIDER: S-EPMC8512178 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. OBJECTIVE:This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. METHODS:A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. RESULTS:Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy. CONCLUSIONS:The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious mental health apps.

Project description:BackgroundIt is estimated that 23% of adults and 55% of older adults do not meet the recommended levels of physical activity. Thus, improving the levels of physical activity is of paramount importance, but it requires the use of low-cost resources that facilitate universal access without depleting the health system. The high number of apps available constitutes an opportunity, but it also makes it quite difficult for the layperson to select the most appropriate app. Furthermore, the information available in the app stores is often insufficient, lacks quality, and is not evidence based, and the systematic reviews fail to assess app quality using standardized and validated instruments.ObjectiveThe objective of this study was to systematically assess the features, content, and quality of the most popular apps that can be used to measure and, potentially, promote physical activity.MethodsSystematic searches were conducted on Apple App Store, Google Play, and Windows Phone Store between December 2017 and January 2018. Apps were included if their primary objective was to assess the aspects of physical activity, if they had a user rating of at least 4, if their number of ratings was ?100, and if they were free. Apps meeting these criteria were independently assessed by two reviewers regarding their general and technical information, aspects of physical activity, presence of behavioral change techniques, and quality. Data were analyzed using means and SDs or frequencies and percentages.ResultsOf 51 apps included, none specified the age of the target group and only one mentioned the involvement of health professionals. Most apps offered the possibility to work in background (n=50) and allowed data sharing (n=40). Regarding physical activity, most apps measured steps and distance (n=11) or steps, distance, and time (n=17). Only 18 apps, all of which measured number of steps, followed the guidelines on recommendations for physical activity. On average, 5.5 (SD 1.8) behavioral change techniques were identified per app; the most frequently used techniques were "provide feedback on performance" (n=50) and "prompt self-monitoring of behavior" (n=50). The overall quality score was 3.88 (SD 0.34).ConclusionsAlthough the overall quality of the apps was moderate, the quality of their content, particularly the use of international guidelines on physical activity, should be improved. Additionally, a more in-depth assessment of apps should be performed before releasing them for public use, particularly regarding their reliability and validity.

Project description:BACKGROUND:In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health-related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence. OBJECTIVE:This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support. METHODS:First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection. RESULTS:We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study. CONCLUSIONS:Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness.

Project description:BACKGROUND:In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality is actually provided by apps for depression, or for whom they are intended. OBJECTIVE:This paper aimed to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns, to better inform the design of apps for depression. METHODS:We reviewed top-rated iPhone OS (iOS) and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data were gathered from the 2 marketplaces and through direct use of the apps. We report an in-depth analysis of app functionality, namely, screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review. Apps were included if they remained accessible at the moment of evaluation, were offered in mental health-relevant categories, received a review score greater than 4.0 out of 5.0 by more than 100 reviewers, and had depression as a primary target. RESULTS:The analysis revealed that a majority of apps specify the evidence base for their intervention (18/29, 62%), whereas a smaller proportion describes receiving clinical input into their design (12/29, 41%). All the selected apps are rated as suitable for children and adolescents on the marketplace, but 83% (24/29) do not provide a privacy policy consistent with their rating. The findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (24/29, 83%) either as a digitalized therapeutic intervention or as support for mood expression; tracking (19/29, 66%) of moods, thoughts, or behaviors for supporting the intervention; and screening (9/29, 31%) to inform the decision to use the app and its intervention. Some apps include overtly negative content. CONCLUSIONS:Currently available top-ranked apps for depression on the major marketplaces provide diverse functionality to benefit users across a range of age groups; however, guidelines and frameworks are still needed to ensure users' privacy and safety while using them. Suggestions include clearly defining the age of the target population and explicit disclosure of the sharing of users' sensitive data with third parties. In addition, we found an opportunity for apps to better leverage digital affordances for mitigating harm, for personalizing interventions, and for tracking multimodal content. The study further demonstrated the need to consider potential risks while using depression apps, including the use of nonvalidated screening tools, tracking negative moods or thinking patterns, and exposing users to negative emotional expression content.

Project description:BackgroundUsing a mobile app for self-management could make it easier for patients to get insight into their blood pressure patterns. However, little is known about the availability, quality, and features of mobile apps targeting blood pressure.ObjectiveThe goal of the research was to determine the availability, functionality, and quality of mobile apps that could be used for blood pressure monitoring purposes.MethodsA systematic app search was performed based on the standards for systematic reviews. We searched the Dutch official app stores for Android and iOS platforms using predefined keywords and included all English and Dutch mobile apps targeting blood pressure. Two independent assessors determined eligibility and quality of the apps using the 5-point Mobile App Rating Scale (MARS). Quality scores of the apps with and without 17 a priori selected characteristics were compared using independent sample t tests.ResultsA total of 184 apps (104 Android, 80 iOS) met the inclusion criteria. The mean overall MARS score was 2.63 (95% CI 2.55-2.71) for Android and 2.64 (95% CI 2.56-2.71) for iOS. The apps Bloeddruk (4.1) and AMICOMED BP (3.6) had the highest quality scores on the Android and iOS platforms, respectively. Of the app characteristics recorded, only pricing, in-app advertisements, and local data storage were not associated with the quality scores. In only 3.8% (7/184) of the apps, involvement of medical experts in its development was mentioned, whereas none of the apps was formally evaluated with results published in a peer-reviewed journal.ConclusionsThis study provides an overview of the best apps currently available in the app stores and important key features for self-management that can be used by health care providers and patients with hypertension to identify a suitable app targeting blood pressure monitoring. However, the majority of the apps targeting blood pressure monitoring were of poor quality. Therefore, it is important to involve medical experts in the developmental stage of health-related mobile apps to improve the quality of these apps.

Project description:BackgroundWomen are increasingly turning to mobile health platforms to receive health information and support in pregnancy, yet the content of these platforms vary. Although there is great potential to influence health behaviors, little research has assessed the quality of these platforms or their ability to change behavior. In recent years, validated tools to assess app quality have become available.ObjectiveTo identify and assess the quality and ongoing popularity of the top 10 freely available pregnancy apps in Australia using validated tools.MethodsA systematic search on app stores to identify apps was performed. A Google Play search used subject terms pregnancy, parenting, and childbirth; the iTunes search used alternative categories medical and health and fitness. The top 250 apps from each store were cross-referenced, and the top 100 found in both Google Play and iTunes were screened for eligibility. Apps that provided health information or advice for pregnancy were included. Excluded apps focused on nonhealth information (eg, baby names). The top 10 pregnancy apps were assessed using the Mobile App Rating Scale (MARS). A comparative analysis was conducted at 2 time points over 2 years to assess the ongoing popularity of the apps. The MARS score was compared to the download and star rating data collected from iTunes and Google Play in 2017 and 2019. Health behaviors including breastfeeding, healthy pregnancy weight, and maternal awareness of fetal movements were reviewed for apparent impact on the user's knowledge, attitudes, and behavior change intentions using the MARS perceived impact section and the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy.ResultsA total of 2052 free apps were screened for eligibility, 1397 were excluded, and 655 were reviewed and scored. The top 10 apps were selected using download numbers and star ratings. All 10 apps were suboptimal in quality, practicality, and functionality. It was not possible to identify a primary purpose for all apps, and there was overlap in purpose for many. The mean overall MARS app quality score across all 10 apps was 3.01 (range 1.97-4.40) in 2017 and 3.40 (range 2.27-4.44) in 2019. A minority of apps scored well for perceived impact on health behavior using the MARS tool. Using the CALO-RE 40 item taxonomy, the number of behavior change techniques used was low. The mean number of behavior change techniques for breastfeeding was 5 (range 2-11), for pregnancy weight was 4 (range 2-12), and for maternal awareness of fetal movements was 5 (range 2-8).ConclusionsThis review provides valuable information to clinicians and consumers about the quality of apps currently available for pregnancy in Australia. Consideration is needed regarding the regulation of information and the potential opportunity to incorporate behavior change techniques to improve maternal and fetal outcomes.

Project description:BackgroundThe wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets.ObjectiveThis study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety.MethodsThis systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps.ResultsIn the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E).ConclusionsThe psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps.

Project description:BackgroundThe importance of mobile health (mHealth) apps is growing. Independent of the technologies used, mHealth apps bring more functionality into the hands of users. In the health context, mHealth apps play an important role in providing information and services to patients, offering health care professionals ways to monitor vital parameters or consult patients remotely. The importance of confidentiality in health care and the opaqueness of transport security in apps make the latter an important research subject.ObjectiveThis study aimed to (1) identify relevant security concerns on the server side of mHealth apps, (2) test a subset of mHealth apps regarding their vulnerability to those concerns, and (3) compare the servers used by mHealth apps with servers used in all domains.MethodsServer security characteristics relevant to the security of mHealth apps were assessed, presented, and discussed. To evaluate servers, appropriate tools were selected. Apps from the Android and iOS app stores were selected and tested, and the results for functional and other backend servers were evaluated.ResultsThe 60 apps tested communicate with 823 servers. Of these, 291 were categorized as functional backend servers, and 44 (44/291, 15.1%) of these received a rating below the A range (A+, A, and A-) by Qualys SSL Labs. A chi-square test was conducted against the number of servers receiving such ratings from SSL Pulse by Qualys SSL Labs. It was found that the tested servers from mHealth apps received significantly fewer ratings below the A range (P<.001). The internationally available apps from the test set performed significantly better than those only available in the German stores (alpha=.05; P=.03). Of the 60 apps, 28 (28/60, 47%) were found using at least one functional backend server that received a rating below the A range from Qualys SSL Labs, endangering confidentiality, authenticity, and integrity of the data displayed. The number of apps that used at least one entirely unsecured connection was 20 (20/60, 33%) when communicating with functional backend servers. It was also found that a majority of apps used advertising, tracking, or external content provider servers. When looking at all nonfunctional backend servers, 48 (48/60, 80%) apps used at least one server that received a rating below the A range.ConclusionsThe results show that although servers in the mHealth domain perform significantly better regarding their security, there are still problems with the configuration of some. The most severe problems observed can expose patient communication with health care professionals, be exploited to display false or harmful information, or used to send data to an app facilitating further damage on the device. Following the recommendations for mHealth app developers, the most regularly observed security issues can be avoided or mitigated.

Project description:BackgroundMobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides.ObjectiveThe aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool.MethodsThe quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: "surgical apps", "surgical preferences", "surgeon preferences", "operating room", and "perioperative procedures". The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages.ResultsA total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%).ConclusionsScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices.