Nursing Review talks to Sandra Ponen, a clinical pharmacist and medical writer who has been working on the App Library project for Health Navigator, about how health professionals can guide patients on whether an app will help them or not.
Access to health support is only a swipe or a tap away on a smartphone or tablet. Hundreds of thousands of health apps are now available, designed to help people track their health info, count carbohydrates, exercise more or drink less and provide information on their health conditions. The quality of apps can vary greatly, not only in design but also in the quality of advice – making some apps potentially dangerous.
Attempting to review the apps available is nearly impossible, but in 2016 the non-profit, consumer-focused Health Navigator website (www.healthnavigator.org.nz) launched a New Zealand-based online app library – with Ministry of Health support – to make it easier and safer for Kiwis to identify useful and relevant apps for the New Zealand setting.
It was never expected to be an easy task and to date about 80 reviews of free health apps – from alcohol tracking to stroke risk prediction and medication adherence to anxiety management – are now available. Many more app categories have yet to be reviewed and included in the library.
Keeping the patient’s own needs in mind
What should a nurse or health professional look for if they are considering ‘prescribing’ an app or helping a patient decide on a useful app for their condition?
Ponen points to Australian research, which indicates there are three main things to keep in mind when considering a health app: Is it credible and safe? Is it user-friendly? Is it appealing and engaging?
She believes health professionals, as experts in their field, definitely have a role in helping determine whether an app is credible and safe for patients or clients to use.
Research showing that the app works (i.e. changes lifestyle behaviours) would be a ‘nice to have’ in the credibility stakes, but Ponen says such trials are rare and difficult to carry out. It is more realistic to check if an app comes from a legitimate source and was developed using evidence-based methods or with health professional expertise (see app review checklist below).
If an app appears credible, health professionals can then go on to discuss with the patient whether it is easy to use and meets their needs. Also under consideration is whether the app is appealing and engaging enough for the patient to use regularly.
Ponen says health professionals also need to take into consideration the app’s target audience, as an app viewed as easy by a teenager may seem fiddly and confusing to a smartphone novice. And what is appealing and engaging to one person could appear childish and patronising to another.
Nurses and other health professionals need to keep in mind that the usability ‘tick lists’ of patients and health consumers might not match their own, says Ponen. For example, an app created by a university may have more clout with health professionals, but a quit-smoking game app developed by an ex-smoker might mean more to a patient struggling to quit.
Ponen points out that an app also should not be just a digital textbook or pamphlet – it can have features like video, pleasing graphics, interactive tools and charts and connect the user to social media and links to more learning resources.
The potential is there for prescribing credible, user-friendly and engaging apps that can make a difference to patients’ health and wellbeing.
You can access the Health Navigator list of peer-reviewed apps at www.healthnavigator.org.nz/app-library.
If you want to review an app yourself, below is a quick checklist to consider before supporting a patient in their choice of app.
IS IT CREDIBLE AND SAFE?
- Does the app come from a legitimate source? I.e. is it sponsored or developed by a reputable organisation/university/health provider ready to put its reputation on the line? Does it have a website with contact details?
- Is it suitable or relevant for New Zealanders? I.e. if it is an overseas app, are its recommendations in keeping with New Zealand practice; does it include options for metric measurements and does it mention medications that are available in New Zealand?
- Does the app make suggestions about changing medication or treatment plans without consultation with the person’s health professional?
- Does the app have clear privacy guidelines on how data shared via the app will be stored and used? Does the app ask for permission to access unrelated information that may be used for advertising or other commercial purposes?
IS IT USER-FRIENDLY?
- Is the layout simple, clear and well designed? Or cluttered and confusing? Is it easy and intuitive to learn how to use? Does it have long lags or technical bugs?
- Is the app’s language and information suitable for the target group your patient belongs to? If local, does it include Māori and other language options?
- How much data space will the app take up on a smartphone or tablet and/or how much mobile data will it require to run? Does it require the internet to use its core features? Does it have ongoing costs or charges?
- What are the reviews and ratings of the app on sites that you trust? (Keeping in mind a company in the US has been prosecuted for being paid to post fake comments on an app it was promoting.)
IS IT APPEALING and ENGAGING?
- Is the app visually attractive and appealing? Is it fun or entertaining? Does it use game strategies or appealing animations to keep you engaged?
- Is the app interactive? Does it provide feedback and options like medication reminders, data syncing, user control, data visualisation and exportation? Or is it more of a glorified information pamphlet?
- How likely is it that the app may engage and motivate the user to change their health behaviour or attitudes or increase their knowledge or improve/maintain the management of their health condition?
Checklist source resources:
- Health Navigator ‘How to choose a health app’ www.healthnavigator.org.nz/app-library/h/how-to-choose-a-health-app
- STOYANOV et al. (2015) Mobile App Rating Scale: A new tool for assessing the quality of Health Mobile Apps. JMIR Mhealth Uhealth 3 (1).
- Mobile App Rating Scale (MARS) App Review Guideline, Queensland University of Technology’s Institute of Health & Biomedical Innovation.
Do you want to help?
You can help Health Navigator build its online app library by emailing firstname.lastname@example.org with:
- apps that you are currently recommending to patients and the reasons why
- an offer to become a peer reviewer of future health apps.