JMIR Publications

ABSTRACT

Background:

Quality of life of people living with chronic conditions is highly dependent on self-management behaviours. Mobile health applications (mHealth apps) could facilitate self-management and thus help improve population health. To achieve their potential, apps need to target specific behaviours with appropriate techniques that support change and do so in a way that allows users to understand and act upon the content they interact with.

Objective:

We identified chronic conditions self-management apps available in France and examined what target behaviours (TBs) and behaviour change techniques (BCTs) they include, what is their level of understandability and actionability, and the associations between these characteristics.

Methods:

We extracted data on Google Play store “TOP” apps in the “Medicine” category or found through 12 popular terms (keywords) for the four most common chronic conditions groups (cardiovascular diseases, cancer, respiratory diseases and diabetes), along with apps identified through literature search. We selected and downloaded native Android apps available in French for the self-management of any chronic condition in one of the four groups and extracted background characteristics (e.g. stars, number of ratings), coded presence of TBs, BCTs using the Behaviour Change Taxonomy v1 (BCTv1), and understandability and actionability using the Patient Education Material Assessment Tool for audiovisual materials (PEMAT-A/V). We performed descriptive statistics and bivariate statistical tests.

Results:

Forty-four distinct native apps were available for download in France and in French, 39 (88.6%) found via Google Play store and 5 (11.4%) via literature search. Nineteen (43.2%) apps were for diabetes, 10 for cardiovascular diseases (22.72%), 8 for more than one condition in the 4 groups (18.8%), 6 for respiratory diseases (13.63%), and 1 for cancer. Median number of TBs per app was 2 (range 0 - 7) and of BCTs per app was 3 (range 0 - 12). Most common BCT was “Self-monitoring of outcome(s) of behaviour” (31 apps), while most common TB was “Tracking symptoms” (30 apps). Median level of understandability was 42% and actionability 0%. Apps with more TBs and more BCTs were also more understandable (rho= 0.31, P = .041; rho= 0.35, P = .021), but not significantly more actionable (rho= 0.24, P = .123; rho= 0.29, P = .054).

Conclusions:

These apps target few behaviours and include few BCTs, limiting their potential for behavior change. While content is moderately understandable, clear instructions on when and how to act are uncommon. Developers need to work closely with health professionals, users and behavior change experts to improve content and format to better support patients to cope with chronic conditions. Developers may use these criteria for assessing content and format to guide app development and evaluation of app performance.