JMIR Publications

ABSTRACT

Background:

Chronic stress is a risk factor for physical and mental well-being. Stress management interventions showed to be effective and stress management apps (SMA) might help to transfer strategies into every day life.

Objective:

This review aims to provide a comprehensive overview of the quality and characteristics of SMA to give potential users or health professionals an orientation when searching for SMA in the common app stores.

Methods:

SMA were identified with a systematic search in the European Google Play Store and Apple App store. SMA were screened and checked for inclusion criteria. General characteristics and quality were assessed by two independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the four dimensions 1) engagement, 2) functionality, 3) aesthetics, and 4) information. In addition, theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the five top-rated SMA were assessed and derived.

Results:

Of 5,650 identified apps 121 SMA were included. Frequently implemented strategies (also of the five top-rated SMA) were psychoeducation, breathing and mindfullness as well as the usage of monitoring and reminder functions. 92% (n = 111) of all SMA provided a privacy policy but only 36% (n = 44) of the apps required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14% (n = 17) of all SMA. The average quality of included apps was above the cut-off score 3.5 (M = 3.59, SD = 0.50). The MARS-G dimensions yielded values above this cut-off score (functionality: M = 4.14, SD = 0.47; aesthetics: M = 3.76, SD = 0.73) but also below (information, M = 3.42, SD = 0.46; engagement: M = 3.05, SD = 0.78). Most theory-based stress management strategies were regenerative stress management strategies. Evidence base for 11 SMA (9%) could be identified indicating significant group differences in several variables (e.g., stress or depressive symptoms) in favor of the SMA. 46 SMA (38%) were no longer available after a two-year period.

Conclusions:

Moderate information quality, scarce evidence base, constraints in data privacy and security features as well as the high volatility of SMA pose challenges for users, health professionals and researcher. However, due to scalability and the (few but) promising results regarding their effectiveness, SMA have a high potential to reach and help a broad audience. For a holistic stress management approach, SMA could benefit from a broader repertoire of strategies (such as more instrumental and mental stress management strategies). Common characteristics of SMA with top-rated quality could be used as orientation for potential users and health professionals, but due to the high volatility of SMA, enhanced evaluation frameworks are needed. Clinical Trial: Registered in the Open Science Framework (OSF) of the Center for Open Science (registration osf.io/9mkvq).