JMIR Publications

ABSTRACT

Background:

The digitization of healthcare has also led to a steady increase in the adoption and use of mHealth apps. With the aim of fully realizing the benefits of mHealth apps, Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. While numerous opportunities are known about how mHealth apps can improve patient health and make healthcare more efficient, not as much is known about the problems and barriers that stand in the way of optimal usage.

Objective:

This scoping review aims to map and categorize the evidence on problems and barriers related to the use of mHealth apps.

Methods:

Systematic searches were conducted in MEDLINE, EMBASE, and PsycINFO. Additional searches were conducted on JMIR and on websites of relevant international organizations. Inclusion criteria were: Publications that (1) dealing with apps corresponding to those approved in the German healthcare system, (2) addressing problems and barriers related to the usage of mHealth apps and (3) were published between January 1, 2015 and June 8, 2021. Study selection was performed by two reviewers. The manuscript was drafted according to the PRISMA extension for scoping reviews (PRISMA-ScR). The analysis of the included publications and the categorization of problems and hurdles were performed using MAXQDA.

Results:

The search identified 1479 publications. Thereof, 21 met inclusion criteria. Further eight publications were included from the focused search. Identified publications were analyzed for problems and barriers studied, which were classified into ten categories ('validity', 'usability', 'technology', 'use and adherence', 'data privacy and data security', 'patient-physician relationship', 'knowledge and skills', 'individuality', 'implementation', 'costs'). The most frequently mentioned categories were use and adherence (e.g., incorporating the app into daily life or dropouts from use) (n=22) and usability (e.g., ease of use, design) (n=19).

Conclusions:

The search identified various problems and barriers in the context of mHealth apps. While problems at the app level (such as usability) are studied frequently, problems at system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers as well as policy-makers should have a special focus on this issue to identify needs for quality assurance.