JMIR Publications

ABSTRACT

Background:

Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Asthma mobile health (mHealth) apps are widely available and represent a potential tool for assisting with asthma self-management. Few studies have conducted a systematic evaluation of asthma mobile apps for quality and functionality, and none have systematically assessed these apps for their content alignment with international best practice guidelines.

Objective:

To conduct a systematic search and evaluation of current mHealth apps for their functionality, quality and consistency with best practice guidelines.

Methods:

The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. A checklist was developed from these recommendations and a modified previously developed asthma app assessment framework. Two popular app stores were reviewed to screen and identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System and finally, the mHealth apps were assessed for their content alignment with the GINA guidelines, using our developed checklist.

Results:

Of the 422 apps initially identified, 53 were suitable for further analysis based on the inclusion/exclusion criteria. The mean number of behavioural change techniques for a single app was 3.26. The mean MARS for all reviewed apps was 3.05. 27 of 53 apps (51%) achieved a total MARS score of 3 or above. On average reviewed apps achieved 5.1 out of 11 functionalities from the IMS functionality scale (SD 2.79). The median number of functionalities identified was 5 (IQR 2-7). 22.2-31.8% of apps provided knowledge regarding asthma in the different domains. Skill training in peak flow meters, inhaler devices, recognising/responding to exacerbations and non-pharmacological asthma management were identified in 8 (17.4%), 12 (24.5%), 11 (28.2%) and 14 (31.1%) apps, respectively. 19 (37.3%) apps had the ability to track or record ‘asthma symptoms’, the most common recorded metric. The most frequently identified prompt/reminder was for taking preventer medications, available for 9 apps (20%). 5 (9.6%) apps provided an area for patients to store or enter their asthma action plan.

Conclusions:

Good quality asthma apps aligned with international best practice asthma guidelines are lacking. This study used a unique checklist developed from the GINA guidelines to evaluate the content alignment of asthma apps. Future app development should target the key features identified in this study as currently lacking, including use of asthma action plans, and deployment of behavioural change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases.