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Hyzy M, Bond R, Mulvenna M, Bai L, Frey AL, Carracedo JM, Daly R, Leigh S. Don't judge a book or health app by its cover: User ratings and downloads are not linked to quality. PLoS One 2024; 19:e0298977. [PMID: 38437233 PMCID: PMC10911617 DOI: 10.1371/journal.pone.0298977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse the relationship between health app quality with user ratings and the number of downloads of corresponding health apps. MATERIALS AND METHODS Utilising a dataset of 881 Android-based health apps, assessed via the 300-point objective Organisation for the Review of Care and Health Applications (ORCHA) assessment tool, we explored whether subjective user-level indicators of quality (user ratings and downloads) correlate with objective quality scores in the domains of user experience, data privacy and professional/clinical assurance. For this purpose, we applied spearman correlation and multiple linear regression models. RESULTS For user experience, professional/clinical assurance and data privacy scores, all models had very low adjusted R squared values (< .02). Suggesting that there is no meaningful link between subjective user ratings or the number of health app downloads and objective quality measures. Spearman correlations suggested that prior downloads only had a very weak positive correlation with user experience scores (Spearman = .084, p = .012) and data privacy scores (Spearman = .088, p = .009). There was a very weak negative correlation between downloads and professional/clinical assurance score (Spearman = -.081, p = .016). Additionally, user ratings demonstrated a very weak correlation with no statistically significant correlations observed between user ratings and the scores (all p > 0.05). For ORCHA scores multiple linear regression had adjusted R-squared = -.002. CONCLUSION This study highlights that widely available proxies which users may perceive to signify the quality of health apps, namely user ratings and downloads, are inaccurate predictors for estimating quality. This indicates the need for wider use of quality assurance methodologies which can accurately determine the quality, safety, and compliance of health apps. Findings suggest more should be done to enable users to recognise high-quality health apps, including digital health literacy training and the provision of nationally endorsed "libraries".
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Affiliation(s)
- Maciej Hyzy
- School of Computing, Ulster University, Belfast, United Kingdom
- ORCHA, Sci-Tech Daresbury, Violet V2, Daresbury, United Kingdom
| | - Raymond Bond
- School of Computing, Ulster University, Belfast, United Kingdom
| | | | - Lu Bai
- School of Electronics, Electrical Engineering and Computer Science, Queen’s University Belfast, Belfast, United Kingdom
| | - Anna-Lena Frey
- ORCHA, Sci-Tech Daresbury, Violet V2, Daresbury, United Kingdom
| | | | - Robert Daly
- ORCHA, Sci-Tech Daresbury, Violet V2, Daresbury, United Kingdom
| | - Simon Leigh
- ORCHA, Sci-Tech Daresbury, Violet V2, Daresbury, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Hyzy M, Bond R, Mulvenna M, Bai L, Dix A, Daly R, Frey AL, Leigh S. Quality of Digital Health Interventions Across Different Health Care Domains: Secondary Data Analysis Study. JMIR Mhealth Uhealth 2023; 11:e47043. [PMID: 37995121 PMCID: PMC10704310 DOI: 10.2196/47043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND There are more than 350,000 digital health interventions (DHIs) in the app stores. To ensure that they are effective and safe to use, they should be assessed for compliance with best practice standards. OBJECTIVE The objective of this paper was to examine and compare the compliance of DHIs with best practice standards and adherence to user experience (UX), professional and clinical assurance (PCA), and data privacy (DP). METHODS We collected assessment data from 1574 DHIs using the Organisation for the Review of Care and Health Apps Baseline Review (OBR) assessment tool. As part of the assessment, each DHI received a score out of 100 for each of the abovementioned areas (ie, UX, PCA, and DP). These 3 OBR scores are combined to make up the overall ORCHA score (a proxy for quality). Inferential statistics, probability distributions, Kruskal-Wallis, Wilcoxon rank sum test, Cliff delta, and Dunn tests were used to conduct the data analysis. RESULTS We found that 57.3% (902/1574) of the DHIs had an Organisation for the Review of Care and Health Apps (ORCHA) score below the threshold of 65. The overall median OBR score (ORCHA score) for all DHIs was 61.5 (IQR 51.0-73.0) out of 100. A total of 46.2% (12/26) of DHI's health care domains had a median equal to or above the ORCHA threshold score of 65. For the 3 assessment areas (UX, DP, and PCA), DHIs scored the highest for the UX assessment 75.2 (IQR 70.0-79.6), followed by DP 65.1 (IQR 55.0-73.4) and PCA 49.6 (IQR 31.9-76.1). UX scores had the least variance (SD 13.9), while PCA scores had the most (SD 24.8). Respiratory and urology DHIs were consistently highly ranked in the National Institute for Health and Care Excellence Evidence Standards Framework tiers B and C based on their ORCHA score. CONCLUSIONS There is a high level of variability in the ORCHA scores of DHIs across different health care domains. This suggests that there is an urgent need to improve compliance with best practices in some health care areas. Possible explanations for the observed differences might include varied market maturity and commercial interests within the different health care domains. More investment to support the development of higher-quality DHIs in areas such as ophthalmology, allergy, women's health, sexual health, and dental care may be needed.
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Affiliation(s)
- Maciej Hyzy
- School of Computing, Ulster University, Belfast, United Kingdom
| | - Raymond Bond
- School of Computing, Ulster University, Belfast, United Kingdom
| | | | - Lu Bai
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, United Kingdom
| | - Alan Dix
- Swansea University, Swansea, United Kingdom
| | - Robert Daly
- Organisation for the Review of Care and Health Apps (ORCHA), Daresbury, United Kingdom
| | - Anna-Lena Frey
- Organisation for the Review of Care and Health Apps (ORCHA), Daresbury, United Kingdom
| | - Simon Leigh
- Organisation for the Review of Care and Health Apps (ORCHA), Daresbury, United Kingdom
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Lin X, Martinengo L, Jabir AI, Ho AHY, Car J, Atun R, Tudor Car L. Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps. J Med Internet Res 2023; 25:e45984. [PMID: 37463036 PMCID: PMC10394504 DOI: 10.2196/45984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health. OBJECTIVE This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. METHODS The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. RESULTS We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. CONCLUSIONS Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.
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Affiliation(s)
- Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Hulme J. Staphylococcus Infection: Relapsing Atopic Dermatitis and Microbial Restoration. Antibiotics (Basel) 2023; 12:antibiotics12020222. [PMID: 36830133 PMCID: PMC9952585 DOI: 10.3390/antibiotics12020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Atopic Dermatitis (AD) skin is susceptible to Staphylococcus aureus (SA) infection, potentially exposing it to a plethora of toxins and virulent determinants, including Panton-Valentine leukocidin (PVL) (α-hemolysin (Hla) and phenol-soluble modulins (PSMs)), and superantigens. Depending on the degree of infection (superficial or invasive), clinical treatments may encompass permanganate (aq) and bleach solutions coupled with intravenous/oral antibiotics such as amoxicillin, vancomycin, doxycycline, clindamycin, daptomycin, telavancin, linezolid, or tigecycline. However, when the skin is significantly traumatized (sheathing of epidermal sections), an SA infection can rapidly ensue, impairing the immune system, and inducing local and systemic AD presentations in susceptible areas. Furthermore, when AD presents systemically, desensitization can be long (years) and intertwined with periods of relapse. In such circumstances, the identification of triggers (stress or infection) and severity of the flare need careful monitoring (preferably in real-time) so that tailored treatments targeting the underlying pathological mechanisms (SA toxins, elevated immunoglobulins, impaired healing) can be modified, permitting rapid resolution of symptoms.
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Affiliation(s)
- John Hulme
- Gachon Bio-Nano Institute, Gachon University, Seongnam-si 461-701, Republic of Korea
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5
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Usefulness of Smartphones in Dermatology: A US-Based Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063553. [PMID: 35329240 PMCID: PMC8949477 DOI: 10.3390/ijerph19063553] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022]
Abstract
(1) Background: As smartphones have become more widely used, they have become an appealing tool for health-related functions. For dermatology alone, hundreds of applications (apps) are available to download for both patients and providers. (2) Methods: The Google Play Store and Apple App Store were searched from the United States using dermatology-related terms. Apps were categorized based on description, and the number of reviews, download cost, target audience, and use of AI were recorded. The top apps from each category by number of reviews were reported. Additionally, literature on the benefits and limitations of using smartphones for dermatology were reviewed. (3) Results: A total of 632 apps were included in the study: 395 (62.5%) were marketed towards patients, 203 (32.1%) towards providers, and 34 (5.4%) towards both; 265 (41.9%) were available only on the Google Play Store, 146 (23.1%) only on the Apple App Store, and 221 (35.0%) were available on both; and 595 (94.1%) were free to download and 37 (5.9%) had a cost to download, ranging from USD 0.99 to USD 349.99 (median USD 37.49). A total of 99 apps (15.7%) reported the use of artificial intelligence. (4) Conclusions: Although there are many benefits of using smartphones for dermatology, lack of regulation and high-quality evidence supporting the efficacy and accuracy of apps hinders their potential.
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Martinengo L, Stona AC, Tudor Car L, Lee J, Griva K, Car J. Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines. J Med Internet Res 2022; 24:e28942. [PMID: 35262489 PMCID: PMC8943550 DOI: 10.2196/28942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/08/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. OBJECTIVE The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. METHODS A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. RESULTS The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non-evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user's support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. CONCLUSIONS Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non-evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential.
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Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Anne-Claire Stona
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jimmy Lee
- Department of Psychosis & North Region, Institute of Mental Health, Singapore, Singapore.,Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJ. Psychological and educational interventions for managing eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd014932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi Singleton
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew Hodder
- Department of Dermatology; Royal Cornwall Hospitals NHS Trust; Truro UK
- Department of Dermatology; University Hospitals Dorset; Christchurch UK
| | - Dwayne Boyers
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Orouba Almilaji
- Department of Medical Science and Public Health; Bournemouth University; Bournemouth UK
| | - Vanessa Heaslip
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme; Cardiff and Vale University Health Board & Cardiff University; Cardiff UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- National Heart & Lung Institute, Section of Inflammation and Repair; Imperial College London; London UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | | | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK
| | - Steven J Ersser
- Department of Nursing Science; Bournemouth University; Bournemouth UK
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8
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Martinengo L, Stona AC, Griva K, Dazzan P, Pariante CM, von Wangenheim F, Car J. Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence. J Med Internet Res 2021; 23:e27619. [PMID: 34328431 PMCID: PMC8367167 DOI: 10.2196/27619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. Objective This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. Methods We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. Results The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19–related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. Conclusions Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users’ data security.
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Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Anne-Claire Stona
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Carmine Maria Pariante
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Florian von Wangenheim
- Professor of Technology Marketing, Department of Management, Technology & Economics, ETH Zurich, Zurich, Switzerland
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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9
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Maintz L, Bieber T, Bissonnette R, Jack C. Measuring Atopic Dermatitis Disease Severity: The Potential for Electronic Tools to Benefit Clinical Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1473-1486.e2. [PMID: 33838840 DOI: 10.1016/j.jaip.2021.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
Severity of atopic dermatitis (AD) correlates with impact on health-related quality of life (HRQoL), work productivity, and burden on health systems. Tools to measure severity inform regulatory approval, drug access, and value- or measurement-based care. A core set of instruments for measuring AD has been established. Clinician-reported tools are divided broadly into multi-item global estimates or precise calculators that also weigh affected corporeal surfaces. Increasingly, subjective patient-reported outcomes are valued, with the potential to capture vast amounts of health-related data. Patient-reported outcomes can be disease-agnostic, skin-related, or AD-specific, and evaluate global disease, itch severity, long-term control, or overall HRQoL. Patient-reported outcomes are expansive in number; therefore, item banks and adaptive digital user interfaces will be increasingly needed, along with capacity to store and analyze data. Technologies for AD include tools for communication, severity assessment, or data exchange, as well as electronic health records (EHRs). For clinicians, a limited number of applications exist, with relatively poor interoperability with EHRs to date. For patients, a growing number of mobile health (mHealth) applications exhibit variable compliance with international guidelines for self-management. Data privacy and information security governance are key considerations in the development of information technologies for AD. Integrated and streamlined digital operational processes for disease measurements may build capacity for high value and efficient care of patients with AD across the globe.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg Campus 1, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg Campus 1, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | | | - Carolyn Jack
- Innovaderm Research, Montréal, QC, Canada; Division of Dermatology, Department of Medicine, McGill University, Montréal, QC, Canada; The Research Institute of the McGill University Health Center, Montréal, QC, Canada.
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10
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Hurault G, Delorieux V, Kim YM, Ahn K, Williams HC, Tanaka RJ. Impact of environmental factors in predicting daily severity scores of atopic dermatitis. Clin Transl Allergy 2021; 11:e12019. [PMID: 33949134 PMCID: PMC8099209 DOI: 10.1002/clt2.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 20% of children worldwide. Environmental factors including weather and air pollutants have been shown to be associated with AD symptoms. However, the time‐dependent nature of such a relationship has not been adequately investigated. This paper aims to assess whether real‐time data on weather and air pollutants can make short‐term prediction of AD severity scores. Methods Using longitudinal data from a published panel study of 177 paediatric patients followed up daily for 17 months, we developed a statistical machine learning model to predict daily AD severity scores for individual study participants. Exposures consisted of daily meteorological variables and concentrations of air pollutants, and outcomes were daily recordings of scores for six AD signs. We developed a mixed‐effect autoregressive ordinal logistic regression model, validated it in a forward‐chaining setting and evaluated the effects of the environmental factors on the predictive performance. Results Our model successfully made daily prediction of the AD severity scores, and the predictive performance was not improved by the addition of measured environmental factors. Potential short‐term influence of environmental exposures on daily AD severity scores was outweighed by the underlying persistence of preceding scores. Conclusions Our data does not offer enough evidence to support a claim that weather or air pollutants can make short‐term prediction of AD signs. Inferences about the magnitude of the effect of environmental factors on AD severity scores require consideration of their time‐dependent dynamic nature.
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Affiliation(s)
- Guillem Hurault
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Young-Min Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Environmental Health Centre for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Environmental Health Centre for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Reiko J Tanaka
- Department of Bioengineering, Imperial College London, London, UK
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11
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Xu X, Griva K, Koh M, Lum E, Tan WS, Thng S, Car J. Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design. JMIR Mhealth Uhealth 2020; 8:e16898. [PMID: 33118949 PMCID: PMC7661237 DOI: 10.2196/16898] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 01/27/2023] Open
Abstract
Background Smartphone apps could support patients and caregivers in disease self-management. However, as patients’ experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers’ and HCPs’ challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development.
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Affiliation(s)
- Xiaomeng Xu
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Woan Shin Tan
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
| | - Steven Thng
- Skin Research Institute of Singapore, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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12
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Blum A, Bosch S, Haenssle HA, Fink C, Hofmann-Wellenhof R, Zalaudek I, Kittler H, Tschandl P. [Artificial intelligence and smartphone program applications (Apps) : Relevance for dermatological practice]. Hautarzt 2020; 71:691-698. [PMID: 32720165 DOI: 10.1007/s00105-020-04658-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI) With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.
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Affiliation(s)
- A Blum
- Hautarzt- und Lehrpraxis, Augustinerplatz 7, 78462, Konstanz, Deutschland.
| | - S Bosch
- Hautarztpraxis, Ludwigsburg, Deutschland
| | - H A Haenssle
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - C Fink
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - R Hofmann-Wellenhof
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Graz, Österreich
| | - I Zalaudek
- Dermatology Clinic, University Hospital of Trieste, Hospital Maggiore, Trieste, Italien
| | - H Kittler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - P Tschandl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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13
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A systematic review into the assessment of medical apps: motivations, challenges, recommendations and methodological aspect. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00451-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Ali FR, Al-Niaimi F. How dermatology will change in the post-COVID-19 ('POST-CORONA') era. Clin Exp Dermatol 2020; 45:764-765. [PMID: 32394512 PMCID: PMC9213899 DOI: 10.1111/ced.14280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/01/2022]
Affiliation(s)
- F R Ali
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Vernova Healthcare Community Interest Company, Macclesfield, Cheshire, UK
| | - F Al-Niaimi
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Aalborg University Hospital, Aalborg, Denmark
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15
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Huang Z, Lum E, Car J. Medication Management Apps for Diabetes: Systematic Assessment of the Transparency and Reliability of Health Information Dissemination. JMIR Mhealth Uhealth 2020; 8:e15364. [PMID: 32130163 PMCID: PMC7057820 DOI: 10.2196/15364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. OBJECTIVE This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. METHODS English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads). RESULTS A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer's email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads. CONCLUSIONS Gaps in the disclosure of the developer's qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps.
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Affiliation(s)
- Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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16
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Lum E, Jimenez G, Huang Z, Thai L, Car J. Appropriateness of action prompts for hypoglycaemia and hyperglycaemia in type 2 diabetes self-management apps. Diabetes Metab Res Rev 2020; 36:e3235. [PMID: 31721421 DOI: 10.1002/dmrr.3235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Control of blood glucose levels is needed not only to alleviate symptoms of hypoglycaemia and hyperglycaemia, but also to prevent or delay diabetes-related complications. Advice for glucose control is usually provided to patients by members of the health care team. However, many diabetes apps claim to enhance self-management of blood glucose by providing decision support to patients when an out-of-range blood glucose level is recorded. In this study, we investigated the appropriateness of action prompts provided by diabetes apps for hypoglycaemia and hyperglycaemia against evidence-based guidelines. METHODS We used methods previously reported to identify and select diabetes apps, which were downloaded and assessed against the American Diabetes Association (ADA) guidelines. Screenshots of action prompts corresponding to low or high out-of-range blood glucose values were subjected to content analysis. RESULTS Of 371 diabetes self-management apps evaluated, only 217 and 216 apps alerted patients about hypoglycaemia and hyperglycaemia, respectively. Of these, 20.7% (45/217) and 15.3% (33/216) also provided action prompts. We found 5.1% of apps (hypoglycaemia: 11/217; hyperglycaemia: 11/216) provided prompts that were either too general to be helpful or not aligned with ADA guidelines. Overall, only 17.9% (39/217) and 14.8% (32/216) provided appropriate action prompts for hypoglycaemia and hyperglycaemia, respectively. CONCLUSION Less than one fifth of apps provided evidence-based steps to guide patients through hypoglycaemia and hyperglycaemia. The majority of apps failed to provide just-in-time diabetes self-management education to prevent frequent or severe episodes of hypoglycaemia and hyperglycaemia. Our findings emphasize the need for better design and quality assurance of diabetes apps.
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Affiliation(s)
- Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Linh Thai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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17
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von Kobyletzki LB. Most eczema smartphone apps do not conform to clinical guidelines. Br J Dermatol 2020; 182:276. [PMID: 31943132 DOI: 10.1111/bjd.18792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Laura B von Kobyletzki
- Centre for Clinical Research, Lund University, SE-205 02, Malmö, Sweden.,Centre for Clinical Research, Örebro University, Örebro, Sweden
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