The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder

Abstract

BackgroundThe delivery of mobile health (mHealth) services is acceptable to mental health consumers. However, despite the benefits of accessibility, cost-effectiveness, anonymity, and ability to tailor content to individual needs, consumer engagement remains a hurdle for uptake and continued use. This may be unsurprising as few studies have examined app content from the consumer perspective or assessed consumer preferences for the content of apps for mental health management. An opportunity to examine consumer perspectives exists in using naturally generated data that is publically available in the Google Play and Apple app stores. Whereas commercial developers routinely use this data, to date there has been no in-depth evaluation within scientific research.ObjectiveThe aim of our study was to explore what consumers consider useful content for mental health management apps, identify unmet needs, and understand user expectations of mental health apps within the context of apps for bipolar disorder.MethodsPublically available English language consumer reviews of 48 apps for bipolar disorder were used as data, providing a total of 2173 reviews. Review text was coded and analyzed using a team approach to qualitative content analysis. Results were presented in 2 forms: (1) a quantitative summary of the 9 major and minor themes and (2) a qualitative synthesis of key thematic findings.ResultsThe majority of reviews were for symptom monitoring apps (87.94%, 1911/2173). The qualitative content analysis revealed 5 main themes: (1) laudatory talk, comments regarding the app’s benefits including helpfulness and successful design features (74.00% of reviews, 1608/2173); (2) unfavorable feedback, negative reviews largely concerning unmet needs, privacy and technical issues, and potential dangers of app use (25.54%, 555/2173); (3) conceptions of community, referring to both communities of users with mental ill-health accessed via the app and a community created among app users and developers (24.25%, 527/2173); (4) wishlist features, app features requested by users (17.53%, 381/2173); and (5) apps and therapy, app use within clinical care (10.58%, 230/2173). Four minor themes were also identified: (1) app cost, (2) privacy and data security, (3) comparisons with traditional monitoring, and (4) evidence-based mHealth.ConclusionsAlthough mostly positive, the proportion of reviews containing wishlist requests indicates consumer needs are not adequately addressed by currently available disorder management apps. Consumers value content that is helpful, supportive, and easy to use, and they are integrating apps into their health management and clinical care without necessarily considering the evidence-base or clinical effectiveness of the tool. User expectations regarding developer responsiveness to their needs has implications for community-based participatory research and integrated knowledge translation. However, this expectation is incompatible with current mHealth funding structures.

A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems

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“…However, participants were positive about the provision of DHIs to enhance user choice, provide an adjunct to existing options and reduce the number of face-to-face appointments required. A recent analysis of user reviews of apps for bipolar disorder highlighted that users had reported using these apps in conjunction with face-to-face care [52], whilst qualitative studies with staff and people experiencing severe mental health problems stressed the need for continued support during DHI engagement [49,51,[53][54][55]. Therefore, DHIs are seen by service users as a method to enhance face-to-face care, rather than replace existing support.…”

Mobile technology use and skills among individuals with fragile X syndrome: implications for healthcare decision making

“…A study examining the use of mobile technology among individuals with diabetes, for example, found improvements in self-rated wellness scores and several quality-of-care metrics (Bovbjerg et al 2017). Reviews of health care management apps for asthma (Tinschert et al 2017) and bipolar patients (Nicholas et al 2017) showed promise for monitoring symptoms and providing condition-specific information.…”

“…) and bipolar patients (Nicholas et al . ) showed promise for monitoring symptoms and providing condition‐specific information.…”

Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews (Preprint)

“…The apps analyzed were still available in their corresponding app stores and allowed the authors to compare results of our quality assessment. Indeed, while qualitative analyses of user reviews for disease-specific apps including for bipolardisorder and weight loss [17,18] have been previously published, target users' (patients') experiences with medication adherence apps have not been extensively studied. Previously, Stawarz et al in 2014 conducted a user review analysis of the top 50 reviews for 40 apps available only on the Android operating system [19].…”