Quality Principles of App Description Texts and Their Significance in Deciding to Use Health Apps as Assessed by Medical Students: Survey Study

Abstract

BackgroundCurrently, there are no binding requirements for manufacturers prescribing which information must be included in the app descriptions of health apps.ObjectiveThe aim of this study was to investigate how medical students perceive a selection of quality principles, intended for usage decisions in the app context, and establish whether the information presented in a sample of app descriptions is perceived as sufficient for facilitating an informed usage decision.MethodsA total of 123 students (mean age 24.2 years, SD 3.4) participating in a 6-week teaching module covering cardiology and pulmonology at the University of Göttingen (original enrollment 152 students, response rate 80.9%) were included. Students were asked to read 3 store description texts of cardiological or pneumological apps and initially assess whether the descriptions sufficed for a usage decision. Subsequently, they were queried on their perception of the relevance of 9 predefined quality principles, formulated for usage decisions. An appraisal of whether the app description texts contained sufficient information to satisfy these quality principles followed. By means of 20 guiding questions, participants were then asked to identify relevant information (or a lack thereof) within the descriptions. A reassessment of whether the description texts sufficed for making a usage decision ensued. A total of 343 complete datasets were obtained.ResultsA majority of the quality principles were described as “very important” and “important” for making a usage decision. When accessed via the predefined principles, students felt unable to identify sufficient information within the app descriptions in 68.81% (2124/3087) of cases. Notably, information regarding undesired effects (91.8%, 315/343), ethical soundness (90.1%, 309/343), measures taken to avert risks (89.2%, 306/343), conflicts of interest (88.3%, 303/343), and the location of data storage (87.8%, 301/343) was lacking. Following participants’ engagement with the quality principles, statistically significant changes in their assessment of whether the app descriptions sufficed for a usage decision can be seen—McNemar-Bowker test (3)=45.803919, P<.001, Cohen g=.295. In 34.1% (117/343) cases, the assessment was revised. About 3 quarters of changed assessments were seen more critically (76.9%, 90/117). Although, initially, 70% (240/343) had been considered “sufficient,” this rate was reduced to 54.2% (186/343) in the second assessment.ConclusionsIn a considerable number of app descriptions, participants were unable to locate the information necessary for making an informed usage decision. Participants’ sensitization to the quality principles led to changes in their assessment of app descriptions as a tool for usage decisions. Better transparency in app descriptions released by manufacturers and the exposure of users to quality principles could collectively form the basis for well-founded usage decisions.

Quality Awareness and Its Influence on the Evaluation of App Meta-Information by Physicians: Validation Study

“…However, in order to make a well-founded decision for usage, as is ethically and legally required for physicians who want to use such health apps in their medical routine, those interested in such apps need sufficient and readily accessible information, ideally provided by the manufacturers; however, there is often a lack of such information. Our own preliminary work confirmed this assumption by means of studying a subset of apps for the cardiological and pulmonological spectrum [9]. Likewise, there are no commonly agreed-upon criteria that those interested in health-related apps, be it for their own use or other purposes such as research, could apply toward assessment of apps in a structured manner [10]; in fact, there is a wide variety of methods that are currently being used.…”

“…After a short introduction to the study and obtaining informed consent, participants were asked to evaluate one randomly assigned app description; these descriptions were taken from a selection of 126 cardiology- and pulmonology-related apps acquired from Apple’s app store in 2018, which were used as basis for our previous study [9]. Initially, they were asked to assess whether, in their opinion, the information presented in the store description was sufficient for deciding for or against using the selected app (see Figure 1, assessment 1 [A1]).…”

“…Thereafter, analogous to the initial assessment, the participants were prompted to reassess whether the descriptive texts were sufficient for making a decision about usage (see Figure 1). The methodology described is based on a preliminary study with medical students, which has been successfully implemented [9].…”

Potenzielle Stigmatisierung von Menschen mit Übergewicht durch Gesundheits-Apps aus dem Formenkreis ‚Adipositas‘

“…Innerhalb von 24 Stunden, vom Mittag des 23.10. bis zum Mittag des 24.10.19, wurden die App-Beschreibungen und zugehörigen Metadaten aller Apps ausgelesen, die zu diesem Zeitpunkt in den Store-Kategorien ‚Medizin' sowie ‚Gesundheit und Fitness' des für deutsche Kunden verfügbare App Stores von Apple gelistet waren. Hierzu sowie zur darauf folgenden Auswertung wurden auf R basierende Skripte verwendet [10], wie bereits an anderer Stelle [11,12] beschrieben. Es folgte eine mehrschrittige, stichwortbasierte, automatisierte Filterung von Apps mit deutschsprachiger Store-Beschreibung und vermutetem Adipositas-Bezug, wobei thematisch offensichtlich unpassende Apps entfernt wurden (▶Tab.…”

“…Die Stichwortsammlung sollte umfassend und spezifisch genug sein, um korrekte und plausible Treffer zu erbringen und gleichzeitig Fehltreffer zu vermeiden. Als Basis des Bewertungsmaßstabes wurde hier lediglich eine Publikation herangezogen, und zwar der ‚Medienleitfaden Adipositas' der DAG [12]. Es ist daher sicher anzunehmen, dass bestehende Kriterien diskutiert und noch weitere Aspekte und Kriterien aufgenommen werden müssen, um die Matrizen zu erweitern und zu verbessern.…”