Background
Mobile medical apps – interactive software tools for consumer mobile devices such as smartphones – offer
a novel context to support self-care by individuals with prevalent long-term conditions, such as diabetes
and asthma. However, little is known about the quality and safety of available mobile medical apps, their
potential to support desired health outcomes, or their acceptability to patients. The contribution of this
thesis is to provide a detailed characterisation of issues of quality and safety affecting mobile medical apps for self-care that combines research, clinical and patient perspectives and to use these data to critique
recent proposals from the UK National Health Services to offer self-care apps ‘on prescription’.
Methods
A multiple methods design to assess the state of research on mobile medical apps for self-care, appraise the quality of publicly-available apps and understand how and why individuals use mobile medical apps for self-care, using asthma and diabetes as representative long-term conditions.
Results
A limited research literature of moderate quality suggests modest benefits of app-supported interventions (defined as those that incorporate mobile medical apps as a major delivery mechanism) for the biochemical control of diabetes and equivalence to existing methods for asthma self-care. Evidence for cost-effectiveness is lacking. Mobile medical apps available through public stores rarely conform to guideline standards for information content or functionality and some, such as insulin dose calculators, pose a safety risk to patients. A range of motivational factors influence patient use of mobile medical apps for self-care, including concrete needs for data arising from changes in health status and the emotional consequences of greater awareness of disease state.
Discussion
Ubiquitous gaps in the quality of apps for self-care represent a potential challenge to healthcare
professionals and policy-makers wishing to incorporate them into practice. A stratified response, which extends the principle of proportionality established in medical device regulation, is presented as a potential strategy to address these gaps while recognising resource and capacity constraints. Without such triangulation, the vision of ‘mobile medical apps on prescription’ is probably unrealistic.