The evolution of mobile apps for asthma: an updated systematic assessment of content and tools

Abstract

Background: Interest in mobile apps that support long-term conditions such as asthma is matched by recognition of the importance of the quality and safety of apps intended for patient use. We assessed how changes over a 2-year period affected the clinical suitability of apps providing self-management information and tools for people with asthma by updating a review first performed in 2011.

Methods: Systematic content assessment of all apps for iOS and Android examining the comprehensiveness of asthma information, consistency with the evidence base for asthma self-management and adherence to best practice principles for trustworthy content, comparing the quality of apps available in 2011 to those released since.

Results: Between 2011 and 2013, numbers of asthma apps more than doubled from 93 to 191, despite withdrawal of 25% (n = 23/93) of existing apps. Newer apps were no more likely than those available in 2011 to include comprehensive information, such as the use of action plans, or offer guidance consistent with evidence; 13% (n = 19/147) of all apps, and 39% (n = 9/23) of those intended to manage acute asthma, recommended self-care procedures unsupported by evidence. Despite increases in the numbers of apps targeting specific skills, such as acute asthma management (n = 12 to 23) and inhaler technique (from n = 2 to 12), the proportion consistent with guidelines (17%, n = 4/23) and inhaler instructions (25%, n = 3/12), respectively, was low, and most apps provided only either basic information about asthma (50%, n = 75/147) or simple diary functions (24%, n = 36/147).

Conclusions: In addition to persisting questions about clinical quality and safety, dynamic aspects of app turnover and feature evolution affect the suitability of asthma apps for use in routine care. The findings underline the need for coordinated quality assurance processes that can adapt to changing clinical and information governance-related risks, ensure compliance with the evidence base and reflect local variations in clinical practice. It is unclear if substantial clinical benefits can be realized from a landscape dominated by low quality generic information apps and tools that do not adhere to accepted medical practice.

Figure 1

Flowchart of app selection process. Flowchart details the process of selecting individual apps for inclusion in the study. After evaluation of 191 apps, duplicates available on both iOS and Android (n = 24) and, when more fully featured versions were available, ‘lite’ or demonstration versions (n = 20) were excluded, leaving 147 unique apps for subsequent analysis.

Figure 2

Growth in numbers of asthma apps. Plot shows the total number of available apps for asthma against time, based on the original release date, for the period 2009 to mid-2013. Withdrawals are accounted for. Vertical lines indicate the dates of the 2011 and 2013 surveys. Data were not available for 5 apps; therefore, final n = 186.