by Grace Gibson

Graphic design by Lauren Jones

As ever-developing technological advancements transform every part of our lives, the medical field must also contend with new healthcare technologies alongside their accompanying benefits and challenges. One area that has seen huge growth in the past decade is mobile healthcare applications (MHAs). As a tool for personal health management, MHAs have great potential for improving healthcare access, empowering patients in their own health management, and reducing inequality in medical care. However, the effectiveness of current MHAs in improving accessibility and quality of care is questionable. If healthcare apps are to transform the world of medicine, they must first undergo significant transformations themselves.

MHAs have the potential to improve healthcare outcomes for those experiencing healthcare inaccessibility by providing them with personalized health management tools.¹ Patients living in a “medical desert,” defined as a rural area with a low density of healthcare institutions, can utilize apps to attend telemedicine appointments without traveling long distances.² In the United States, where cost is a detrimental barrier for those without health insurance, an app can help patients triage and use over-the-counter treatments for mild illnesses without a costly doctor’s visit.¹ Chronically ill patients who find it difficult to attend frequent appointments can utilize apps to track their symptoms.³ While these cases remain understudied, evidence suggests that MHAs can improve some health outcomes, like increasing physical activity and decreasing anxiety symptoms.^4,5 

However, the majority of current MHA users are not members of underserved communities.⁶ MHAs appear to be more effective for younger, wealthier, more educated, and more technology literate users—demographics with greater overall health access.^7,8,9 While results vary, some studies also suggest that MHA users are more likely to report good health, simply utilizing their apps to continue their healthy behaviors.^6,8,10 Despite this being an area of potential for MHAs, many people do not engage with health apps for various reasons, including smartphone inaccessibility, technology illiteracy, age, and cost.^6,9 If these apps are most effective among populations already less likely to experience healthcare inequity, MHA use may simply mirror existing inequities.¹¹ 

Additionally, members of marginalized communities who experience barriers to healthcare need more than personal health tools; they deserve transformative policies to improve healthcare access, including improvements to healthcare infrastructure and specialized training for physicians.² MHAs offer an opportunity for personalized care, but individual improvements cannot replace community-based change, and personal health management is not a substitute for public health.

Of course, using MHAs as a transformative healthcare solution assumes that the apps themselves are safe, medically accurate, and evidence-based—requirements that many existing MHAs do not achieve.^6,12 Anyone can create an app and make it publicly available, often without oversight or regulation, leading to the proliferation of substandard apps.⁶ Very few of the currently available apps were created with the involvement of medical professionals, with even fewer evaluated in randomized controlled trials before release.^13,14  Additionally, many MHAs fail to implement adequate security measures to protect users’ data, which frequently includes private information about their health. Users are therefore not only vulnerable to typical data sharing practices (i.e. their address or location), they also risk third-party collection of sensitive health information, such as medications they take or diagnoses they receive.^6,15

As most MHAs are designed for individual use by the general public, potential negative consequences are alarming. Many app users may not have the health literacy to evaluate medical content, and they may inadvertently absorb false information, leading to inaccurate self-diagnosis or misguided actions in future health management.¹³ Moreover, many apps are limited in scope and lack the functionality to build truly personalized healthcare solutions.¹⁶ While MHAs can help patients take a more active role in their health, most currently available apps are either insufficient to meet users’ needs or even detrimental to their health outcomes.^6,13 In such cases, even if the logistics of widespread use are not a factor, MHAs must undergo overall improvements to quality and functionality before they can be considered as transformative healthcare tools. 

Despite these existing challenges, the potential benefits of MHAs remain strong, and the future of healthcare technology will likely include further improvements in app development. With our knowledge on necessary changes to MHAs, we can hope to see the creation of a mobile health app landscape that truly does have the power of transforming healthcare for the better.  

References

1. Steinhubl SR, Muse ED, & Topol, EJ. Can Mobile Health Technologies Transform Health Care? JAMA. 2013 11 Dec; 310(22): 2395-96. 
2. Flinterman LE, González-González AI, Seils L, et al. Characteristics of medical deserts and approaches to mitigate their health workforce issues: a scoping review of empirical studies in western countries. Int J Health Policy Manag. 2023 15 Aug; 12:7454. 
3. Ancker JS, Witteman HO, Hafeez B, et al. “You get reminded you’re a sick person”: personal data tracking and patients with multiple chronic conditions. J Med Internet Res. 2015 Aug 19;17(8):e202. 
4. Direito A, Carraça E, Rawstorn J, et al. mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques, Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Behav Med. 2017 Apr;51(2):226-239. 
5. Firth J, Torous J, Nicholas J, et al. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. J Affect Disord. 2017 Aug 15;218:15-22.
6. Grundy Q. A Review of the Quality and Impact of Mobile Health Apps. Annu Rev Public Health. 2022 Apr 5;43:117-134. 
7. Ernsting C, Dombrowski SU, Oedekoven M, et al. Using smartphones and health apps to change and manage health behaviors: a population-based survey. J Med Internet Res. 2017 Apr 5;19(4):e101.
8. Carroll JK, Moorhead A, Bond R, et al. Who Uses Mobile Phone Health Apps and Does Use Matter? A Secondary Data Analytics Approach. J Med Internet Res. 2017 Apr 19;19(4):e125. 
9. Krebs P, Duncan DT. Health app use among US mobile phone owners: a national survey. JMIR Mhealth Uhealth. 2015 Nov 4;3(4):e101.
10. Robbins R, Krebs P, Jagannathan R, et al. Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status. JMIR Mhealth Uhealth. 2017 Dec 19;5(12):e197. 
11. Singh K, Drouin K, Newmark LP, et al. Many Mobile Health Apps Target High-Need, High-Cost Populations, but Gaps Remain. Health Aff (Millwood). 2016 Dec 1;35(12):2310-2318. 
12. Huang Z, Soljak M, Boehm BO, et al. Clinical relevance of smartphone apps for diabetes management: A global overview. Diabetes Metab Res Rev. 2018 Feb 12;34:e2990. 
13. Portenhauser AA, Terhorst Y, Schultchen D, et al. Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores. JMIR Aging. 2021 Feb 19;4(1):e23313
14. Sander LB, Schorndanner J, Terhorst Y, et al. ‘Help for trauma from the app stores?’ A systematic review and standardised rating of apps for Post-Traumatic Stress Disorder (PTSD). Eur J Psychotraumatol. 2020 Jan 9;11(1):1701788. 
15. Tangari G, Ikram M, Sentana IWB, et al. Analyzing security issues of android mobile health and medical applications. J Am Med Inform Assoc. 2021 Sep 18;28(10):2074-2084
16. Grossman MR, Zak DK, Zelinski EM. Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis. JMIR Mhealth Uhealth. 2018 Jul 30;6(7):e162.