Technology

Sonya Collins

Eighty-five percent of Americans own a smartphone, according to the Pew Research Center. These devices put untold health information in patients’ pockets. As it is no longer only the youngest, the healthiest, or the most tech-savvy who wield these tools, pharmacists may want to counsel patients on one of their smartphone’s most popular components: health apps.

“Pharmacists can think of mobile health apps as they do over-the-counter products,” says Ravi Patel, PharmD, lead innovation advisor of pharmacy and therapeutics at University of Pittsburgh School of Pharmacy. “A patient [often] walks in and says, ‘Hey, while I’m picking up this prescription, let me ask you if there’s something that can help with this problem I’m having.’ In the same way that pharmacists recommend over-the-counter products in these instances, they may also begin to recommend health apps, digital therapeutics, or other smartphone functions for the patient’s situation.”

In fact, apps bear many strong parallels to some OTC products.

Health apps are unregulated

Much like dietary supplements, mobile health apps are not regulated by FDA. Researchers who acknowledge the potential of health apps have highlighted the need for regulation, standardization, and quality control in this field, if for no other reason than to optimize their undeniable potential.

Also like dietary supplements, studies of health apps are often small, contradictory, and/or inconclusive.

“We don’t know much about health apps. Part of the reason we did our paper was because we could not find a lot of literature on them,” says Jenna Hua, PhD, MPH, RD, founder and CEO of health tech startup Million Marker in Berkley, CA, and co-author of “A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates,” which appeared in JMIR mHealth and uHealth in May 2019.

Health apps do bring benefits

Of course, lack of evidence to support an intervention does not mean the intervention does not work. Many studies, though some may be small, have shown that mobile health apps can lead to some degree of positive behavior change for at least some period of time.

Hua’s 2019 review of the 7 most downloaded free diet apps found that most could play a potential role in lifestyle change. The apps got high marks for usability, and each incorporated some type of behavior change construct as well as estimating calorie and carbohydrate counts relatively accurately.

“These apps are very decent, but they could use a lot more [application of] behavior theory,” Hua says.

Similar studies have shown that mobile apps may help some patients manage chronic disease, mental health, and other conditions that have a strong self-management component.

Simply tracking a behavior in an app tends to prompt the user to change the behavior for the better. “Any time you start logging something—[e.g.,] calories, steps—there’s a ton of research to show that you change it for the better,” Hua said.

Motivation is everything

Researchers would be hard-pressed to say which single app is best for the management of any particular condition. To start, the sheer number of apps that offer a solution to any one problem is, as Patel says, “mind-boggling.”

As is the case with many medication regimens, the best health app is the one that patients will stick with and use.

 If a patient simply cannot remember to take multiple pills each day, then monthly injections may be best. For the patient who loathes needles, daily pills might be the ideal solution. Similarly, if a user feels that an app requires too much user input or that the interface is unattractive, it matters very little how effective the app may be for someone who doesn’t share those negative opinions.

“Some studies show that the people in the app intervention do better than the control group at first, but in the long run there is no difference because they don’t sustain use of the apps,” says Hao Wang, MD, PhD, FACEP, research director at Integrative Emergency Services in Dallas.

As with medicine, the health benefits of smartphone apps only come to those who stick to them and use them correctly. ■