With more than 40,000 health apps in the iTunes store and many others available on health websites for download, it can be a daunting task for parents to choose what's appropriate for their family's needs. From obesity prevention to asthma management, there may be "an app for that," but is it providing credible information? Some apps – special software that you add to your smartphone – can even provide diagnoses, track your child's medical condition, or give medical advice, but can you trust them?
The sad fact is that there is limited rigorous, scientific evaluation about the safety and effectiveness of digital apps. In October 2013, the U.S. Food and Drug Administration (FDA) released guidance on the regulation of mobile medical devices, and the upshot is that a small minority of the 40,000 apps will be regulated. For the most part health apps will be treated no differently from other apps (like games and music), and user reviews and ratings will drive what you see in searches. A very sophisticated friend recently told me that he downloaded an app to monitor his health condition because it had high user ratings. When he purchased the device that went with the app, he found that it was faulty and unreliable. Very few people go back and change their ratings on devices; so, the ratings you see are often gut or early reactions to the apps.
To begin to meet this unmet need for evidence-based digital health that is accountable to health outcomes, the Center for Injury Research and Prevention at The Children's Hospital of Philadelphia recently launched the Digital Health Initiative. In addition to providing credible web content through our family of websites, our Center supports research on development and evaluation of digital health solutions – apps, devices, health games and more. We know that the motivation behind the digital health developers is largely good, but we want to assure that the digital health promise of improved health is actually realized.
In the meantime, "buyer beware."
In a previous post, I provided advice on how to find credible information online. Much of the advice I provided for websites applies to being a savvy app consumer – make sure the app's recommendations are current and credible and be careful before sharing your personal health information. Remember that apps are a growing target for malware: only download apps from a reputable app store. Also, here are some questions parents should ask before tapping into apps to help manage their children's health:
Is the advice consistent with what your child's healthcare provider recommends? As with websites, beware of endorsements for particular products or medications, especially if the organization behind the app is sponsored by a service or company or other product manufacturer that provides the product or medication. Be sure to discuss any conflicting advice with your child's healthcare team. Some families have told me about expensive apps they have downloaded to help their child with autism or other conditions. Sadly, despite great promises from the promotional literature attached to them, there was little benefit from the apps. Unfortunately, we do not yet have a simple treatment for autism and other chronic health conditions. Do not trust an app or other digital health tool promising one.
Does it meet your family's goals and are they achievable? It's admirable to look to apps to improve your family's health goals, but remember most have not been evaluated. Before purchasing an app, think about why you need it and whether what the app does will help you achieve your goals. If after using it you don't achieve the outcomes you want, stop using the app but keep your goal set on improving your family's health. One family downloaded a calorie counter app and after a year, continued to gain weight. Rather than changing their eating behaviors, they focused on keeping track of what they ate! Some evidence shows apps that send reminders via text messages or include incentives have more impact.
Is the app backed by years of study and scientific review? Most health apps are not developed in research organizations. Because app programming is so accessible, creative, well-meaning people – whether in their homes or in large corporations – can make health and wellness apps. And they do. They may not be aware of research findings or how to build an evidence-based app. Look for citations to journal articles and medical literature or a peer-review process for content and recommendations. Look for apps sponsored by a medical school or university, nonprofit healthcare organization, or government agency. These apps are more likely to be based on sound evidence, but even these might not have gone through rigorous evaluation to determine that they actually work to change behavior and improve health outcomes.
In the end, what really matters is whether you and your family are achieving your health outcomes. Apps are just one tool among many strategies for achieving health, wellness and safety. Continue to work closely with your child's healthcare team to achieve your family's goals, even in the digital age.