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Published on 4. Authors of this article:. Background: Mobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Objective: The purpose of this study was to examine health app use among mobile phone owners in the United States.

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Methods: We conducted a cross-sectional survey of mobile phone users throughout the United States. Fitness and nutrition were the most common of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Cost was a ificant concern among respondents, with a large proportion indicating that they would not pay anything for a health app.

Interestingly, among those who had downloaded health apps, trust in their accuracy and data safety was quite high, and most felt that the apps had improved their health. Conclusions: These findings suggest that while many individuals use health apps, a substantial proportion of the population does not, and that even among those who use health apps, many stop using them.

These data suggest that app developers need to better address consumer concerns, such as cost and high data entry burden, and that clinical trials are necessary to test the efficacy of health apps to broaden their appeal and adoption. As such, it is not surprising that mobile phone apps, which focus on health, fitness, or medical care ie, health appshave become highly popularized. Over 40, health-related apps were available for download from the Apple iTunes store alone as of [ 3 ].

While many people may first associate health apps with fitness and diet-focused apps eg, Lose It! The field of mobile health apps is still in a nascent stage and is characterized by a of limitations, both in terms of sophistication of the apps themselves as well as in knowledge of consumer profiles. Most health apps have not been deed with input from health care and behavior change professionals. A detailed analysis found that among apps classified as "health and fitness" or "medical," only one-fifth offered the possibility of facilitating actual behavioral or physical changes versus nonevidence-based gimmicks or simple information provision [ 3 ].

Data is also limited with regard to consumer opinions and usage patterns of health-related apps. Others have only examined specific apps, for instance, reporting demographics of MapMyFitness users [ 6 ], or have surveyed specific populations such as those with health insurance [ 7 ]. Additionally, developers typically do not release information on the of users and the extent to which consumers continue to use apps over time. Download statistics and feedback ratings from app stores are available, but such data lack validity and do not provide detailed information with regard to important information such as demographics of users, primary reasons people download health apps, barriers to use, consistency of use, and reasons for noncontinuance.

Given this lack of population-based data on health apps, the goal of this study was to survey multiple aspects of health app use from a consumer perspective using a diverse sample of mobile phone users in the United States. A cross-sectional survey of mobile phone users in the United States was conducted in June Toluna, a survey management company, hosted the survey and recruited participants.

Toluna identified potential participants by ing their existing panel of respondents and by posting targeted online advertisements. Once respondents clicked on the Toluna survey link, they were screened for the following eligibility criteria: aged 18 years or older, spoke English, and owned a mobile phone.

Those who were eligible completed an online informed consent document. Respondents received points for completing the survey through Toluna, which they could redeem for rewards. Respondents were required to indicate an answer before moving on to the next question, but could review and change answers.

Each question appeared individually on a unique .

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Start and stop times were assessed and only surveys completed within less than minutes were analyzed. Toluna sent the authors a deidentified data file. As there was no precedent for app use items, our research team developed app-related questions and field-tested them among a diverse team of colleagues with expertise in survey development.

Questions were presented to each participant in the same order as there was a necessary logical order; however, the order of within-item responses was randomly ased to reduce response-set bias. The survey took participants an average of 9 minutes to complete. Descriptive statistics were calculated for all items. Open-ended responses were examined qualitatively using thematic analysis.

In particular, we used an inductive qualitative analytical approach [ 8 ]. Two coders examined the data and determined overarching. Representative quotes were selected for each theme. Statistical ificance was determined by P values less than. All statistical analyses were conducted using SAS version 9.

A total of people visited the surveyand Of the who agreed to participate, The mean age of the analytic sample was A total of Figure 1 shows the spatial distribution of the sample throughout the United States by self-reported residential ZIP codes. In terms of health, only Only With regard to health app use, Belief that apps keep data secure was high, with Similarly, Among the In terms of potential features and uses for health apps, Three primary themes emerged from the analysis of open-ended items, as discussed below.

The majority of comments concerned the intersection of food intake, physical activity, and weight management. For instance, a of respondents noted they wanted an app to assess their health history, and for the app to tell them what exercises they should do and what they should and should not eat. The next most common theme involved improved communication with the health care system. Many participants simply wanted an app to show their medical records, while others wanted to easily make appointments and to engage in two-way communication with their doctors.

Having reminders for medication taking and appointments was also commonly mentioned. Some respondents wanted an all-in-one system such that they did not have to use multiple medical-related apps. Participants described a desire for an app that would keep track of all their vital statistics weight, diet, sleep, etc to better communicate with their doctors during appointments ie, linking with and inputting these data into their medical record.

A of participants mentioned they wanted an app to track symptoms and make possible diagnostic suggestions.

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No ificant relationship was found with sex or history of chronic disease after controlling for other variables Table 3. This study examined health app usage among a socioeconomically and geographically diverse sample of US mobile phone users. A fairly large proportion of respondents, however, had not used health apps.

Common reasons for not doing so were lack of interest, cost, and concern about apps collecting their data. Our study provides a novel and meaningful contribution to the literature, as few prior studies have specifically examined the use of mobile health apps. Similar to our findings, the Pew survey indicated that younger persons and those with higher incomes and education were more likely to use a health app. In contrast to our findings, the Pew survey found that women were more likely to use health apps. In terms of the most common reasons for health app use, our findings mirror those of two surveys indicating that exercise, nutrition, weight management, and blood pressure apps are most popular among consumers [ 710 ].

While we did not ask an exactly similar question, our data indicate a much higher regard for health apps, with respondents noting they found that apps improved their health and wanted increased features. Qualitative responses from our study indicated that consumers want improved health information capacity from their apps, with more specific and tailored health suggestions. This discrepancy may indicate that consumers have problems with the interfaces available on current apps rather than the concept of getting health information from apps in general.

This study has of strengths.

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First, the survey was conducted with a highly diverse national sample. Second, the survey assessed novel information, especially with regard to reasons for use and discontinuance of health apps, and analyzed demographic and health-related correlates of health app use.

In terms of limitations, the responses relied on self-report and included only persons who participate in panels managed by the survey company. In addition, these are cross-sectional data, and while helpful for examining health app usage at one point in time, it is likely that people vary their use patterns over time.

These limitations should have minimal impact on the validity of the data, however, given the sampling and survey management techniques employed. Survey data from this study provides critical insight with regard to directions for the development of health-related mobile apps.

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While many people use health apps, a substantial portion of the population does not, primarily due to lack of interest or perceived need. Many consumers find that the abilities of apps remain limited. It appears that people are using apps to manage health conditions related to weight, which may be attributable to the proliferation at present of apps related to activity and nutrition, as well as use of mobile phone-connected wearable devices, such as the Fitbit and Apple Watch.

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The primary reason respondents stopped using apps was the demanding nature of data entry. Burdensome manual recording requirements are especially prominent in calorie- and nutrition-tracking apps. Open-ended responses indicated a strong interest in apps that would simplify their use and improve the ability of apps to track data without manual entry.

Mobile monitoring devices are only in their infancy, primarily consisting of watches and similar bands eg, Jawbone. Further development of more advanced and integrated products, such as biometric smart clothing [ 11 ] and even noninvasive sensor devices that continuously monitor end points such as blood glucose [ 12 ], will further the advancement of health apps by overcoming data entry burden. It also appears that many respondents were unaware of apps that accomplish some of the functions they wanted eg, scanning a barcode to show nutritional information.

This finding suggests that apps are generally difficult to find among the large available, and supports the need for refereed clearinghouses that could help consumers evaluate features and make sense of available apps. Cost also appears to be a ificant concern both for nonusers and users, with most people unwilling to pay anything for apps and discontinuing use when they find that in-app payments are required. Consumer aversion to cost may be due to the perception that mobile phone use and apps are primarily associated with communication and entertainment.

While consumers are relying on their apps for health advice, they do not yet appear to see them as providing information that warrants payment. App developers need to do more to promote the value and worth of their apps if they are to sustain a viable business model. This will likely necessitate increased openness to partnering with researchers to conduct well-deed trials examining the efficacy of health-directed apps. The state of the evidence for health apps is ificantly lacking [ 413 - 15 ], limiting enthusiasm and perceived value among both consumers and health care professionals.

Recommendations by health care providers could be influential in promoting health app adoption, but our indicate that few health care providers currently advise health app use. This may be attributable to limited familiarity, but also to a lack of clinical trial evidence [ 16 ], which would likely be a foundational requirement for providers to feel comfortable that they are making sound recommendations to their patients [ 17 ].

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