Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination

Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulate...

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Main Authors: Huang, Zhilian, Lum, Elaine, Car, Josip
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2020
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Online Access:https://hdl.handle.net/10356/145555
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Institution: Nanyang Technological University
Language: English
id sg-ntu-dr.10356-145555
record_format dspace
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Health Apps
Digital Health
spellingShingle Science::Medicine
Health Apps
Digital Health
Huang, Zhilian
Lum, Elaine
Car, Josip
Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
description Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. Objective: This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. Methods: English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads). Results: A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer’s email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads. Conclusions: Gaps in the disclosure of the developer’s qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Huang, Zhilian
Lum, Elaine
Car, Josip
format Article
author Huang, Zhilian
Lum, Elaine
Car, Josip
author_sort Huang, Zhilian
title Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
title_short Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
title_full Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
title_fullStr Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
title_full_unstemmed Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
title_sort medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination
publishDate 2020
url https://hdl.handle.net/10356/145555
_version_ 1759856843885117440
spelling sg-ntu-dr.10356-1455552023-03-05T16:46:24Z Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination Huang, Zhilian Lum, Elaine Car, Josip Lee Kong Chian School of Medicine (LKCMedicine) Interdisciplinary Graduate School (IGS) Centre for Population Health Sciences NTU Institute for Health Technologies Science::Medicine Health Apps Digital Health Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. Objective: This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. Methods: English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads). Results: A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer’s email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads. Conclusions: Gaps in the disclosure of the developer’s qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps. Nanyang Technological University Published version This study was funded by the Nanyang Technological University, Singapore, through (1) the Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; (2) the Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore; and (3) the Institute for Health Technologies, Nanyang Technological University, Singapore. The funder did not have direct involvement in the research including manuscript preparation, apart from employing the authors. The research presented in this paper is solely the responsibility of the authors and does not reflect the views of the funder. The authors wish to acknowledge Mr Geronimo Jimenez for his input in piloting and refining the app assessment criteria and Mr Geronimo Jimenez, Ms Christina Tan, and Ms My Linh Thai for their assistance in app assessment. ZH would like to acknowledge funding from the Nanyang Technological University Research Scholarship. 2020-12-28T06:58:35Z 2020-12-28T06:58:35Z 2020 Journal Article Huang, Z., Lum, E., & Car, J. (2020). Medication management apps for diabetes : systematic assessment of the transparency and reliability of health information dissemination. JMIR mHealth and uHealth, 8(2), e15364-. doi:10.2196/15364 2291-5222 https://hdl.handle.net/10356/145555 10.2196/15364 32130163 2 8 en JMIR mHealth and uHealth © 2020 Zhilian Huang, Elaine Lum, Josip Car. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 19.02.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included. application/pdf