tag:theconversation.com,2011:/uk/topics/health-apps-22088/articlesHealth apps – The Conversation2024-03-26T16:40:09Ztag:theconversation.com,2011:article/2242542024-03-26T16:40:09Z2024-03-26T16:40:09ZWant to quit vaping? There’s an app for that<figure><img src="https://images.theconversation.com/files/579066/original/file-20240229-21-z0wh8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-tattoos-on-arms-hands-2271193519">SeventyFour/Shutterstock</a></span></figcaption></figure><p>More Australians than ever are vaping, according to recently released data.</p>
<p>The National Drug Strategy Household Survey <a href="https://www.aihw.gov.au/getmedia/b8b298cc-6d3f-4ab0-a238-9bd63f300c09/national-drug-strategy-household-survey-2022-2023.pdf?v=20240229072409&inline=true#:%7E:text=interpreted%20with%20caution.-,Use%20of%20illicit%20drugs%20increases%2C%20driven%20by%20hallucinogens,million%20people%20had%20done%20so.">shows</a> the proportion of Australians aged 14 and over who, in 2022–2023, said they currently vaped was 7%. In 2019 it was just 2.5%. Users are most likely to be aged 18-24.</p>
<p>As we learn more about the potential harms of vaping, <a href="https://www.mdpi.com/2673-995X/4/1/3">many</a> will be keen to quit.</p>
<p>But because vapes have only been widespread in recent years, there is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460321000836">limited evidence</a> on how to go about quitting. With the addictive nature of nicotine-containing vapes, it can also be hard to stop vaping on your own.</p>
<p>Could apps be the answer? The <a href="https://www.statista.com/statistics/730101/australia-smartphone-ownership-by-age/">vast majority</a> of young people have a smartphone. And we know apps have helped people <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2770816">quit smoking</a>. So why not use apps to help people quit vaping?</p>
<p>But which apps are best? And which app <a href="https://mhealth.jmir.org/2019/7/e11926/">features</a> should you look for? Our <a href="https://mhealth.jmir.org/2024/1/e55177">recently published study</a> gives us some clues.</p>
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Read more:
<a href="https://theconversation.com/could-messages-from-social-media-influencers-stop-young-people-vaping-a-look-at-the-governments-new-campaign-224621">Could messages from social media influencers stop young people vaping? A look at the government's new campaign</a>
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<h2>We tested 30 apps</h2>
<p>We searched the Apple iTunes and Google Play stores in May 2023 to identify apps available in Australia claiming to help people quit vaping.</p>
<p>We then made a shortlist of 20 iOS apps and ten Android apps to assess for:</p>
<ul>
<li><p><a href="https://mhealth.jmir.org/2015/1/e27/">quality</a> (including ease of use, how it engaged users, appearance, and the information it conveyed)</p></li>
<li><p>the potential to <a href="https://mhealth.jmir.org/2019/1/e11130">change behaviour</a> (including setting goals, making an action plan, identifying barriers, monitoring progress and giving feedback).</p></li>
</ul>
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Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
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<h2>Here’s what we found</h2>
<p>The highest rated app overall was the iOS app <a href="https://apps.apple.com/au/app/quit-smoking-stop-vaping-app/id1641262016">Quit smoking. Stop vaping app</a>. This had 19 out of 21 features known to help people change behaviour.</p>
<p>The highest rated app for Android devices was <a href="https://play.google.com/store/apps/details?id=com.despdev.quitsmoking&hl=en_US">Quit Tracker: Stop Smoking</a>, with 15 behaviour change features. </p>
<p>The highest rated app for both <a href="https://play.google.com/store/apps/details?id=org.instaquit.app&hl=en_US">Android</a> and <a href="https://apps.apple.com/us/app/quitsure-quit-smoking-smartly/id1523992725">iOS users</a> was the QuitSure Quit Smoking Smartly app. This had 15 behaviour change features for iOS users and 14 for Android users.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Quit vaping app" src="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=308&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=308&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=308&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=387&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=387&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=387&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This ‘Quit smoking. Stop vaping app’ had the most features known to help people change behaviour.</span>
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<em>
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Read more:
<a href="https://theconversation.com/my-teens-vaping-what-should-i-say-3-expert-tips-on-how-to-approach-the-talk-196205">My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'</a>
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</em>
</p>
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<h2>So what should I look for?</h2>
<p>There are key <a href="https://mhealth.jmir.org/2019/7/e11926/">app features</a> to look for in an app that could help you change your behaviour. These features also apply to apps helping people to quit alcohol, or to take more exercise, for instance. These features include:</p>
<ul>
<li><p><strong>full customisability</strong>, allowing individuals to tailor the app to their needs</p></li>
<li><p><strong>goal setting</strong>, allowing individuals to create their own goals, monitor their progress, then update them over time. This is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00915/full">more likely</a> to lead to positive behaviour change</p></li>
<li><p><strong>external help</strong>, allowing users to access more help or advice, directly from the app</p></li>
<li><p>apps that are <strong>easy to use</strong> or navigate, so users are more likely to stick with the app.</p></li>
</ul>
<p>But not all apps we assessed scored highly on these. On average, apps only had about nine out of 21 behaviour change features. And only 12 of the 30 apps included a goal-setting feature.</p>
<p>The overall quality of the apps was moderate – scoring about three out of five. While apps were easy to use and navigate, we found they were not always transparent in who funded or developed them.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-apps-and-influencers-are-changing-the-way-we-sleep-for-better-or-for-worse-211749">How apps and influencers are changing the way we sleep, for better or for worse</a>
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<h2>Future apps</h2>
<p>Earlier research shows quit smoking apps <a href="https://mhealth.jmir.org/2019/7/e11926/citations">rate higher</a> for their potential to change behaviour than ones to quit vaping.</p>
<p>In one study, researchers found more than half of users of one quit smoking app were still not smoking <a href="https://formative.jmir.org/2023/1/e51658">after a month</a>.</p>
<p>So app developers could look at quit smoking apps to identify strategies and features to develop or update quit vaping apps.</p>
<p>App developers need to create apps with comprehensive goal-setting features. These apps need to be trialled or tested by the developer, users or an external party. This is important as, to our knowledge, no publicly available app has undergone such testing.</p>
<p>As many young people vape to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460322001319?via%3Dihub">relieve stress or anxiety</a>, future apps could provide extra features, such as meditation, cognitive behaviour therapy and relaxation.</p>
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<p>Apps need to align with current <a href="https://www.health.nsw.gov.au/tobacco/Publications/e-cigarette-young-people-guide.pdf">guidelines</a> on how to quit vaping, so evidence-based messaging is consistent. Unfortunately, information and guidelines on quitting vaping are in their infancy and vary across different countries or jurisdictions.</p>
<p>Developers also need to ensure they disclose who owns and paid for the app. Is it a commercial company, a research group, a government agency, or a not-for-profit? We found it difficult to tell during our analysis.</p>
<p>Last of all, quit vaping apps need to be updated and improved over time, to iron out bugs, make improvements as the evidence changes, and to respond to changes in how users behave.</p>
<p>In an ideal world, we’d see partnerships between app developers, people who vape, researchers and experts in health behaviour change to develop and update quit vaping apps – ones with the highest chance of actually shifting people’s behaviour.</p>
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<p><em>We wish to thank Lilian Chan, Rebecca Cerio, Sandra Rickards, Phillipa Hastings, Kate Reakes and Tracey O’Brien from Cancer Institute NSW for their assistance with this research.</em></p><img src="https://counter.theconversation.com/content/224254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona McKay has previously received funding from Cancer Institute NSW (which funded this study) and VicHealth.</span></em></p><p class="fine-print"><em><span>Matthew Dunn has previously received funding from Cancer Institute NSW and VicHealth, and currently receives funding from VicHealth. </span></em></p>Here’s what to look for when you’re browsing for apps.Fiona McKay, Associate Professor of Health Equity, Deakin UniversityMatthew Dunn, Senior Lecturer in Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117492023-10-27T01:24:05Z2023-10-27T01:24:05ZHow apps and influencers are changing the way we sleep, for better or for worse<figure><img src="https://images.theconversation.com/files/554430/original/file-20231017-21-7t15ti.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-woman-watching-bad-online-content-1074562523">Shutterstock</a></span></figcaption></figure><p><em>This is the final article in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
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<p>Insomnia is not just a personal issue that affects an individual’s health and wellbeing. It’s a <a href="https://treasury.gov.au/sites/default/files/2019-03/360985-Sleep-Health-Foundation-and-Australasian-Sleep-Association.pdf">public health</a> issue, affecting public safety. It’s a <a href="https://academic.oup.com/eurpub/article/33/2/242/7049369?login=false">socioeconomic</a> issue, as poorer sleep is linked to a <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-040119-094412">lower education and income</a>. And, increasingly, it’s a commercial issue.</p>
<p>The global insomnia market is expected to reach <a href="https://www.alliedmarketresearch.com/insomnia-market">US$6.3 billion by 2030</a>, driven by increased diagnoses <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12820">and</a> therapy, as well as sleep aids, including <a href="https://www.openpr.com/news/3228602/sleep-tech-devices-market-2023-driving-factors-forecast">sleep apps</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
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<h2>There’s an app for that</h2>
<p>There are <a href="https://www.jstor.org/stable/27213628">numerous</a> <a href="https://www.nature.com/articles/s41746-020-0244-4">digital devices and apps</a> to help people sleep better. You can buy wearable devices, such as smartwatches and smart rings or wristbands, to digitally monitor your sleep. You can download apps that record how long you sleep and where you can log your tiredness and concentration levels. </p>
<p>Some devices are designed to promote sleep, by generating <a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">white or brown noise</a> or other peaceful sounds. You can also buy “smart” <a href="https://thegadgetflow.com/blog/smart-pillows/">pillows</a>, <a href="https://www.sleepfoundation.org/best-mattress/best-smart-mattress">mattresses</a> and a range of <a href="https://sleepspace.com/smart-lights-improve-perceived-sleep-quality/">smart light-fittings and lightbulbs</a> to help track and improve sleep.</p>
<p>Such technologies operate to “digitise” sleep as part of “<a href="https://www.amazon.com.au/Quantified-Self-Deborah-Lupton/dp/150950060X">the quantified self</a>”. They render sleep practices and bodily responses into data you can review. So these devices are promoted as offering scientific insights into how to control the disruption to people’s lives caused by poor sleep.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CqpQFLMAp-x","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>You can listen to “<a href="https://www.theguardian.com/lifeandstyle/2019/feb/08/rise-of-sleep-story-apps-talking-books-that-send-you-to-sleep">sleep stories</a>” – bedtime stories, music or guided meditations meant to help you sleep. Then there are the sleep <a href="https://blog.feedspot.com/insomnia_blogs/">blogs</a>, <a href="https://www.timeout.com/things-to-do/best-sleep-podcasts">podcasts</a> and social media content on <a href="https://www.tiktok.com/tag/insomnia?lang=en0">TikTok</a>, <a href="https://www.youtube.com/watch?v=i9sR_T76H34">YouTube</a> and <a href="https://www.instagram.com/p/CqpQFLMAp-x/">Instagram</a>. </p>
<p>Where there is social media content, there are social media “influencers” sharing their take on sleep and how to get more of it. These “<a href="https://influencers.feedspot.com/sleep_instagram_influencers/">sleep influencers</a>” have accumulated large numbers of followers. Some have <a href="https://www.bbc.com/news/technology-66524539">profited</a>, including those who live-stream themselves sleeping or invite audiences to try to wake them up – for a price.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1693353491161325720"}"></div></p>
<h2>Sharing and connecting can help</h2>
<p>There may be benefits to joining online communities of people who can’t sleep, whether that’s in an online forum such as <a href="https://www.reddit.com/r/sleep/?rdt=60835">Reddit</a> or a specially designed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861843/">sleep improvement program</a>.</p>
<p>Sharing and connection can ease the loneliness we know <a href="https://academic.oup.com/sleep/article/34/11/1519/2454670?login=false">can impact</a> sleep. And technology can facilitate this connection when no-one else is around.</p>
<p>We know social media communities provide much-needed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156131/">support</a> for health problems more generally. They allow people to share personal experiences with others who understand, and to swap tips for the best health practitioners and therapies. </p>
<p>So online sharing, support and feelings of <a href="https://www.psychologytoday.com/au/blog/the-science-of-fandom/202303/can-social-media-and-online-communities-be-good-for-us">belonging</a> can alleviate the stresses and unhappiness that may prevent people from finding a good night’s sleep.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
</strong>
</em>
</p>
<hr>
<h2>What is this fixation costing us?</h2>
<p>But there are some problems with digitising sleep. A <a href="https://www.theguardian.com/commentisfree/2023/may/09/obsession-sleep-harm-drivers-legal-sleep-limit">focus</a> on sleep can create a <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">vicious cycle</a> in which worrying about a lack of sleep <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796717301638">can itself</a><a href="https://www.bps.org.uk/research-digest/misbelieving-youve-got-sleep-problems-can-be-more-harmful-actual-lack-sleep"> worsen sleep</a>. </p>
<p>Using sleep-tracking apps and wearable devices can encourage people to become <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">overly fixated</a> on the metrics these technologies gather. </p>
<p>The data generated by digital devices are not necessarily <a href="https://www.nature.com/articles/s41746-020-0244-4">accurate or useful</a>, particularly for groups such as <a href="https://mhealth.jmir.org/2021/6/e26462">older people</a>. Some young people say they feel <a href="https://journals.sagepub.com/doi/abs/10.1177/10949968221142806">worse</a> after using a sleep app. </p>
<p>There are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157780/">data privacy issues</a>. Some digital developers do not adequately protect the very personal information smart sleep devices or apps generate.</p>
<p>Then, there’s the fact using digital devices before bedtime <a href="https://www.sleepfoundation.org/how-sleep-works/how-electronics-affect-sleep">is itself</a> linked to <a href="https://www.sciencedirect.com/science/article/pii/S2352721823000347">sleep problems</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-sleep-trackers-accurate-heres-what-researchers-currently-know-152500">Are sleep trackers accurate? Here's what researchers currently know</a>
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</em>
</p>
<hr>
<h2>Are we missing the bigger issue?</h2>
<p>Other critics argue this intense focus on sleep ignores that sleeping well is impossible for some people, however hard they try or whatever expensive devices they buy. </p>
<p>People living in poor housing or in noisy environments have little choice over the conditions in which they seek good sleep. </p>
<p>Factors such as people’s income and education levels <a href="https://www.mdpi.com/2254-9625/12/8/80">affect</a> their sleep, just as they do for <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjop.12645">other health issues</a>. And <a href="https://www.sciencedirect.com/science/article/pii/S2352721823000864">multiple socioeconomic factors</a> (for instance, gender, ethnicity and economic hardship) can combine, making it even more likely to have poor sleep.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Plane flying low over houses" src="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554442/original/file-20231018-25-99hpyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living in poor housing or in noisy environments have little choice over their sleep environment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/heathrow-airport-london-9-september-british-114954946">Steve Heap/Shutterstock</a></span>
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<p>Sleep quality is therefore just as much as a <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjop.12645">socioeconomic</a> as a biological issue. Yet, much of the advice offered to people about how to improve their sleep focuses on individual responsibility to make changes. It assumes everyone can buy the latest technologies or can change their environment or lifestyle to find better “sleep health”. </p>
<p>Until “<a href="https://www.mdpi.com/2624-5175/5/1/13">sleep health inequalities</a>” are improved, it is unlikely digital devices or apps can fix sleep difficulties at the population level. A good night’s sleep should not be the preserve of the privileged.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
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<img src="https://counter.theconversation.com/content/211749/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton receives funding from the Australian Research Council.</span></em></p>Fixating on sleep can make your sleep worse. But some people crave the connection online sleep communities provide.Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115132023-08-16T04:51:48Z2023-08-16T04:51:48ZNot all mental health apps are helpful. Experts explain the risks, and how to choose one wisely<figure><img src="https://images.theconversation.com/files/542935/original/file-20230816-15-67z0ok.jpeg?ixlib=rb-1.1.0&rect=49%2C30%2C4044%2C2694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others. You would think such “health” and “wellbeing” apps – which often present as solutions for conditions such as <a href="https://www.headspace.com/">anxiety</a> and <a href="https://www.calm.com">sleeplessness</a> – would have been rigorously tested and verified. But this isn’t necessarily the case. </p>
<p>In fact, many may be taking your money and data in return for a service that does nothing for your mental health – at least, not in a way that’s backed by scientific evidence. </p>
<h2>Bringing AI to mental health apps</h2>
<p>Although some mental health apps connect users with a <a href="https://www.betterhelp.com/get-started/?go=true&utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=betterhelp+australia_e&utm_content=133525856790&network=g&placement=&target=&matchtype=e&utm_campaign=15228709182&ad_type=text&adposition=&kwd_id=kwd-401317619253&gclid=Cj0KCQjwoeemBhCfARIsADR2QCtfZHNw8mqpBe7cLfLtZBD-JZ5xvAmDCfol8npbAAH3ALJGYvpngtoaAtFlEALw_wcB¬_found=1&gor=start">registered therapist</a>, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals. </p>
<p>These apps also increasingly claim to be incorporating artificial intelligence into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s <a href="https://help.netflix.com/en/node/100639">recommendation algorithm</a>.</p>
<p>Some apps such as <a href="https://legal.wysa.io/privacy-policy#aiChatbot">Wysa</a>, <a href="https://www.youper.ai/">Youper</a> and <a href="https://woebothealth.com/">Woebot</a> use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use. </p>
<p>It’s likely most of these AI chatbots use <a href="https://www.techtarget.com/searchenterpriseai/feature/How-to-choose-between-a-rules-based-vs-machine-learning-system">rules-based systems</a> that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often <a href="https://www.vice.com/en/article/pkadgm/man-dies-by-suicide-after-talking-with-ai-chatbot-widow-says">harmful and inappropriate</a>) outputs AI chatbots have become known for – but there’s no guarantee. </p>
<p>The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.</p>
<h2>Misleading marketing and a lack of supporting evidence</h2>
<p>Mental health apps might be able to provide certain benefits to users <em>if</em> they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.</p>
<p>The <a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">clinical value</a> of automated mental health and mindfulness apps is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1077722918300233?casa_token=lwm1E6FhcG0AAAAA:saV7szbZl4DqbvmZiomLG9yMWi_4-zbmy3QCtQzVEQr957QX1E7Aiqkm5BcEntR0mVFgfDVo">still being assessed</a>. Evidence of their efficacy is generally <a href="https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000002">lacking</a>. </p>
<p>Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on: </p>
<ul>
<li><a href="https://sensa.health/">user testimonials</a></li>
<li>short-term studies with narrow <a href="https://www.wired.co.uk/article/mental-health-chatbots">or homogeneous cohorts</a></li>
<li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533203/#">studies involving</a> researchers or funding from the very group <a href="https://www.theguardian.com/us-news/2022/apr/13/chatbots-robot-therapists-youth-mental-health-crisis">promoting the app</a></li>
<li>or evidence of the benefits of a <a href="https://www.headspace.com/meditation/anxiety">practice delivered face to face</a> (rather than via an app).</li>
</ul>
<p>Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes. </p>
<p>For some users, mental health apps may even cause harm, and lead to increases in the very <a href="https://pubmed.ncbi.nlm.nih.gov/34074221/">symptoms</a> people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">While a well-designed mental health app may bring benefits to a user, this shouldn’t be confused with evidence of efficacy.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In the case of most mental health apps, research on their effectiveness won’t have considered <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505389/">individual differences</a> such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-effective-is-mindfulness-for-treating-mental-ill-health-and-what-about-the-apps-182436">How effective is mindfulness for treating mental ill-health? And what about the apps?</a>
</strong>
</em>
</p>
<hr>
<h2>Inadequate privacy protections</h2>
<p>Mental health apps are subject to standard consumer protection and privacy laws. While data protection and <a href="https://cybersecuritycrc.org.au/sites/default/files/2021-07/2915_cscrc_casestudies_mentalhealthapps_1.pdf">cybersecurity</a> practices vary between apps, an investigation by research foundation Mozilla <a href="https://foundation.mozilla.org/en/privacynotincluded/articles/are-mental-health-apps-better-or-worse-at-privacy-in-2023">concluded that</a> most rank poorly. </p>
<p>For example, the mindfulness app <a href="https://www.headspace.com/privacy-policy">Headspace</a> collects data about users from a <a href="https://foundation.mozilla.org/en/privacynotincluded/headspace/">range of sources</a>, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict <a href="https://legal.wysa.io/privacy-policy">users’ moods</a>, and use anonymised user data to train the language models <a href="https://www.youper.ai/policy/privacy-policy">underpinning the bots</a>.</p>
<p>Many apps share so-called <a href="https://theconversation.com/popular-fertility-apps-are-engaging-in-widespread-misuse-of-data-including-on-sex-periods-and-pregnancy-202127">anonymised</a> data with <a href="https://www.wysa.com/">third parties</a>, such as <a href="https://www.headspace.com/privacy-policy">employers</a>, that sponsor their use. Re-identification of <a href="https://www.unimelb.edu.au/newsroom/news/2017/december/research-reveals-de-identified-patient-data-can-be-re-identified">these data</a> can be relatively easy in some cases.</p>
<p>Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">health and lifestyle</a> products or tools for <a href="https://www.tga.gov.au/sites/default/files/digital-mental-health-software-based-medical-devices.pdf">managing mental health</a> that are excluded from TGA regulations (provided they meet certain criteria).</p>
<h2>How can you choose an app?</h2>
<p>Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as <a href="https://onemindpsyberguide.org/apps/">usability</a> or <a href="https://foundation.mozilla.org/en/privacynotincluded/categories/mental-health-apps/">privacy</a>. Different guides may also be inconsistent with each other.</p>
<p>Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.</p>
<ol>
<li><p>consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual</p></li>
<li><p>check whether a mental health professional or trusted institution was involved in developing the app </p></li>
<li><p>check if the app has been rated by a third party, and compare different ratings</p></li>
<li><p>make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront</p></li>
<li><p>stop using the app if you experience any adverse effects.</p></li>
</ol>
<p>Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ai-chatbots-are-still-far-from-replacing-human-therapists-201084">AI chatbots are still far from replacing human therapists</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeannie Marie Paterson receives funding from the Australian Research Council and has taken part in industry led roundtable discussions about digital mental health. </span></em></p><p class="fine-print"><em><span>Nicholas T. Van Dam receives funding from the Three Springs Foundation Pty Ltd to establish the Contemplative Studies Centre at the University of Melbourne. </span></em></p><p class="fine-print"><em><span>Piers Gooding receives funding from the Australian Research Council to examine the regulation of digital technologies in mental health care.</span></em></p>Claims regarding on these apps’ effectiveness are often based on less than robust findings.Jeannie Marie Paterson, Professor of Law, The University of MelbourneNicholas T. Van Dam, Associate Professor, School of Psychological Sciences, The University of MelbournePiers Gooding, Postdoctoral Research Fellow, Disability Research Initiative, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021272023-03-22T00:06:33Z2023-03-22T00:06:33ZPopular fertility apps are engaging in widespread misuse of data, including on sex, periods and pregnancy<figure><img src="https://images.theconversation.com/files/516601/original/file-20230321-690-se9b8m.jpeg?ixlib=rb-1.1.0&rect=24%2C58%2C3210%2C2095&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>New research reveals serious privacy flaws in fertility apps used by Australian consumers – emphasising the need for urgent reform of the Privacy Act.</p>
<p>Fertility apps provide a number of features. For instance, they may help users track their periods, identify a “fertile window” if they’re trying to conceive, track different stages and symptoms of pregnancy, and prepare for parenthood up until the baby’s birth. </p>
<p>These apps collect deeply sensitive data about consumers’ sex lives, health, emotional states and menstrual cycles. And many of them are intended for use by children as young as 13. </p>
<p>My report <a href="https://allenshub.unsw.edu.au/sites/default/files/2023-03/KKemp%20Your%20Body%20Our%20Data%2022.03.23.pdf">published today</a> analysed the privacy policies, messages and settings of 12 of the most popular fertility apps used by Australian consumers (excluding apps that require a connection with a wearable device). </p>
<p>This analysis uncovered a number of concerning practices by these apps including:</p>
<ul>
<li>confusing and misleading privacy messages</li>
<li>a lack of choice in how data are used</li>
<li>inadequate de-identification measures when data are shared with other organisations</li>
<li>retention of data for years even after a consumer stops using the app, exposing them to unnecessary risk from potential data breaches.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/proposed-privacy-reforms-could-help-australia-play-catch-up-with-other-nations-but-they-fail-to-tackle-targeted-ads-200166">Proposed privacy reforms could help Australia play catch-up with other nations. But they fail to tackle targeted ads</a>
</strong>
</em>
</p>
<hr>
<h2>The data collected</h2>
<p>The apps in this study collect intimate data from consumers, such as:</p>
<ul>
<li>their pregnancy test results</li>
<li>when they have sex and whether they had an orgasm</li>
<li>whether they used a condom or “withdrawal” method</li>
<li>when they have their period</li>
<li>how their moods change (including anxiety, panic and depression)</li>
<li>and if they have health conditions such as polycystic ovary syndrome, endometriosis or uterine fibroids. </li>
</ul>
<p>Some ask for unnecessary details, such as when a user smokes and drinks alcohol, their education level, whether they struggle to pay their bills, if they feel safe at home, and whether they have stable housing.</p>
<p>They also track which support groups you join, what you add to your “to-do list” or “questions for doctor”, and which articles you read. All of this creates a more detailed picture of your health, family situation and intentions.</p>
<h2>Confusing or misleading privacy messages</h2>
<p>Consumers should expect the clearest information about how such data are collected, used and disclosed. Yet we found some of the messaging is highly confusing or misleading.</p>
<p>Some apps say “we will never sell your data”. But the fine print of the privacy policy contains a term that allows them to sell all your data as part of the sale of the app or database to another company. </p>
<p>This possibility is not just theoretical. Of the 12 apps included in the study, one was previously taken over by a drug development company, and another two by a digital media company.</p>
<p>Other apps explain privacy settings using language that makes it almost impossible for a consumer to understand what they are choosing, or obscure the privacy settings by placing them numerous clicks and scrolls away from the home screen. </p>
<h2>Keeping sensitive data for too long</h2>
<p>The <a href="https://www.abc.net.au/news/2022-10-21/medibank-optus-data-hack/101558932">major data breaches</a> of the past six months highlight the risks of companies holding onto personal data longer than necessary. </p>
<p>Breaches of highly sensitive information about health and sexual activities could lead to <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4387341">discrimination, exploitation, humiliation or blackmail</a>. </p>
<p>Most of the apps we analysed keep user data for at least three years after the user quits the app – or seven years in the case of one brand. Some apps give no indication of when user data will be deleted. </p>
<h2>Can’t count on ‘de-identification’</h2>
<p>Some apps also give consumers no choice regarding whether their “de-identified” health data will be sold or transferred to other companies for research or business. Or, they have consumers opted-in to these extra uses by default, putting the onus on users to opt out.</p>
<p>Moreover, some of these data are not truly de-identified. For example, removing your name and email address and replacing it with a unique number is not de-identification for legal purposes. Someone would only need to work out the link between your name and that number in order to link your whole record with you.</p>
<p>When supposedly de-identified Medicare records were published in 2016, <a href="https://www.unimelb.edu.au/newsroom/news/2017/december/research-reveals-de-identified-patient-data-can-be-re-identified">University of Melbourne researchers</a> showed how just a few data points can connect a de-identified record to a unique individual.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/post-roe-women-in-america-are-right-to-be-concerned-about-digital-surveillance-and-its-not-just-period-tracking-apps-185865">Post Roe, women in America are right to be concerned about digital surveillance – and it’s not just period-tracking apps</a>
</strong>
</em>
</p>
<hr>
<h2>Need for reform</h2>
<p>This research highlights the unfair and unsafe data practices consumers are subjected to when they use fertility apps. And these findings reinforce the need for Australia’s privacy laws to be updated. </p>
<p>We need improvements in what data are covered by the Privacy Act, what choices consumers can make about their data, what data uses are prohibited, and what security systems companies must have in place.</p>
<p>The government is seeking <a href="https://www.ag.gov.au/rights-and-protections/publications/privacy-act-review-report">submissions</a> on potential privacy law reforms until March 31. </p>
<p>In the meantime, if you’re using a fertility app, there are some steps you can take to help reduce some of the privacy risks: </p>
<ol>
<li>when launching the app for the first time, don’t agree to tracking of your data, or you can limit ad tracking via iPhone device settings </li>
<li>don’t log in via a social media account</li>
<li>don’t answer questions or add data you don’t need to for your own purposes</li>
<li>don’t share your Apple Health or FitBit data</li>
<li>if the app provides privacy choices, opt out of tracking and having your data sold or used for research, and delete your data when you stop using the app</li>
<li>bear in mind that every article you read, and how long you spend on it, and every group you join and comment you make there may be added to a profile about you. </li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/after-roe-v-wade-heres-how-women-could-adopt-spycraft-to-avoid-tracking-and-prosecution-186046">After Roe v Wade, here's how women could adopt 'spycraft' to avoid tracking and prosecution</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202127/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharine Kemp receives funding from The Allens Hub for Technology, Law and Innovation. She is a Member of the Advisory Board of the Future of Finance Initiative in India, and the Australian Privacy Foundation.</span></em></p>An analysis of 12 popular apps’ privacy policies reveals a number of concerns, including confusing privacy messages and unnecessarily long data retention windows.Katharine Kemp, Senior Lecturer, Faculty of Law & Justice, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1356992020-04-06T14:54:01Z2020-04-06T14:54:01ZCoronavirus: location-tracking apps could stop the disease – here’s how<figure><img src="https://images.theconversation.com/files/325714/original/file-20200406-151304-1nn28c8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ill-man-glasses-feeling-sick-wearing-1358067473">DimaBerlin/Shutterstock</a></span></figcaption></figure><p>Nearly <a href="https://news.sky.com/story/coronavirus-nearly-half-the-worlds-population-now-under-restrictions-11963490">half of the world’s population</a> is now locked down in their homes to avoid spreading the coronavirus. With a vaccine likely still many months away, many countries are looking for ways they can get their people and economies moving again without risking further deaths. <a href="https://science.sciencemag.org/content/early/2020/03/30/science.abb6936">New research</a> suggests that using an app to track people’s movements and identify and isolate anyone who has come into contact with an infected person could be critical in avoiding or leaving lockdown.</p>
<p>This kind of contact-tracing technology has already been used with some success in countries such as China and <a href="https://theconversation.com/coronavirus-south-koreas-success-in-controlling-disease-is-due-to-its-acceptance-of-surveillance-134068">South Korea</a>. But <a href="https://www.telegraph.co.uk/news/2020/03/28/coronavirus-far-will-surveillance-go-name-public-health/">there are questions</a> over whether western countries would accept such levels of surveillance. However, as someone who has spent years researching the use of technology in healthcare, I feel there are good reasons to believe people would be willing and motivated to use a location-tracking app to help end the pandemic.</p>
<p>The <a href="https://science.sciencemag.org/content/early/2020/03/30/science.abb6936">new research</a>, conducted by the University of Oxford and published in leading journal Science, shows the virus is spreading too quickly for the pandemic to be contained by simply isolating those we know are infected or by manually tracing all their contacts. Working out all the places a patient has been and finding everyone they have been in contact with to test or isolate them can take days or weeks – much slower than it takes the virus to spread.</p>
<p>By modelling the spread of the virus in response to different tracing strategies, the researchers showed that only digital contact-tracking could get control over the pandemic. This would involve using a smartphone app to track people’s movements and automatically notifying them if they have come in contact with someone known to have caught the virus. It would then encourage them to immediately self-isolate and prevent further contamination. </p>
<p>The location-tracking aspect of the app could be enhanced by enabling users to check in to locations such as shops, public transport stations or workplaces. To encourage more people to use the app, it could also provide access to health services, information and even food or medicine deliveries during self-isolation. The researchers also said that the app should be combined with other measures such as social distancing and frequent handwashing. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325712/original/file-20200406-74220-kdj5as.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The app would alert you if you need to self-isolate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stay-home-female-hand-smartphone-challenge-1675565497">Peter Kniez/Shutterstock</a></span>
</figcaption>
</figure>
<p>The two practical questions about relying on such an app to tackle the virus are: would enough people be motivated to download the software and would they be willing for health authorities to constantly track their movements? Given our near-wartime conditions, I believe there are many good reasons even democratic states will and should adopt this strategy, even if citizens are allowed to participate voluntarily.</p>
<p>Research <a href="https://link.springer.com/article/10.1007/s13347-016-0215-5">has shown</a> that <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.468.1757&rep=rep1&type=pdf">people are willing</a> to share personal health data when they receive <a href="https://core.ac.uk/download/pdf/89359062.pdf">significant value in exchange</a>. Giving up some personal freedom can lead to lifesaving benefits in times of crisis and so provide important value.</p>
<p>Many governments are already enforcing a widespread lockdown that prevents people leaving their homes except in limited circumstances. Police are stopping individuals and cars, handing out fines and even arresting people (who in some cases may later receive <a href="https://www.independent.co.uk/news/world/europe/coronavirus-italy-prison-sentence-fine-police-lockdown-a9424036.html">prison sentences</a>) for failing to comply with restrictions. </p>
<p>The digital tracker could be presented as a safe way to end this highly onerous and in some cases unpleasant situation. It seems reasonable to think the low-effort requirement of downloading an app would be much preferred – even if it constantly tracks you. A tracking app would enable us to watch over each other so we can get safely back to work, school and something resembling our regular lives. </p>
<p>It may even make it easier to visit family members who are at particular risk because you would have a much greater chance of knowing if you had come into contact with the virus. People would be motivated to use the app because it would help them keep loved ones safer but not completely cut off from contact.</p>
<h2>Lessening opposition</h2>
<p>It is also very likely that the virus will continue to circulate globally for an extended period, starting new infections even in countries where it may seemingly have been wiped out. Over time, general public opinion about the risks of being tracked will probably become less opposed. </p>
<p>People may actually start to expect this level of intervention in their lives from the state or public health organisations. For example, the UK has gradually become <a href="http://library.college.police.uk/docs/hordsolr/rdsolr1005.pdf">more accepting</a> of privacy-infringing security measures such as CCTV, especially <a href="https://ideas.repec.org/p/diw/diweos/diweos13.html">since the 7/7 terrorist attacks</a> on the London Underground and bus network.</p>
<p>Of course tracking apps presents risks to public trust. One challenge is to ensure that tracking systems are not indefinitely maintained. When the pandemic is over, citizens need assurance that Big Brother will not be looking over their shoulder. There also needs to be transparency over who has access to the data, what they can do with it, and when it will be destroyed.</p>
<p>But in the meantime, the new research suggests digital contact tracing is likely to be the best means for restoring a sense of safety and freedom in our communities.</p><img src="https://counter.theconversation.com/content/135699/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eivor Oborn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research indicates people would be willing to give up privacy to tackle the COVID-19 pandemic.Eivor Oborn, Professor of Healthcare Management, Warwick Business School, University of WarwickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1222802020-03-27T12:14:12Z2020-03-27T12:14:12ZScreen time that supports new parents and young kids can enhance family health<figure><img src="https://images.theconversation.com/files/323436/original/file-20200326-133027-10bwr7o.jpg?ixlib=rb-1.1.0&rect=0%2C307%2C4451%2C3351&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies don't come with instruction manuals... mobile health apps can help new parents.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/new-jersey-jersey-city-woman-texting-and-holding-royalty-free-image/525445885">Tetra Images via Getty Images</a></span></figcaption></figure><p>Screen time for little kids takes a lot of heat under normal conditions. The American Academy of Pediatrics’ official recommendations urge families to be <a href="https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx">thoughtful and judicious about screen time</a> for youngsters from birth to age five. And there is evidence that too much technology can lead to <a href="https://theconversation.com/why-its-wrong-for-pediatricians-to-eliminate-daily-screen-time-recommendations-49408">loss of child development opportunities</a>.</p>
<p>But technology can also connect families to important parenting and educational opportunities, especially at a time when people are sheltering in place and avoiding health care facilities for all but the most pressing concerns. The current generation of parents are <a href="https://doi.org/10.1007/978-3-662-46590-5_2">digital natives</a> themselves, having grown up in an era when internet was readily accessible. They often prefer technological solutions for their families.</p>
<p>We are <a href="https://scholar.google.com/citations?hl=en&authuser=2&user=DQ0Q4ekAAAAJ">a professor of social work</a> and <a href="https://keck.usc.edu/faculty-search/ashwini-lakshmanan/">a neonatologist</a> interested in how using internet-supported technologies – including apps, voice and text messaging, videoconferencing and e-learning platforms – can ease the parenting burden and promote healthy development. Reducing burdens on parents and increasing access to parent support are vital elements in helping families raise healthy children.</p>
<h2>Trusted info within arm’s reach</h2>
<p>Users can access apps, websites and programs from their cellphones or computers to receive information about medical tests, screenings and how to make healthier choices.</p>
<p>Phone apps can put trusted medical information right into a parent’s hand. Users can skip the hassle of having to visit a clinic or class. Health care providers recommend free apps like <a href="http://nicu2home.com">NICU2Home</a>, Providence Hospital Systems’ <a href="https://www.providence.org/services/circle-app">Circle</a> and March of Dimes’ <a href="https://www.marchofdimes.org/nicufamilysupport/my-nicu-baby-app.aspx">My NICU Baby</a> to their patients as sources of tips and helpful videos about how to care for a baby. The apps can help do things like track breastfeeding sessions, baby’s sleep patterns and baby’s weight; teach medical terminology; and connect families to others with similar experiences.</p>
<p>App can also provide task lists that ease a family’s transition from hospital to home with a newborn. For example, these apps can tell families about to be discharged from a NICU what supplies and special equipment they will need to have at home to support their baby after leaving the hospital. Having access to this information in an app, rather than a paper handout from a doctor, means it can be easily accessed on demand and won’t get lost in the shuffle of family life.</p>
<figure>
<iframe src="https://player.vimeo.com/video/310900917" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Children’s Hospital Los Angeles produced the Baby Steps LA app to help patient families.</span></figcaption>
</figure>
<p>One of us (Dr. Lakshmanan) created the app Baby Steps LA to help families and children with special health care needs at Children’s Hospital Los Angeles. The app includes information about how social factors like housing, insurance and food security can influence health and offers related resources.</p>
<p>There are also several apps that focus on the importance of peer support groups and how important they can be <a href="https://doi.org/10.1097/NMC.0000000000000489">for new mothers</a>. </p>
<p>Cellphones can potentially help new parents, even without specific apps installed. One study found that new mothers who received text messages with tips about breastfeeding and child development while enrolled in the Supplemental Nutrition Program for Women, Infants, and Children breastfed their children <a href="https://doi.org/10.1111/mcn.12488">more consistently and for a longer period of time</a>. </p>
<p>Text messaging chatbots like <a href="https://redtri.com/parentspark-interactive-chatbox-teach-you-to-be-better-parent/">ParentSpark</a> use artificial intelligence and user patterns to respond to parents’ queries on topics like feeding and exercise, helping inform their choices and teach new strategies.</p>
<p>Families can even turn to <a href="https://www.ncbi.nlm.nih.gov/pubmed/18999101">video games to help prepare them</a> for discharge from the hospital or to learn about medical conditions.</p>
<h2>Connecting to live experts via screens</h2>
<p><a href="https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine">Telehealth</a> is an important option for families with young children, because it expands access to medical, mental health and developmental care options, especially in areas where there are limited numbers of specialty providers. Parents and their children can videoconference with experts, reducing time spent traveling and in waiting rooms.</p>
<p>The expansion of <a href="https://www.healthrecoverysolutions.com/blog/telehealth-autism-diagnosis">autism services on telehealth platforms</a> is a prime example of how this technology can meet the needs of families with young children. Families can access screening, early diagnosis, applied behavior analysis, speech language pathology, parent training and overall treatment planning from home by logging into a videoconferencing platform and speaking to a live provider.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ExMZtrH1Jm4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Live suggestions via on-screen interactions can help with parenting.</span></figcaption>
</figure>
<p>Families can also access parent support and parent training, including developmental assessments, using telehealth. One of us (Dr. Traube) designed a service called <a href="https://pat.usc.edu">Virtual Home Visitation</a> that gives families direct access to a parenting coach who guides them through activities that support their child’s development using videochat technology.</p>
<p>These services can be difficult to find in local communities. But, through weekly screen interactions with a parenting coach, families can promote their child’s development, ensure any developmental delays are quickly identified and find intervention options early.</p>
<h2>Online content aimed at kids</h2>
<p>Plenty of research indicates that <a href="https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx">young children should not</a> interact with video games or content to the exclusion of books or in the absence of an adult to coach them. </p>
<p>But thoughtfully built educational platforms can be a productive way for parents to use technology to support their child’s early learning. <a href="https://doi.org/10.1542/peds.2014-2251">When designed with child development research in mind</a>, content platforms offering games, e-books, and videos can help kids build motor, socio-emotional and cognitive skills, as well as help to reduce skill gaps in important foundational areas like color, letter and number recognition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323437/original/file-20200326-133001-1pfny1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A crucial component in young children’s screen time is a parent’s close involvement and supervision.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-boy-and-young-girl-sitting-on-a-grey-sofa-royalty-free-image/910586842">Mint Images via Getty Images</a></span>
</figcaption>
</figure>
<p>For example, studies suggest that well-designed e-books can <a href="https://files.eric.ed.gov/fulltext/ED560635.pdf">support early literacy</a>. Thoughtful use of highlighting, or animating relevant parts of picture or text, and interactive features including dictionaries, word readouts or learning games can help with word learning and reading.</p>
<p>When parents assess e-learning platforms, they should <a href="https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx">evaluate them on the basis</a> of whether they are engaging, actively involve the child, have meaningful content, and demonstrate or encourage social interaction. Organizations including <a href="https://pbskids.org/">Public Broadcasting Service</a> and <a href="https://www.sesamestreet.org/">Sesame Workshop</a> focus on early childhood and have invested a lot of research into developing trustworthy e-platforms.</p>
<p><a href="https://doi.org/10.1056/NEJMp1713180">Over two-thirds of Americans use mobile health applications</a> and the iTunes and Android app stores offer more than 165,000 of them. All of these technologies offer health care providers an opportunity to meet families where they are whenever they need us. Done right, they could lead to sustainable improvements in child health and development.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em>]</p><img src="https://counter.theconversation.com/content/122280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dorian Traube receives funding from the Overdeck Family Foundation, Gary Community Investments, Parsons Foundation, and Queenscare Foundation. </span></em></p><p class="fine-print"><em><span>Ashwini Lakshmanan receives funding from the Sharon D. Lund foundation and the Zumberge Diversity and Inclusion Award. She previously received funding from the National Institutes of Health, the Packard foundation for Children's Health and the Confidence Foundation.</span></em></p>Mobile health apps, teleconferencing with experts and thoughtfully designed educational platforms can all help families during the chaotic and confusing early years.Dorian Traube, Associate Professor of Social Work, University of Southern CaliforniaAshwini Lakshmanan, Assistant Professor of Clinical Pediatrics, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1074282018-12-12T11:42:38Z2018-12-12T11:42:38ZDon’t worry about screen time – focus on how you use technology<figure><img src="https://images.theconversation.com/files/249815/original/file-20181210-76977-1c28o2h.jpg?ixlib=rb-1.1.0&rect=0%2C33%2C5615%2C3699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Through creative off-label uses of technology, some people have improved close relationships and their health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/pixel-girl-peeps-out-phone-720066970">KristinaZ/Shutterstock.com</a></span></figcaption></figure><p>Many Americans find themselves bombarded by expert advice to limit their screen time and break their addictions to digital devices – including enforcing and modeling this restraint for the children in their lives. However, <a href="https://scholar.google.com/citations?user=8bP4OqUAAAAJ&hl=en">over 15 years</a> of closely observing people and talking with them about how they use technological tools, I’ve developed a more nuanced view: Whether a technology helps or hurts someone depends not just on the amount of time they spend with it but on how they use it.</p>
<p>I’ve found many people who have found impressively creative ways to tailor the technologies they have to serve their values and personal objectives, improving their relationships and even their health.</p>
<p>In my forthcoming book, “<a href="https://mitpress.mit.edu/books/left-our-own-devices">Left to Our Own Devices</a>,” I introduce readers to people who pushed products beyond their intended purpose, creating their own off-label uses. Some of them turned self-help products, like smart scales and mood apps, into mechanisms for deepening relationships; others used apps like Tinder, designed to spark interpersonal connection, as an emotional pickup – gathering data to feel better about themselves without the hookup. And still others have pieced together different tools and technologies to suit their own needs.</p>
<h2>Looking beyond the rules</h2>
<p>A few years ago, for instance, my colleagues and I <a href="https://doi.org/10.2196/jmir.1371">created an app to help people manage stress</a> as part of a health technology research project. Psychotherapy and other mental health services have traditionally been offered as individual treatments, and so we expected people would use our app on their own, when they were alone. We put a great deal of effort into assuring privacy and instructed people who participated in our research that the app was for their use only.</p>
<p>But many of the participants ended up bringing the app into their conversations with others. One woman used it with her son to process a heated argument they had earlier in the day. She sat down with him and together explored the visuals in the app that represented stages of anger. They followed the app’s cognitive therapy cues for thinking about feelings and reactions – their own and each other’s. She shared it with him not as a flashy distraction, but as a bridge to help each understand the other’s perspectives and feelings.</p>
<p>The app was intended to help her change the way she thought about stress, but she also used it to address the source of her stress – making the app more effective by, in a certain sense, misusing it.</p>
<h2>New turns with familiar devices</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250033/original/file-20181211-76971-12cj5ow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Controlling the lights can send a message.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mobile-phone-womans-hand-night-city-157563695">LDprod/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Another woman I spoke with took smart lights – the ones that can change color at the tap of a button in a smartphone app – far beyond their intended functions of improving decor and energy efficiency. When she changed the color of the lights in the home she shared with her partner from white to red, it was a <a href="https://doi.org/10.1145/3027063.3053141">signal that she was upset</a> and that they needed to talk. The light color became an external symbol of the conflict between them and provided a new way to begin a difficult conversation. </p>
<p>Similarly creative thinking helped strengthen the relationships between patients and a physician I interviewed. She practiced primarily through telemedicine, meeting with patients via a secure medical videoconferencing system. She was aware that physical and emotional distance could weaken a relationship already fraught with sensitivity and an imbalance of power between an expert and a patient.</p>
<p>So she experimented with the view her camera provided of her and her surroundings. First, she showed patients a view of just her face, in front of an unadorned white wall that revealed nothing about her. Then she shifted the camera to show more of her home, which of course revealed more of herself. Patients could now see some of the art that she liked as well as elements of her home, which said something about her habits, values and personality. </p>
<p>This sharing leveled the playing field in some ways. As patients were opening up themselves to her by describing symptoms and the details of their lifestyle, they could see that she was not a lab-coat-clad expert issuing directives from an intimidating medical office – she was a real person living in an ordinary apartment. This step toward reciprocity made it easier for patients to relate to her. She believes this is part of why her patients have expressed feeling close to her and so much trust in her treatment. It was a small adaptation that brought greater rapport and connection to a technology often viewed as a poor replacement for in-person meetings.</p>
<p>With increasing attention to the effects of technologies, we should not only be concerned with their potential harms. As I’ve observed, experimenting with how – not just how much – we use technology might uncover unexpected ways to make life better.</p>
<p>
<section class="inline-content">
<img src="https://images.theconversation.com/files/248895/original/file-20181204-133100-t34yqm.png?w=128&h=128">
<div>
<header>Margaret E. Morris is the author of:</header>
<p><a href="https://mitpress.mit.edu/books/left-our-own-devices">Left to Our Own Devices: Outsmarting Smart Technology to Reclaim Our Relationships, Health, and Focus</a></p>
<footer>MIT Press provides funding as a member of The Conversation US.</footer>
</div>
</section>
</p><img src="https://counter.theconversation.com/content/107428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret E. Morris does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether a technology helps or hurts people depends not on how much time they spend with it, but how they use it.Margaret E. Morris, Affiliate Faculty in Human Centered Design and Engineering, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1035122018-10-18T10:27:53Z2018-10-18T10:27:53ZWhy health apps are like the Wild West, with Apple just riding into town<figure><img src="https://images.theconversation.com/files/240829/original/file-20181016-165924-1k4n0t3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jeff Williams, chief operating officer of Apple, talks about the Apple Watch 4 and its ability to detect irregularities in heartbeat on Sept. 12, 2018 in Cupertino, California.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Apple-Showcase/96a0a48962604e9c8b03bc2a18af12cc/33/0">Marcio Jose Sanchez/AP Photo</a></span></figcaption></figure><p>The heart rate monitor built into the new Apple Watch has sparked sharp <a href="https://www.marketwatch.com/story/apple-watch-wants-to-monitor-your-hearts-health-and-cardiologists-say-it-could-make-you-worry-instead-2018-09-13">debate</a> over its risks and benefits, even though the feature was <a href="https://www.theverge.com/2018/9/13/17855006/apple-watch-series-4-ekg-fda-approved-vs-cleared-meaning-safe">cleared</a> by the Food and Drug Administration. </p>
<p>But out of the spotlight, the FDA has been <a href="https://www.fda.gov/medicaldevices/digitalhealth/mobilemedicalapplications/default.htm">doing away with regulatory action altogether</a> on many diagnostic health apps targeting consumers, seeking to accelerate digital health adoption by defining many of these as “low risk” medical devices.</p>
<p>As the <a href="https://research2guidance.com/325000-mobile-health-apps-available-in-2017/">number of mobile health apps surged to a record 325,000</a> in 2017, app performance is going largely unpoliced, leading to what’s been dubbed a “Wild West” situation. Unfortunately for health consumers, the public can’t rely on the research community to play the role of sheriff.</p>
<p>When colleagues and I recently examined the medical literature on direct-to-consumer diagnostic apps in <a href="https://www.degruyter.com/view/j/dx.2018.5.issue-3/dx-2018-0009/dx-2018-0009.xml">a study published in Diagnosis</a>, we repeatedly found studies marred by bias, technological naïveté or a failure to provide crucial information for consumers. There was also a glaring lack of studies with actual consumers to see how they use these apps and what the impact on individual health, whether for better or worse, might be. </p>
<h2>The app will see you now?</h2>
<p>Interactive diagnostic apps now go well beyond “Dr. Google” keyword searches. They promise personalized information on whether a nagging symptom can likely be relegated to self-care or whether a visit to the doctor’s office or even the emergency room may be needed. Some of these apps become so popular that they have been downloaded <a href="https://www.degruyter.com/view/j/dx.2015.2.issue-2/dx-2014-0068/dx-2014-0068.xml?format=INT&intcmp=trendmd">tens of millions of times</a>. </p>
<p>To understand whether the promising nature of these apps is backed up by the evidence, we searched both the peer-reviewed literature and nonacademic sources. The disturbing unreliability of that evidence for the average consumer is starkly visible when you consider apps that “advise” (a carefully chosen word) whether you might have skin cancer.</p>
<p>There are hundreds of cancer-related apps. Perhaps because <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">melanoma rates</a> have been rising for decades and it’s one of the most common young adult cancers, the largest group of articles we found focused on dermatology apps. One of the most prominent is <a href="https://www.skinvision.com">Skin Scan</a>.</p>
<p>If you’re a physician or reasonably savvy consumer, Google Scholar provides the easiest access to evidence-based information. One of the first results that pops up is <a href="https://www.jaad.org/article/S0190-9622(12)01181-4/abstract">a 2013 article</a> entitled, “Skin Scan: A demonstration of the need for FDA regulation of medical apps on iPhone.” If that title suggests a certain lack of objectivity, the problem isn’t limited to dermatology. We also found an orthopedist examining <a href="http://journals.sagepub.com/doi/abs/10.1007/s11552-014-9707-x">whether a symptom checker could “guess” the right diagnosis</a>, and an ear, nose and throat doctor investigating whether an app could diagnose his own patients as well as he could.</p>
<p>That Skin Scan study sounding the alarm on regulation warned of a substantial potential for harm. Yet <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.12648">a separate study</a> of the same app published online two years later was much more positive. Did app developers pour in improvements, or was it that the first researchers used their own skin growth photos while the second group used the smartphone’s images? </p>
<p>The answer is unclear. More broadly, however, researchers often seemed unaware of the impact of basic technological distinctions such as whether an app relied on user answers to questions, “crowdsourced” answers to others or used inputs from a smartphone’s camera and sensors.</p>
<p>More troubling was researchers’ lack of understanding of the public’s pressing need for reliable information. So, for instance, a <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/1557488?__hstc=102463454.337ee291351309f40c7c5d244ce0fc11.1412640000403.1412640000404.1412640000405.1&__hssc=102463454.1.1412640000406&__hsfp=1314462730">study</a> of four smartphone apps found that their sensitivity in detecting malignant skin lesions ranged from 7 percent to 98 percent. Yet the researchers chose not to identify any of the apps by name. Similarly, few studies mentioned cost (CrowdMed, for example, charges users<a href="https://www.crowdmed.com/faqs"> a minimum of US$149 per month</a>), and those that did sometimes gave only a price range for a group of apps.</p>
<p>With scientific evidence sparse, consumers are left to rely upon online reviews – which, as <a href="https://www.scientificamerican.com/article/blood-pressure-apps-may-be-dangerously-wrong/">a just-published study of popular blood pressure apps warned</a>, can be dangerously wrong.</p>
<p>Or there’s always a random web search.</p>
<p>In the case of Skin Scan, my search found that in July the company that developed the app reported a melanoma detection sensitivity of 96 percent. That “report,” however, was part of a <a href="https://www.mobihealthnews.com/content/skinvision-gets-76m-continue-expanding-skin-cancer-app">trade publication interview</a> with SkinVision CEO Erik de Heus as the company announced it had raised another $7.6 million from investors.</p>
<p>Three years ago, a National Academy of Medicine report on diagnostic error called upon professionals to direct patients to reliable online resources. However, we found that search terms used by the National Library of Medicine’s PubMed Life Sciences search engine have lagged the digital health revolution, and medical journals do a hit-or-miss job of simply indexing every app mentioned in an article. The English National Health Service has launched <a href="https://digital.nhs.uk/news-and-events/latest-news/nhs-apps-library-reaches-70-apps-in-honour-of-the-nhs-birthday">an Apps Library</a> to cut through the confusion, but there’s no similar resource in this country. </p>
<h2>Is there a way to bring some order, if not law?</h2>
<p>Some web-savvy researchers at sites like iMedicalApps are advising physicians about apps they can use themselves or others they can trust to recommend to their patients. Others trying to bring law and order to the wide-open health app field have suggested various frameworks, such as combining stakeholders’ expertise in collaborative health app rating teams. The goal would be to get innovators, policymakers and evidence-generators to jointly help corral confusing and contradictory information.</p>
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<img alt="" src="https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=855&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=855&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=855&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1074&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1074&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1074&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Gunslinger, gambler and lawman Wyatt Earp.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wyatt-earp-18481929-legendary-western-hero-242817085?src=QAAMoEDfBMbd8HsoxVUcKg-1-0">Everett Library/Shutterstock.com</a></span>
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<p>And as the debate over using Apple Watch data to measure heart health shows, FDA approval alone doesn’t remove the risk of consumers jumping to the wrong conclusion about what the information they’re receiving actually means. Nonetheless, as the pioneering stage of health apps starts to settle into the medical mainstream, the health of the American public requires apps and devices we know we can trust.</p><img src="https://counter.theconversation.com/content/103512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael L. Millenson receives funding from the Gordon and Betty Moore Foundation.</span></em></p>As health care grows more digital, an array of health apps promise to track steps, count heartbeats and look at moles. But without more FDA oversight, could we be shooting ourselves in the foot?Michael L. Millenson, Adjunct Associate Professor of Medicine, Feinberg School of Medicine, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/905652018-01-30T12:31:19Z2018-01-30T12:31:19ZHow neoliberalism is damaging your mental health<figure><img src="https://images.theconversation.com/files/204002/original/file-20180130-107690-ryolqu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-commuters-230462692?src=ZQtKYr-jigzy9YJ6L46lyg-1-2">Lance Bellers/Shutterstock.com</a></span></figcaption></figure><p>There is a widespread perception that mental ill health is on the rise in the West, in tandem with a prolonged decline in collective well-being. The idea that there are <a href="https://www.counterpunch.org/2017/10/18/mental-health-and-neoliberalism-an-interview-with-william-davies/">social and economic causes</a> behind this perceived decline is increasingly convincing, amid what has been termed the <a href="https://www.opendemocracy.net/uk/austerity-media/johnna-montgomerie/beyond-zombie-economy">zombie economics</a> and grinding <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/mental-health-figures-depression-anxiety-children-tory-government-theresa-may-pledge-end-stigma-a7517531.html">austerity</a>, which have followed the global financial crash. </p>
<p>In particular, there is growing concern that the conditions and effects of neoliberalism – the enervating whirl of relentless privatisation, spiralling inequality, withdrawal of basic state support and benefits, ever-increasing and <a href="https://books.google.com/books/about/Resisting_Work.html?id=FeqnAwAAQBAJ&source=kp_cover">pointless work demands</a>, <a href="https://theconversation.com/being-more-media-savvy-wont-stop-the-spread-of-fake-news-heres-why-77888">fake news</a>, <a href="https://www.amazon.co.uk/Non-Stop-Inertia-Ivor-Southwood-ebook/dp/B004XCAYVQ/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1516649641&sr=1-1&keywords=ivor+southwood">unemployment and precarious work</a> – is partly to blame. Perhaps most wearying are the invasive yet distant commands from media, state institutions, advertisements, friends or employers to self-maximise, persevere, grab your slice of the diminishing pie, “because you are worth it” – although you must constantly prove it, every day.</p>
<p>In our work and leisure we are urged to feign permanent enthusiasm amid radically lowered expectations. <a href="https://philpapers.org/rec/BOUNNN">Neoliberal newspeak</a> hollows out the terminology of achievement, mandating boasts about personal “excellence” and “dedication” as actual possibilities for achievement diminish and work becomes stripped of meaning. At my institution, the cleaners’ uniforms are emblazoned with inscriptions announcing that they deliver their work with “passion, professionalism and pride” – as if it were reasonable to demand “passion” from a cleaner on minimum wage whose workload has doubled since 2012.</p>
<h2>‘Free choice’</h2>
<p>A colleague recently informed me that young children in Bermuda make amends for misbehaviour by intoning, “I want to make good choices”. As criminologists Steve Hall, Simon Winlow and Craig Ancrum have explored, “choices” become life-or-death when a bad choice or two can turn you into <a href="https://books.google.co.uk/books/about/Criminal_Identities_and_Consumer_Culture.html?id=8DfoOoQd3M8C&source=kp_cover&redir_esc=y">an irremediable “loser”</a>. We are told that structural barriers to aspiration, achievement and contentment will melt away in our fantasy “choice” economy.</p>
<p>But this falsehood of “free choice” demotivates and depoliticises. In such a world, depression, anxiety, narcissism (the primitive defence of the infantile self against overwhelming attack) are entirely logical responses. It has been <a href="http://www.palgrave.com/gb/book/9781137463067">confirmed</a> that neoliberal societies make their citizens physically as well as mentally sick; the effect is magnified the more unequal the society and the more unprotected its citizens from free-market “competitiveness”.</p>
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<img alt="" src="https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204010/original/file-20180130-107700-dotil6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Non-stop distraction.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-yorkusa-august-172016-times-square-490246627?src=i3nGNLM7Q-GqDWdcykzh9A-1-2">Kamira/Shutterstock.com</a></span>
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<p>Depression in this context may appear almost self-protective: an opt-out from an unwinnable set of continual competitions. The recent <a href="https://psychnews.psychiatryonline.org/doi/10.1176/pn.42.19.0018">rise in diagnoses of mental illnesses</a> and “<a href="https://www.nhs.uk/news/2013/11november/pages/experts-argue-that-adhd-is-overdiagnosed.aspx">developmental disorders</a>” involving states of agitation and hyperstimulation is similarly interesting. In the case of ADHD, for example, a person’s hyperactivity and distractibility render them officially “disordered” or even disabled, to the extent that they are supposedly unable to cope with a hyperstimulating, late-capitalist environment. Yet they are, in another sense, entirely in tune with an economy of non-stop distraction, in which attention is repeatedly grabbed at and <a href="https://www.mindful.org/attention-become-biggest-commodity/">financially exploited</a>.</p>
<h2>Self-measurement</h2>
<p>Neoliberalised healthcare requires every patient (or rather, “client” of healthcare “services”) to <a href="https://pure.qub.ac.uk/portal/files/120912347/Responsibility_and_Well_Being.pdf">take responsibility</a> for her own state or behaviour. Mental healthcare is therefore <a href="https://www.centreformentalhealth.org.uk/recovery-quality-and-outcomes">being reframed</a> as a series of “outcomes” geared at measurable improvement which the “service user” must manage by themselves as far as possible. Access to psychiatric diagnosis and support from public health services (and also within private or employer-run occupational healthcare schemes) sometimes depends on completion of a mood or symptom diary using <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608852/">smartphone or Fitbit self-tracking techniques</a>. And there may well be more punitive future consequences for failure to self-track, as employers and perhaps benefit agencies <a href="https://theconversation.com/big-data-could-bring-about-workplace-utopia-or-the-office-from-hell-86967">gain more power</a> to command this sort of performance from workers. </p>
<p>This “mHealth” app “<a href="http://www.who.int/goe/publications/goe_mhealth_web.pdf">revolution</a>” also shows us how mental illness and anxiety about mental health itself may be deftly commodified and financialised. Measurement apps like <a href="https://moodgym.com.au/">MoodGym</a> are purchased by the UK’s National Health Service for use with patients. As the patient self-monitors, she is persistently encouraged to demonstrate “recovery”, regardless of <a href="http://www.independent.co.uk/voices/mental-health-treatment-tory-government-nhs-funding-access-work-benefits-a8037331.html">long-term impairment</a>. It is telling, too, that recovery is based on “<a href="http://www.independent.co.uk/news/uk/politics/fit-to-work-wca-tests-mental-health-dwp-work-capability-assessment-benefits-esa-pip-a7623686.html">fitness for work</a>” since the worthwhile adult is engaged in work activity <a href="http://www.zero-books.net/books/non-stop-inertia">at all times</a>. </p>
<p>This focus on work-readiness partially explains the relative paucity of children’s mental health services in the UK, which are <a href="https://www.theguardian.com/society/2017/aug/03/xs-case-is-only-latest-in-shocking-saga-of-childrens-mental-health-care">catastrophically low in beds</a> and were among the first to be <a href="https://www.theguardian.com/society/2012/mar/15/devon-nhs-childrens-services-privatisation">privatised</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204005/original/file-20180130-107713-19i2ihr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Rushing to work.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rush-hour-511342570?src=eZ6h6ssNN5l1SHYq_i_KOQ-1-45">estherpoon/Shutterstock.com</a></span>
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<h2>Care – or risk management?</h2>
<p>Neoliberal states divest themselves of the costs of care by individualising and privatising care duties. People displaying troubling symptoms are divided into the “dangerous”, against whom punitive or authoritarian containment methods may be used, and those left to cope with what resources they or their families have left. </p>
<p>The 1970s-80s saw the closure of the last asylums in the UK and the welcome end of long-term institutionalisation for thousands written off as “mad” and without rights to liberty. As the state also made significant savings through the transfer of patients back into “the community”, the situation <a href="http://webspace.qmul.ac.uk/spriebe/publications/pub%20by%20year/2007/2007%20-%20Deinstitutionalisation%20and%20reinstitutionalisation%20-%20major%20changes%20in%20the%20provision%20of%20mental%20heathcare%20Psychiatry%206,%20313-316.pdf">appeared win-win</a>. But half a century after “<a href="http://www.tandfonline.com/doi/abs/10.1080/00207411.1982.11448923">care in the community</a>” became the norm for most chronically ill patients, effective community treatment is stymied by <a href="http://www.bbc.co.uk/programmes/b08f0htn">slashed budgets, low staffing levels and morale</a>. Systematically defunded NHS psychiatric services struggle to fulfil the legal burdens placed on them to provide basic care. </p>
<p>Increasingly, it is <a href="https://theconversation.com/changes-to-controversial-police-mental-health-act-powers-may-only-be-a-sideways-step-88504">the police</a> who handle “front-line” <a href="https://www.theguardian.com/public-leaders-network/2017/oct/28/mental-health-nhs-crisis-police-struggle-public-sector-cuts">mental health crises</a> in the UK. Prisons “<a href="http://www.prisonreformtrust.org.uk/ProjectsResearch/Mentalhealth">warehouse</a>” the mentally distressed. Meanwhile in US prisons “mental health” wards <a href="https://www.reddit.com/r/NoStupidQuestions/comments/2iln8z/when_i_was_put_in_jail_a_police_officer_asked_me/">house</a> suicidal or otherwise mentally or emotionally unstable prisoners, who are placed in special “suicide-proof” garments and cells, sometimes in prolonged isolation. Any pretence of care will ultimately recede in favour of protection against litigation in the prison context. “<a href="http://www.bostonmagazine.com/news/2013/02/01/prison-suicide-safety-smocks/">Suicide smocks</a>” are now placed on patients who appear suicidal or psychotic on admission or during incarceration in many US states, and are worn even in court.</p>
<p>What ways, then, are there to resist these worrying trends? Black humour is one way to deal with systems which command “positivity” while simultaneously informing you at every stage that you are already a “loser”. But collectivity of various kinds will be our best protector. As psychologist Paul Verhaeghe <a href="https://www.psychologytoday.com/blog/there-are-free-lunches/201502/neoliberalism-viewed-the-couch">predicts</a>, the age of the “<a href="https://press.princeton.edu/titles/5715.html">utterly unrelieved individual</a>” has (probably) reached its limit. What lies beyond the limit, particularly for those already broken or caught in the punitive grip of incarcerative “care”, is less clear.</p><img src="https://counter.theconversation.com/content/90565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Cain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Can today’s crisis in mental health be seen as the result of neoliberalism, the 2007/08 financial crisis and the austerity policies that followed?Ruth Cain, Senior Lecturer in Law, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/832452017-08-31T10:15:34Z2017-08-31T10:15:34ZNew app detects pancreatic cancer in the early stages<figure><img src="https://images.theconversation.com/files/183978/original/file-20170830-30776-sbutmi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">BiliScreen, used for detecting signs of jaundice in a person's eye.</span> <span class="attribution"><a class="source" href="https://www.eurekalert.org/multimedia/pub/149069.php?from=368931">Dennis Wise/University of Washington</a></span></figcaption></figure><p>Pancreatic cancer is one of the most deadly cancers. It has a five-year survival of <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer">just 3%</a>, and a ten-year survival of <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer">less than 1%</a>. The prime reason for these depressing figures is that the disease is very difficult to detect in the early stages. By the time it is detected, it is often incurable. But help may be at hand.</p>
<p>Researchers at the University of Washington have developed an app called BiliScreen that can detect pancreatic cancer at the early stages. A build-up of bilirubin – which causes the eyes and skin to yellow – is one of the early indicators of the disease. The app calculates the amount of bilirubin in the whites of a person’s eyes. The user takes a selfie and a machine-learning algorithm – a type of artificial intelligence – performs the diagnosis.</p>
<p>Bilirubin is produced when the liver breaks down old red blood cells. Jaundice, the yellow discoloration of the skin and sclera (the white part of the eyes), results from an excess of this substance. This discolouration is only visible when jaundice is quite severe. However, BiliScreen produces an estimate of a person’s bilirubin level even at levels too low to be detected by the naked eye. </p>
<p>At the moment, the user of the app needs to use a special box (similar to a VR headset) to block out light from other sources, but the makers of the app hope that future versions won’t need this additional equipment. </p>
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<p>A <a href="https://ubicomplab.cs.washington.edu/pdfs/biliscreen.pdf">clinical study</a> of BiliScreen, involving 70 participants, found that the app has a high sensitivity (90%). This is the ability of a test to correctly identify people with a disease. In this case, 90% of the people with abnormally elevated bilirubin levels were correctly identified. The app also had high specificity, meaning there were few “false positives” – healthy people wrongly identified as having a disease. </p>
<p>BiliScreen can also be used to detect other reasons for jaundice, such as <a href="http://www.nhs.uk/Conditions/Hepatitis/Pages/Introduction.aspx">hepatitis</a> and <a href="http://www.nhs.uk/conditions/Gilbertssyndrome/Pages/Introduction.aspx">Gilbert’s syndrome</a>, a common, harmless liver condition in which the liver doesn’t properly process bilirubin. </p>
<p>An earlier version of the app – called <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=BiliCam">BiliCam</a> – was used to detect jaundice in newborns by taking snapshots of their skin. </p>
<h2>Not a doctor</h2>
<p>BiliScreen joins a growing list of apps used for diagnosis, including other cancers. For example, there are a number of apps that screen for skin cancer. Some of these apps use fractal geometry to assess the shape of moles. </p>
<p>A scientific <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjd.13665/full">review of these melanoma-detecting apps</a> found that some of them have high sensitivity and specificity (73% and 83% respectively). However, the study found that a diagnosis given by a dermatologist and pathologist, if a biopsy is needed, gives a higher sensitivity and specificity – 88% and 97% respectively.</p>
<p>Although diagnostic apps will never take the place of doctors, they can act as useful early detectors of disease. And, in the case of BiliScreen, they are more convenient and less invasive than the usual test for jaundice, which involves a trip to the doctor and a blood draw. But whether people will be disciplined enough to regularly use a growing range of apps to screen for diseases, when they’re feeling in the peak of health, remains to be seen.</p><img src="https://counter.theconversation.com/content/83245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pinar Uysal-Onganer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An app could help diagnose one of the most deadly cancers at the early stages using eye-scanning technology.Pinar Uysal-Onganer, Lecturer in Molecular Biology, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/766202017-05-03T14:42:55Z2017-05-03T14:42:55ZAlphabet’s new plan to track 10,000 people could take wearables to the next level<figure><img src="https://images.theconversation.com/files/167384/original/file-20170501-17313-1vlzuwx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What can your data tell us?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/280924796?size=huge_jpg">www.shutterstock.com</a></span></figcaption></figure><p>Verily – the life sciences research arm of Google parent company Alphabet – wants to track the health of 10,000 people. </p>
<p>On April 19, the group announced that it was starting to recruit for Project Baseline, in partnership with Duke and Stanford. Over the course of four years, Project Baseline will sequence participants’ genomes, test their blood, survey them and track biometric data such as heart rate and activity level on a Study Watch – basically, a Fitbit on steroids. </p>
<p>What I find perhaps most interesting is their plan to collect thousands of medical images, which my colleagues and I also are doing in a big data analysis of childhood brain development. </p>
<p>Ventures like Project Baseline open up new opportunities in health care, both for the researchers working with big data and for consumers who want more sophisticated ways to track their health. </p>
<p>This allows us to start asking questions like: “How should we modify our behavior based on real-time interactions? Is there something relatively painless that anyone can do to alter their risk for particular medical problems? What can make us a healthy society that may be easier or more effective than the current recommendations?” </p>
<h2>Project Baseline in context</h2>
<p>Ten thousand people is a lot. To put that number into perspective, Project Baseline will follow enough participants to fill First Tennessee Park, Nashville’s new minor league baseball stadium. </p>
<p>In the U.S., we define a rare disease as something that strikes about five in 10,000, so several rare diseases will likely be seen in Project Baseline. Hundreds of other participants will likely develop more common illnesses, such as heart disease or diabetes, over the study’s four years. </p>
<p>Big data is nothing new for medicine. Project Baseline has been compared with the Framingham Heart Study, a project that tracked 5,209 subjects from 1948 on. Just this year, Stanford University researchers presented <a href="https://www.nature.com/nature/journal/v542/n7639/pdf/nature21056.pdf">a paper in Nature</a> that analyzed 129,450 clinical images to detect skin cancer.</p>
<p>Meanwhile, the <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169649">U.K. Biobank</a> study is currently following the health of 500,000 adults. Just a day after the Project Baseline announcement, <a href="http://www.gla.ac.uk/news/headline_522765_en.html">a study using U.K. Biobank data</a> indicated bicycling to work was associated with a 46 percent lower risk of heart disease. </p>
<p>My team is working with brain scans of up to 10,000 children, to look at how brain growth correlates with disease status, age, phenotype, genetics and other characteristics. As a biomedical engineer, I am focused on building tools that allow neuroscientists and psychiatrists to ask the hard questions and discover others we didn’t know we could or should ask. We begin to model and understand differences, and Verily is going to see the same sort of thing.</p>
<p>Researchers need large amounts of data to test many ideas and uncover subtle relationships. The less well-framed an idea is, the more data we need to collect, in order to better understand the connections between genetics, environment and health. </p>
<h2>New applications</h2>
<p>Where Project Baseline stands to break new ground in medical research that tracks people over time is in its use of wearable devices.</p>
<p>Project Baseline continues a 2014 pilot study of 200 healthy participants that included both a comprehensive health assessment and data collection through wearable devices.</p>
<p>The new study could help advance Google’s wearable devices from general wellness products – which are not regulated by the U.S. Food and Drug Administration (FDA) – to medical devices that capture specific information, with their safety and benefits proven to the FDA. </p>
<p>That’s really exciting because, while everyone loves their Fitbit, we don’t know which diseases could be mitigated by using it. We could see Fitbit and similar devices being used the way doctors advise patients to use the <a href="http://khn.org/news/self-health-care-kiosks-walmart/">automated blood pressure cuffs</a> at Walgreens: Eat a certain way, exercise a certain amount, take your medication and check the results on your device. </p>
<p>Moreover, with Alphabet/Google’s track record of affordable access to data resources (think Google Maps), Project Baseline could be a huge win for smaller companies seeking to build businesses around personal health devices. It also could open up better medical information to those in rural areas or those studying rare diseases.</p>
<p>There are implications as well for radiology, since Project Baseline will also collect medical imaging on its participants. Everybody loves to see an image. However, there is a lot of information in images that we’d like to better automatically pick out. Just as big data can improve personalized health devices, it can also boost our ability to extract subtle signs of disease in images. </p>
<h2>Doing big data right</h2>
<p>My team looks at data in anonymous ways, in order to protect the privacy of the patients who donated it. For example, in addition to removing patient names, we are careful to protect dates of visits and other information unique to a patient.</p>
<p>Verily’s newest project could have exciting implications for groups like ours, as the organization promises to provide anonymous data to qualified researchers. It will be critical for Verily <a href="https://victr.vanderbilt.edu/pub/biovu/">to build trust</a> in the anonymous nature of this data. </p>
<p>Patients generally don’t mind being seen at a teaching or research hospital, knowing that doctors will learn from their care, but they absolutely don’t want their insurance agents or co-workers to know what treatments they might be receiving. The same goes for real-time health data like the kind that Project Baseline is collecting. Verily must ensure that there is no way to connect the data back to individual subjects, just as we are doing. </p>
<p>In addition, the deep level of these medical records can open unlimited possibilities in computer-guided health care. But, for any such work, it’s essential that you are able to check your results. If, for instance, we suspect that a particular brain area develops earlier than another, we can design the model in one data set, then show with another subgroup from the data that, in this population that we studied, our finding still holds true. Project Baseline will provide a wealth of data to develop new hypotheses and to replicate results from other studies.</p><img src="https://counter.theconversation.com/content/76620/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bennett Allan Landman receives funding from the National Science Foundation (NSF) and the National Institutes of Health (NIH). </span></em></p>Project Baseline opens up new opportunities in health care, both for the researchers working with big data and for consumers who want more sophisticated ways to track their health.Bennett Allan Landman, Associate Professor of Electrical Engineering, Computer Science, Biomedical Engineering, Radiology, Image Science, and Psychiatry and Behavioral Sciences, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/698702016-12-22T19:08:56Z2016-12-22T19:08:56ZDownside of fitness trackers and health apps is loss of privacy<figure><img src="https://images.theconversation.com/files/150842/original/image-20161219-24263-ju0wsz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Do you know how the data from your running app is being used?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-538639498/stock-photo-jogger-using-smart-phone-female-runner-holding-cell-phone-while-taking-break.html?src=oBtvZ-vItpekJYULp7h_Gw-1-20">from www.shutterstock.com/Artfully Photographer</a></span></figcaption></figure><p>At the touch of an app, Emma tracks her diabetes. She enters food, exercise, weight and blood sugar levels, then sets up medication reminders.</p>
<p>Suzanne uses the latest <a href="https://theconversation.com/au/topics/wearable-technology-5180">wearable device</a> to track her running route and distances walked. As she has not slept too well in the past month, she also records her sleep patterns.</p>
<p>Richard takes his tablet for schizophrenia. The tablet contains a sensor that communicates with central health databases to tell health professionals if he has taken his medication.</p>
<h2>The participatory health revolution</h2>
<p>This is the participatory health revolution, where people use apps and wearable devices, and swallow sensors, to keep track of their health and well-being, to take control in the name of empowerment.</p>
<p><a href="https://cybersecuritystrategy.dpmc.gov.au">Latest figures</a> indicate two in three Australians have a social media account and most spend almost the equivalent of one day a week online. In 2017, 90% of Australians will be online and by 2019 most households will have an average of 24 home devices (like alarms, phones, cars and computers) connected online.</p>
<p>Researchers <a href="http://www.tandfonline.com/doi/full/10.1080/14461242.2016.1228149?src=recsys">say</a> there are currently more than 160,000 medical and health apps; an estimated 485 million wearable devices <a href="http://link.springer.com/article/10.1007/s13347-016-0215-5">are projected</a> to be released a year by 2018.</p>
<p>All of this self-tracking and connectivity has implications for health care delivery. It is also changing how researchers collect and analyse data.</p>
<p>The public have now become the study subjects <em>and</em> the collection tools. People can also share this data in new ways.</p>
<p>Emma’s app data can be used during her health care consultations to guide her diabetes treatment and fill her medical records. So, Emma has become an active partner in how her health care is managed.</p>
<p>Emma could also join an online community to share this personal health information publicly. She can use <a href="https://www.patientslikeme.com">new platforms</a> to donate data for the public good.</p>
<p>The idea is that someone else like Emma, perhaps recently diagnosed with diabetes, or even diabetes researchers, will access this information and use it for the greater good. Yet, the implications of this data sharing have not received much attention.</p>
<h2>Emerging risks</h2>
<p>Emma chooses to upload her personal health information to one of these data sharing websites; she is in control and empowered. As the website promises anonymity, she thinks there’s little risk. But there are risks, some unintended. </p>
<p>Some <a href="http://btlj.org/data/articles2015/vol30/30_3/1741-1806%20Hoffman.pdf">researchers</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/22473380">suggest</a> publicly available datasets could be combined and analysed to identify negative behaviours linked with particular conditions. These negative behaviours may then be linked with particular social or cultural groups and increase the potential for stigmatisation.</p>
<p>The flow and movement of data is also creating more questions around consent and privacy. Many people remain unaware of where data is going and how it is then used. A <a href="http://www.pc.gov.au/inquiries/current/data-access/draft/data-access-overview-draft.pdf">recent draft report</a> indicates 13% of Australians own a wearable device like the one Suzanne uses to track her running, walking and sleep.</p>
<p>How many people know the well-being and location data these wearable devices collect travels back to the companies that sell them and is used in ways we know little about?</p>
<h2>How participatory is this?</h2>
<p>A <a href="http://www.ey.com/Publication/vwLUAssets/EY_-_Health_reimagined:_a_new_participatory_health_paradigm/$FILE/ey-health-reimagined-2016.pdf">recent report</a> paints a picture of Australians poised to embark on this revolution.</p>
<p>It found 87% of people would make appointments online, 74% would use home diagnostic kits for cholesterol, 70% would order prescriptions using a mobile app, 61% would consult with their doctor by video on their computer and 70% would communicate with a doctor or other health professional by email, text or social media.</p>
<p>But is this for everyone? Researchers <a href="http://www.invent-journal.com/article/S2214-7829(16)30019-7/abstract">argue</a> many health and medical apps are mental health specific but few people use them. People are more likely to download a mental health app when a health professional recommends it rather than download it themselves.</p>
<p>Until now, most <a href="http://www.ey.com/Publication/vwLUAssets/EY_-_Health_reimagined:_a_new_participatory_health_paradigm/$FILE/ey-health-reimagined-2016.pdf">discussion</a> has been on people’s capacity to use apps and wearable devices to promote their autonomy as truly empowered citizens.</p>
<p>But there is equal concern that new digital technologies may erode autonomy. One example is through the data movement to businesses without individual knowledge or consent. </p>
<p>Another example might be in Richard’s case of monitoring his use of schizophrenia medication, with its potential for greater surveillance and control, a form of digital paternalism.</p>
<h2>Ethical guidance</h2>
<p>Ethical guidance is needed to mitigate these emerging risks of participatory health. The unprecedented opportunities for public involvement in tracking and sharing data means we need to ensure participation is more than mere data generation and actually achieves true partnership and empowerment.</p>
<p>Research institutions will need to establish guidelines to determine the trustworthiness and legitimacy of publicly shared data. Research ethics committees and the research community will need to discuss where the boundaries lie between being a data subject and data collector.</p>
<p>We need to think about who owns data and how rights to use that data will be granted.</p>
<p>There also needs to be a better understanding of the impact of mental health apps and new technological sensor devices for people living with mental illness.</p><img src="https://counter.theconversation.com/content/69870/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria J Palmer receives funding from the Victorian Government Mental Illness Research Fund and the National Health and Medical Research Council. </span></em></p>Apps and wearable devices promise greater participation and empowerment in health care. But what are we risking when we take part in this new era of participatory health?Victoria J Palmer, Postdoctoral Researcher Applied Ethics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/585082016-05-30T20:21:16Z2016-05-30T20:21:16ZHow to pick the good from the bad smartphone health apps<figure><img src="https://images.theconversation.com/files/121844/original/image-20160510-20713-1sk17zp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mobile phone is not a medical device – so don't believe apps that say they are. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jasonahowie/8585047526/">Jason Howie/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>With an estimated 100,000 health and fitness apps available on the two leading smartphone platforms, iOS and Android, it seems there is an app for everything – from tracking your bowel movements, to practising your pimple-popping technique. </p>
<p>However, a number of apps are starting to raise the ire of government regulators. Brain-training juggernaut Lumosity was recently <a href="https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges">fined US$2 million</a> (A$2.7 million) for making unfounded claims that its app could improve work performance and delay the onset of Alzheimer’s.</p>
<p>“Ultimeyes”, a vision-training app touted to “turn back the clock on your vision” and reduce the need for glasses and contact lenses, was <a href="https://www.ftc.gov/news-events/press-releases/2016/02/ftc-approves-final-order-prohibiting-ultimeyes-manufacturer">fined US$150,000</a> for misrepresenting scientific research and ordered to stop making deceptive marketing claims. </p>
<p>“MelApp” claimed to be able to assess melanoma on the basis of a photograph of the mole and some other inputted information, analysed using “patent protect, highly sophisticated mathematical algorithms and image pattern recognition technology”. The US <a href="http://www.mobileworldlive.com/apps/news-apps/melanoma-diagnostic-app-barred-making-deceptive-claims/">Federal Trade Commission (FTC) found its claims lacked scientific evidence</a>, leading to a hefty fine and strict instructions regarding future marketing.</p>
<p>To date, authorities have primarily pursued rogue health apps from a consumer rights perspective, on the basis of misleading advertising – that is, the apps claiming to do something when, in fact, they may be ineffective – rather than from a medical-safety perspective.</p>
<p>In the US, the Food and Drug Authority (FDA) is traditionally responsible for approving medical devices. However, apps that essentially allow a smartphone to become a medical device present a grey area. The FDA has issued <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm369431.htm">guidelines</a>, but compliance is primarily voluntary. Only a minuscule percentage of apps available in the Apple and Google Play stores have <a href="http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf#page=26">FDA approval</a>. </p>
<p>Most apps that present themselves as substitute medical devices offer fine-print disclaimers, such as “not FDA cleared” and “for entertainment purposes”. This information is buried in the expandable description of the app on the app store, which most users will never read. </p>
<p>An interesting case in point is the hugely popular “Instant Blood Pressure” app, which has sold an estimated 148,000 copies. This app and others like it claim to read blood pressure – “no cuff required” (instead, the app supposedly uses the phone’s microphone pressed against the chest and a finger over the camera).</p>
<p>Independent testing published in <a href="http://archinte.jamanetwork.com/article.aspx?articleid=2492134">March’s JAMA Internal Medicine</a> found the app failed to identify high blood pressure in around 80% of true cases. </p>
<p>This is disturbing, considering such apps are likely to appeal to people with high blood pressure. It is conceivable that users could delay seeking medical attention on the basis of false normal-range readings, with potentially dire consequences. </p>
<p>So in this ever-expanding and largely unregulated app landscape, how can you go about distinguishing the good health apps from the bad?</p>
<h2>1. Does the app use the phone’s built-in hardware to perform medical diagnoses?</h2>
<p>Medical diagnostic equipment is highly specialised and specific, stringently tested and usually interpreted by skilled professionals. It’s therefore highly dubious that a smartphone app can match these diagnostic capabilities, based on the in-built microphone and camera, and interpretation by a commercial algorithm (which is typically unpublished and unproven). </p>
<h2>2. Does the app use the phone’s in-built hardware to treat a medical condition?</h2>
<p>While apps exist that claim to treat conditions such as pain, acne and seasonal affective disorder using smartphones’ vibrations and/or screen light (yes, really, and they’ve had <a href="https://www.ftc.gov/news-events/press-releases/2011/09/acne-cure-mobile-app-marketers-will-drop-baseless-claims-under">thousands of paying downloads</a>), such outputs lack scientific evidence and are extremely unlikely to be of therapeutic quality or intensity.</p>
<h2>3. Is the app from a reputable source?</h2>
<p>Affiliation with a reputable peak body, university or government department suggests the app is likely to be trustworthy. Beware, though, sneaky developers have been caught out inaccurately associating their app with <a href="http://www.wired.com/2014/07/medical_apps/">leading universities</a> (when, in fact, they simply studied there years earlier). Also, endorsement from obscure bodies shouldn’t convey confidence.</p>
<h2>4. Does the app use self-help methods?</h2>
<p>Self-monitoring, goal-setting and feedback are well-established techniques for boosting motivation and facilitating behaviour change. Such techniques are <a href="http://download.springer.com/static/pdf/611/art%253A10.1186%252Fs12966-014-0097-9.pdf?originUrl=http%3A%2F%2Fijbnpa.biomedcentral.com%2Farticle%2F10.1186%2Fs12966-014-0097-9&token2=exp=1462319918%7Eacl=%2Fstatic%2Fpdf%2F611%2Fart%25253A10.1186%25252Fs12966-014-0097-9.pdf*%7Ehmac=cdb64f75235e27b0352373a41871da66e35ad29e4d87a6418a57b4bdb41efd47">commonly offered in health apps</a> and are likely to be useful for both people working on health goals that they wouldn’t normally see a doctor for (such as increasing fitness) and people self-managing a health condition in consultation with their doctor. </p>
<h2>5. Does the app have bad reviews?</h2>
<p>If reviews are bad, the app probably doesn’t work well, so give it a miss. However, good reviews aren’t necessarily a sign that an app is fundamentally trustworthy. </p>
<h2>6. Might you put off seeing a doctor based on advice from the app?</h2>
<p>Simply, don’t. While <a href="http://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0359-9">many apps contain sound medical information</a>, they are no substitute for a consultation with a doctor. If you have a health concern, you should see a GP.</p>
<p>The landscape of smartphone health apps is quickly evolving, and regulators are struggling to keep pace. There are many outstanding apps to help people improve their health. My advice? Have fun experimenting with health and fitness apps – just be sure to bring along a healthy dose of common sense and scepticism. </p>
<p>And remember, an app does not put a doctor and specialist medical lab in your pocket.</p><img src="https://counter.theconversation.com/content/58508/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Maher receives funding from the National Health and Medical Research Council and the National Heart Foundation. In the past, she has received funding from the Australian Research Council, the South Australian Department of State Development, SA Health, Coca-Cola, Channel 7 Children's Research Fund and the Cerebral Palsy Alliance Research Foundation.
Carol Maher has engaged with the software development company, Portal Australia, to develop physical activity smartphone apps.</span></em></p>With an estimated 100,000 health and fitness apps available, it seems there is an app for everything – from tracking your bowel movements to practising your pimple-popping technique.Carol Maher, National Heart Foundation Senior Research Fellow in Physical Activity, Sedentary Behaviour and Sleep, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/491712015-10-27T16:49:56Z2015-10-27T16:49:56ZIt’s not too late to turn the NHS apps library disaster into an opportunity<figure><img src="https://images.theconversation.com/files/99860/original/image-20151027-4994-unnyix.jpg?ixlib=rb-1.1.0&rect=0%2C619%2C4500%2C3247&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's still potential for health apps, but good ones.</span> <span class="attribution"><span class="source">Macrovector/shutterstock.com</span></span></figcaption></figure><p>The NHS has been keen to use the proliferation of smartphones as a way to encourage people to maintain their health through smartphone apps. There are more than <a href="http://ebooks.iospress.nl/publication/40182">97,000 health-related apps</a> available for smartphones, so NHS chiefs correctly realised that someone had to vet the good from the bad. Since 2013 the NHS <a href="http://www.nhs.uk/pages/healthappslibrary.aspx">has run a library</a> of 220 approved, health-related apps that it encourages us to use.</p>
<p>Or rather it did, <a href="http://www.computerweekly.com/news/4500255254/NHS-Health-Apps-Library-to-close">until it was closed</a> after some <a href="https://theconversation.com/the-problem-with-most-nhs-recommended-mental-health-apps-theres-no-evidence-they-actually-work-49021">recent negative publicity</a>, including some studies that cast doubt on whether many of the apps had any beneficial effects at all and others that revealed that the apps were leaking sensitive personal data to all and sundry.</p>
<p>While it was only a two-year pilot, the <a href="http://apps.nhs.uk/review-process/">review criteria</a> used by the library to grade the apps was described as “<a href="http://www.computing.co.uk/ctg/news/2415698/caredata-nhs-choices-and-now-apps-could-it-be-three-failures-in-a-row-for-tim-kelsey">weak</a>” and of “<a href="http://www.theguardian.com/politics/2015/jun/26/nhs-patient-data-plans-unachievable-review-health">low standard</a>”, leading to serious concerns over the quality of apps.</p>
<h2>A library full of problems</h2>
<p>A six-month research <a href="http://www.biomedcentral.com/1741-7015/13/214">study of 79 apps</a> from the library certified as clinically safe and trustworthy found that 66% of them also sent information that could identify the user unencrypted over the internet, while four apps (5%) sent both identifying data and health data without any encryption. Clearly this is a serious risk to the user’s privacy and security.</p>
<p>Back in 2014 the privacy campaign group MedConfidential <a href="http://www.theregister.co.uk/2015/07/09/credibility_of_nhs_endorsed_apps_in_question/">identified</a> several NHS-approved apps that didn’t even meet the basic review criteria set by the NHS.</p>
<p>Another <a href="https://www.researchgate.net/publication/273060024_Developing_a_quality_control_framework_for_mobile_app_based_health_behaviour_change_interventions_Adapting_the_NICE_behaviour_change_guidance">study</a> compared methods used by apps aimed at changing behaviour (such as stopping smoking) to those endorsed by the <a href="https://www.nice.org.uk/guidance/ph49/resources/guidance-behaviour-change-individual-approaches-pdf">National Institute for Health and Care Excellence</a>. While all apps used a recognised behaviour change technique, they focused more on starting the behaviour change and less on maintaining the new behaviour, meaning the apps were of questionable use over the long term – the role they’d be expected to play. Other apps in the NHS App Library employ techniques such as NLP that have <a href="http://ebmh.bmj.com/content/early/2013/05/29/eb-2013-101355.extract">not stood up to peer review</a>. </p>
<p>The app accreditation process for the NHS library is seriously deficient if apps it recommends display this range of problems. In fact a look at the apps that were available from the library and feedback from users shows that some had technical issues, including the official NHS Quit Smoking app and NHS Health and Symptom Checker. Others such as Babylon Health – which promotes private GP consultations – arguably have no place in the library at all.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99862/original/image-20151027-4971-qrsjwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We spend enough time with our phones, done right health apps could be a help to many.</span>
<span class="attribution"><span class="source">Bloomua/shutterstock.com</span></span>
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</figure>
<h2>Taking the right way forward</h2>
<p>So how should the NHS tackle this mess? It can carry on regardless, leaving the business of testing and approving apps to the NHS App Library reviewing process. Clearly this hasn’t worked so far.</p>
<p>A second option is to allow more technically adept companies – Apple or Google, for example, who develop the two main smartphone operating systems, iOS and Android – to provide the testing and reviews. Apple already develops its <a href="https://developer.apple.com/healthkit/">HealthKit</a> while Google offers <a href="https://developers.google.com/fit/?hl=en">Google Fit</a> for consumers, and <a href="http://readwrite.com/2015/06/03/google-study-kit-health-wearables">Study Kit</a>, a participant platform for researchers running studies.</p>
<p>This approach might iron out technical problems, but what do Apple and Google know about clinical evidence and healthcare outcomes? How would the privacy and security of health data be handled if outsourced to a third party?</p>
<p>A third approach might be to combine the two, whereby the NHS works closely with one or more tech companies in order to raise the bar both technically and clinically. The challenge here is how such companies would manage to collaborate closely with such a large and complex institution as the NHS.</p>
<p>What’s really needed is a fourth approach, where the NHS Health Apps Library is rebuilt around a rigorous, standards-based accreditation process, and where the organisation in charge is given the resources to run it effectively. This means preventing poor quality, clinically dubious or insecure apps from entering the library in the first place and taking a proactive approach to intervening when problems arise in those it approves.</p>
<p>There are lessons to be learned here from the banking sector, which has had to cover similar ground to ensure its banking apps are sufficiently secure to carry out financial transactions safely. The NHS needs to build a partnership that marries health and technical expertise with a regulatory approach, establishing an expert team as an app reviewing body that comprises not just healthcare professionals but also experts from the fields of medical research, mobile technology, and security. Without this sort of rigorous approach, the NHS Health Apps Library’s approval is next to worthless.</p><img src="https://counter.theconversation.com/content/49171/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmanuel Tsekleves does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Having ‘approved’ poor quality, privacy-busting and clinically dubious apps, the NHS Health App Library closes - but it didn’t need to be this way.Emmanuel Tsekleves, Senior Lecturer in Design Interactions, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.