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It is more than likely that a patient, their family member or a colleague may have recently asked you “Is there an app for that?” Mobile technology is inescapable. It is pervasive in almost every aspect of daily life. Wherever we look, people are often hunched over and fully immersed by a small 6 × 3 inch screen, whether it be walking on the street, travelling on the bus, at the coffee shop or in the clinic waiting room. Mobile devices have infiltrated most aspects of our lives and offer quick, adaptive tech-based solutions to many previously administrative, repetitive or otherwise time-consuming tasks. Everyday tasks such as banking, planning a trip on public transport, maintaining a diary or reviewing the weather all easily accomplished for most, via their mobile device. At the beginning of 2017, more than 2.2 million apps were available to download to various iOS devices such as iPads, iPhones and iPods, and more than 2.6 million apps were available in the Google Play store, formerly known as the Android Market (Statista, 2017a,b). Mobile applications in the “Health” category are now prolific and wide-ranging including popular apps such as the “Nursing Drug Handbook,” “Lark,” “Medscape” and BUPA's “FoodSwitch” App. It is likely you already make use of a few nursing-related mobile apps, and possibly have even made recommendations to patients about health-related apps in the past. Yet, what informed your decision to download or recommend to patients? The McKinsey Digital Patient Survey (Biesdorf a growing culture of instantaneous access to information (including health); ease of app development; their low cost; patient empowerment and the movement towards recognition of the informed patient; the want for personalised health information; big data and analytics; personalised health data; feedback loop from apps to assist with behaviour modification and personal motivation (Elsevier Clinical Solutions, 2015). However, many barriers still exist to the integration of apps in health care. The busy, human and complex risk environment of health care and a lack of skills by patients and providers contribute to the slow augmentation to routine clinical practice. Further, both clinicians and patients may be averse to what they perceive as impersonal or dehumanising interface design of some apps, detracting from the personalisation and caring perspectives of health care (Dean, Lewis, O'Connor et al., 2016). There is huge variability in the purpose, function and quality of health-related apps. They can be used to inform, instruct, record, display, guide, remind or alert and communicate. However, the majority of apps are used to provide health content and information, with largely no interactive functionality (IMS Institute for Healthcare Informatics, 2013). With so many apps available for nurses, patients and caregivers, it can be difficult to distinguish between a good app and those that serve little purpose or effect. With health-related apps fast becoming an essential component of nursing practice, little guidance exists for nurses in the selection and critical appraisal of the quality of mobile applications. Yet, the proliferation in the availability has seen an increase in patients and caregivers seeking recommendations and advice of “the best app” to support self-management of their health, well-being or chronic disease. There are a few key critical factors in the appraisal of health-related websites and guidelines that can be used in critically assessing health-related apps. iMedical Apps ( www.imedicalapps.com) is a useful website available to review the rank and quality of apps which have usually been evaluated by other health professionals (MEDPAGETODAY, 2017). To date, excellent tools and instruments are available to clinicians to help us make sense of evidence and research. CASP (Critical Appraisal Skills Programme (CASP): Making sense of the evidence, 2017), AGREE (Brouwers et al., 2010) and AMSTAR (Shea et al., 2009) are highly useful tools that are available for the critical appraisal of research and different types of evidence. These tools are helpful to guide appraisal of evidence such as randomised controlled trials, cohort studies, qualitative studies, systematic reviews and clinical practice guidelines. However, there is little guidance for clinicians on how to appraise the quality of health-related apps using a similar systematic approach. Drawing on existing critical appraisal instruments, we suggest the following criteria for nurses to apply, to guide a systematic quality appraisal of a health-related app. Once an app has been selected for suitability and appraised for quality, it is important that clinicians identify and address factors that would impede or facilitate use (Brouwers et al., 2010). The overall suitability and quality of the app must be considered; however, it is important to consider other factors that will influence use and sustain adherence to the app intervention. In deciding to use an app for a healthcare intervention, nurses must help patients to make sense of the app, assist in the quality appraisal of the app and provide support for using the app. This may include initiating use with a patient at point of care. In deciding to recommend an app, it may be useful to draw on the Digital Health Engagement Model (DIEGO) developed by O'Connor and colleagues (O'Connor et al., 2016), to help identify factors that impact an individuals’ ability to uptake digital health interventions. O'Connor et al. (2016) make a number of recommendations to help address some challenges in the uptake of healthcare apps. These include raising the awareness of apps, so that the general public are knowledgeable of them (such as advertising of apps). Developers may seek accreditation and endorsement by peak bodies to assist to increase engagement. There is also a need for targeted funding to support improvement of digital literacy skills alongside improved funding models to ensure equity of access to health apps (O'Connor et al., 2016). We provide the following considerations for nurses who are integrating apps into practice: Health-related mobile app use is increasing across all age groups. Nurses have a key role in supporting patients and caregiver in the careful selection and quality appraisal of apps. Nurses must develop a new skill set to better support patients in the initiation, use and evaluation of app use to improve health. Whilst apps at present are not routinely prescribed by health professionals, nurses are well situated to make recommendations and target these nonpharmacological, therapeutic health interventions. Overall, greater research, education and evidence-based tools are required to support nurses in helping patients select, initiate and sustain the use of apps to improve health outcomes. None declared.
Ferguson et al. (Mon,) studied this question.