App fatigue in mHealth: Beyond improving apps, advance equity by meeting people where they are

When more becomes less: The rising toll of app fatigueThe past decade has seen an extraordinary surge in digital health technologies, with more than 350,000 health applications (apps) now populating app stores.In 2020 alone, 90,000 were released-nearly 250 each day 1.This proliferation reflects optimism that digital tools could extend healthcare reach, empower patients, and reduce barriers to care 2.Yet most apps remain narrowly focused on basic tracking, offer limited functionality, and rarely undergo rigorous testing for effectiveness, safety, or equity impacts 3.At the same time, this optimism has increasingly been tempered by recognition that the rapid expansion of fragmented and overlapping tools can overwhelm rather than enable users, a problem described as app overload 4.App overload refers to the excessive number of digital health applications that create cluttered, inconsistent user experiences and require constant switching between platforms.Over time, this contributes to app fatigue 5, which describes the cumulative sense of burden, disengagement, and cognitive exhaustion that arises from managing too many disconnected tools.App fatigue reflects not only frustration with the number of available apps but also the ongoing effort of navigating, logging into, and maintaining multiple systems and data streams.App development has outpaced evaluation mechanisms, leaving patients and clinicians overwhelmed by choice and uncertain about which tools to trust 4,6.Platform fragmentation can discourage sustained use and care integration 4.Poorly utilized apps lose their potential to improve outcomes, with disproportionate effects on those with lower digital literacy.Multiple apps generate overlapping notifications and information overload, which recent evidence links to anxiety and unnecessary health service use 7.Importantly, app fatigue is often distinct from issues of app quality or access.While poor-quality apps fail to meet users' needs and access barriers limit who can participate 8, app fatigue can emerge even when tools are well designed and affordable.It reflects a deeper structural problem of cognitive overload and ongoing management demands 9, where the effort required to navigate and coordinate multiple systems can erode users' confidence in digital tools, disrupt continuity of use, and weaken long-term engagement.Although some empirical work has begun to examine the