How to Satisfy Health Care Professionals’ Information Needs on the Quality of Health Apps – Developing a Health App Quality Report for CEN-ISO/TS 82304-2: Participatory Design Study (Preprint)

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BACKGROUND Health apps, which comprise both medical and wellness apps, hold potential to improve prevention, diagnosis, treatment, and management of disease. Yet, adoption by health care professionals (HCP) including recommendation and prescription rates are low, even in countries where these apps are reimbursed. Professional guidelines from medical societies and trusted standardized health app quality assessment reports providing the information HCPs need to recommend or prescribe a specific app for an individual patient are crucial to enable this digital transformation of medicine. The CEN-ISO/TS 82304-2 (hereinafter “82304-2”) Technical Specification, an initiative of the European Commission, includes a research-based health app quality assessment framework comprising 81 quality requirements. Results of 82304-2 app assessments are summarized in a “health app quality label”. The 82304-2 label’s potential to increase willingness to recommend health apps was recently confirmed. However, to adequately inform HCPs for recommending and prescribing high-quality apps a more detailed “health app quality report” is required in addition to the 82304-2 label. OBJECTIVE To codesign the 82304-2 health app quality report by including the information detail that satisfies the information needs of individual HCPs in decision-making on a health app. METHODS A Participatory Design approach was applied to generate the report. In an 18-month process of participatory prototyping with 9 HCPs with digital health expertise the 82304-2 health app quality report was iteratively developed, designed, and validated. A convenience sample of 31 HCPs indicated the priority 82304-2 health app quality requirements that would inform their decision-making on recommending an app and as such need detailed quality information. Final feedback meetings with the 9 HCPs with digital health expertise and 8 medical societies were used to finalize the 82304-2 report design. Web-based questions in these meetings, as well as a comparative content analysis and the Health Education Materials Assessment Tool (HEMAT) were used to indicatively evaluate the 82304-2 report design. RESULTS In total 30/81 (37%) of the 82304-2 quality requirements were prioritized by >50% of the HCPs. The final 82304-2 report design provides detailed information for 27/30 (90%) of the prioritized 82304-2 quality requirements. The reporting detail for two 82304-2 quality requirements requires more research. The final feedback meetings, comparative content analysis and HEMAT provide indicative proof of the usefulness and usability of the 82304-2 report design. CONCLUSIONS We succeeded in our aim to design the 82304-2 health app quality report and found promising potential for its distinctive usefulness for HCPs and medical societies. Further efforts are needed to test and fine-tune its multi-stakeholder and intercontinental usefulness and usability, to support medical societies in providing guidance and potentially training on recommending health apps, and to advance from the current design to a scalable fully-functional version of the 82304-2 report and associated open access database.