A systematic review and evaluation of mobile health apps designed for parents who are preparing or caring for medically complex infants
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Anne Chevalier McKechnie1, Nellie Munn Swanson1, Ratchada Jantraporn1
1Child and Family Health, School of Nursing, University of Minnesota, Minneapolis, MN, USA.
Insights
This review found that many mobile health apps for parents of medically complex infants are of acceptable or good quality, but engagement remains a significant issue. Further development is needed to create high-quality apps that meet user needs and offer evidence-based support.
Area of Science:
- Digital Health
- Pediatric Healthcare
- Health Informatics
Background:
- Parents of children with medical complexity utilize various resources, including mobile health applications (mHealth apps).
- mHealth apps offer potential benefits like improved access to information, reduced healthcare costs, and enhanced care delivery.
- The quality of existing mHealth apps for this specific population is largely unknown.
Purpose of the Study:
- To systematically identify and evaluate the quality of publicly available mHealth apps.
- To assess apps designed for parents preparing for or caring for infants with medical complexity.
Main Methods:
- Systematic search of Apple and Google Play app stores (November 2022, replicated August 2024).
- Inclusion criteria: free, English, for parents of hospitalized infants with perinatal medical complexity.
- Exclusion criteria: apps for healthy pregnancies, older children, non-parental caregivers, or primarily for tracking.
- Quality assessment using the Mobile Application Rating Scale (MARS) subscales: Engagement, Functionality, Aesthetics, and Information.
Main Results:
- 15 unique mHealth apps were included from 1,917 identified apps.
- Apps primarily focused on prematurity, neonatal intensive care, congenital heart disease, and hypoxic-ischemic encephalopathy.
- Overall MARS ratings indicated 20% (3/15) were good quality and 67% (10/15) were acceptable quality.
- Apps performed best in Functionality and Information, but weakest in Engagement.
Conclusions:
- Most evaluated mHealth apps lack sufficient user engagement, failing to meet parents' interests or needs.
- Many apps suffer from infrequent updates or become unavailable, highlighting a need for sustained support.
- Development of high-quality, evidence-based mHealth apps is crucial to effectively support parents and extend healthcare beyond clinical settings.
Background:
Parents learning about their children with medical complexity often use numerous health-related resources, including mobile health applications (mHealth apps). mHealth apps could provide broad access to key information and support, lower healthcare costs, and improve care. The quality of mHealth apps for this population has been a concern, but is currently unknown. The objective of this systematic review was to identify and evaluate the quality of publicly available mHealth apps designed for parents who are preparing or caring for medically complex infants.
Methods:
A systematic search strategy was applied to identify mHealth apps in the Apple and Google Play app stores in November 2022 and replicated in August 2024. Apps with no cost, in English, designed for parents of infants with perinatal medical complexity requiring hospitalization were included. Apps for healthy pregnancies, children >1 year, non-parental caregivers or healthcare professionals, primarily for tracking/monitoring, or unrelated activities/products were excluded. Independent raters used the Mobile Application Rating Scale (MARS) subscales of Engagement, Functionality, Aesthetics, and Information to evaluate quality for each app. Mean ratings were calculated by subscale and for overall app quality.
Results:
From 1,917 identified apps, 32 apps were downloaded and fully screened. The final sample of 15 unique apps were available on the Apple App Store, with six also available on the Google Play Store. Most apps focused on prematurity (n=6), followed by the neonatal intensive care experience (n=4), congenital heart disease (n=4), and hypoxic-ischemic encephalopathy (n=1). MARS ratings of the overall sample (mean =3.61, median =3.58; range, 2.65-4.68) indicated 20% (3/15) were of good quality and 67% (10/15) were of acceptable quality. Apps showed strengths in Functionality and Information and performed worst in Engagement.
Conclusions:
The poorest quality found in Engagement suggests that most of these apps do not effectively target users' interests or needs. Notably, many suffered from a lack of recent updates or became unavailable. This decline appears to parallel the increasing integration of digital health technologies within healthcare systems, which could prompt testing of mHealth apps on health outcomes. High-quality mHealth apps that are valued by parents and offer evidence-based information and support are needed to extend care.
