The Landscape of Mobile Apps for Healthy Eating: Case Study for a Systematic Review and Quality Assessment

Mobile apps are being increasingly used to foster healthy lifestyles. There is a growing need for clear, standardized guidelines to help users select safe and effective health apps.

Our study aimed to highlight the importance of establishing a structured framework for quality evaluation in mobile health (mHealth) through a case study of mobile apps promoting healthy eating.

We conducted a systematic review of apps promoting healthy eating that had already been evaluated by one or more of 28 recognized health app certification bodies. Three rounds of app evaluations were conducted by experts in nutrition and behavior change. The first two rounds focused on the quality of the content of the recommendations and were performed pairwise using the Quality Evaluation Scoring Tool (QUEST), which has not been previously used by the certification bodies. In addition, in the second and third rounds, each reviewer answered the question "How probable is it that you would recommend this app?" using a subjective scale score from 0 to 10. In the third round, this score was weighed by usability (30%), content quality (40%), and promotion of behavior change (30%). Discussions were held to resolve scoring discrepancies and to identify the top-quality apps. We also assessed correlations among QUEST, Google Play Store, and certification body scores.

Of the 41 apps identified by five certification bodies, 19 (46.3%) met the inclusion criteria and were examined. Only 16 (84.2%) of these remained accessible for the second round. Eight of these surpassed 20 points (out of a maximum of 28) on the QUEST scale and were evaluated by all six experts in the third round, and the top 5 (62.5%) apps were selected. No correlations were found among QUEST, Google Play Store, and certification body scores.

Despite numerous evaluations by various certification bodies, only 5 (12.2%) of the 41 apps met the quality standards set by our experts. Our results mark the importance of rigorous, transparent, and standardized app evaluation processes to guide users toward making informed decisions about health apps. Guidelines for developers for the design of evidence-based, unbiased, high-quality apps, as well as technological solutions for real-time monitoring of the health apps, would address these challenges and improve reliability.