Trust and Use of Recommendations for Health Apps Among European Residents: Cross-Sectional Survey

There is growing recognition of the role of health apps in addressing health care system challenges, yet app quality and evidence vary widely, and consumers have little decision support at the point of download.

This study aimed to explore which sources of recommendations European residents use and trust when choosing health apps and whether residents support government review and rating of health apps.

We conducted a cross-sectional online survey (December 7, 2022, to February 16, 2023) in 26 languages targeting residents of the European Economic Area, the United Kingdom, and Ukraine. The survey contained 11 questions covering demographics, types of apps used, sources of advice used and trusted, and views on government review and rating. We included only fully completed responses (N=1228). Descriptive statistics are presented as counts and percentages. For subgroup analyses, we dichotomized trust responses ("I trust" vs other responses) and tested associations with gender (Fisher exact test), age group, and education level (chi-square test); an adjusted significance threshold was applied (P<.004) to account for multiple testing. We followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines for reporting online surveys and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations for observational studies.

A total of 1228 respondents from 33 countries completed the survey; 1110 (90.4%) reported using one or more health apps. COVID-19 apps (763/1228, 62.1%) and activity apps (737/1228, 60.0%) were the most frequently used, whereas disease management (86/1228, 7.0%), diagnostic (77/1228, 6.3%), and treatment apps (70/1228, 5.7%) were the least used. Sources used to choose apps included family and friends (434/1228, 35.3%), health professionals (412/1228, 33.6%), and government or health authorities (358/1228, 29.2%). The most trusted sources were health professionals (987/1228, 80.4%), pharmacists (750/1228, 61.1%), and government or health authorities (736/1228, 59.9%). No statistically significant differences in trust by gender were observed (all P>.0038). Some differences by age and education were observed for select sources (eg, government or health authorities: χ21=8.546; P=.003; family and friends: χ2=19.133; P<.001). Overall, 1060 (86.3%) of 1228 respondents supported government review and rating of health apps (either directly or by commissioning another organization).

In this large multilingual European survey, most respondents reported experience with health apps and placed greatest trust in health professionals, pharmacists, and government or health authorities, yet professional recommendations were used less often than informal sources. There is clear public support for government-led review and rating schemes to guide consumer choice. Efforts to make trustworthy, easy-to-find information available at the point of download and to support health care professionals in recommending high-quality apps could help bridge the gap between trusted and used sources.