Don’t judge an App by its cover!

An overview of the quality and potential to promote behaviour change of the most downloaded Apps for people with one or more chronic conditions
Photo by Daria Nepriakhina on Unsplash

We have a problem…

Osteoarthritis, hypertension, type 2 diabetes, depression, heart conditions, and chronic obstructive pulmonary disease affect millions of people around the world, often co-occur (i.e., multimorbidity) and cause physical and mental impairments. 1 2 Compared to people living without medical conditions, people with one or more chronic conditions have poorer physical and mental health, 3are more likely to die prematurely, and be admitted to and have an increased length of stay in hospital.4 5 This is also associated with increased health care cost and health care utilization.6

A possible solution…

A healthy lifestyle is associated with up to 6.3 years longer life for men and 7.6 years for women with one or more chronic conditions.7 Mobile Applications (Apps) may improve the lifestyle of patients with chronic conditions, for example, through personalised self-monitoring, goal setting and behaviour change (e.g., increase physical activity) available anytime and everywhere.8 9  This topic has been the focus of recent research with promising results.10 However, although widely used (in 2019, more than 204 billion apps were downloaded)11 the quality (e.g., engagement and functionality), content and potential for behaviour change of the Apps is still unclear.12 13  This can compromise user lifestyle and, at worst, their health and safety.

What we did…

  • We performed a systematic search, in the App Store and Google Play, of health Apps targeting lifestyle behaviours such as physical activity and diet, directed at patients with one or more of the following conditions: osteoarthritis of the knee or hip, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and depression.14
  • We assessed their quality and potential for behaviour change of the free content of the Apps, using the Mobile App Rating Scale (MARS-23 items)15 and the App Behavior Change Scale (ABACUS 21 items)16, respectively.

What we found…

  • Overall, Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but with a low-to-moderate potential for behaviour change.
  • Apps for depression tended to have the highest quality, while Apps for osteoarthritis tended to have the lowest quality.
  • Apps for patients with multimorbidity tended to have the highest potential for behaviour change, while Apps for osteoarthritis tended to have the lowest potential for behaviour change.
  • Self-monitoring of physiological and behavioural parameters such as tracking medication intake, step counts, and diet were the most common features of the Apps.
  • Most of the top-rated and most downloaded Apps for patients with a chronic condition or multimorbidity are not completely free.

Take home message

We suggest researchers:

  • To develop and evaluate Apps with both high quality and potential for behaviour change.

We suggest patients and clinicians who would like to use Apps for managing chronic conditions:

  • To use and recommend Apps with higher quality and potential for behaviour change (Figure 1)

    Figure 1 – Highest rated quality Apps and potential for behaviour change.
  • To use and recommend Apps based on the patient skills, needs and preferences.

Authors and Affiliations:

Bricca A1,2, Pellegrini A 1,2, Zangger G 1,2, Ahler J 2, Jäger M 1,2, Skou ST1,2

1 Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark

2 The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark

Corresponding author

Alessio Bricca,, +45 65 50 95 10

Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark.

The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark.

Competing interests

STS is the founder of the non-for-profit initiative Good Life with osteoArthritis in Denmark (GLA:D), implementing evidence-based clinical guidelines for patients with knee and hip osteoarthritis in clinical practice. STS is currently funded by a program grant from Region Zealand (Exercise First) and two grants from the European Union’s Horizon 2020 research and innovation program, one from the European Research Council (MOBILIZE, grant agreement No 801790) and the other under grant agreement No 945377 (ESCAPE). AB and MJ are postdocs in the MOBILIZE project (funded by the European Research Council, Næstved, Slagelse and Ringsted Hospitals’ Research Fund and The Association of Danish Physiotherapists Research Fund). The funding sources were not involved in any aspect of this work other than to provide funding. The authors declare to have no financial conflicts of interest.


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