There are many free apps available that claim to support health, from getting fit and losing weight, to quitting smoking and improving mental health.

The NHS also provides links to approved apps that you can access through NHS login.

 

 But is there any evidence that health-related apps have any impact, and how can we make educated choices about which ones we use? This article offers answers to this and to many other questions about health apps:

• Can apps help us change our behaviour and follow a healthier lifestyle?
• How do health apps work?
• Can health apps really change our behaviour?
• What factors affect consistent use of health apps?
• What are the risks?
• How can I choose an app that may work for me?
• Conclusions

 

Can apps help us change our behaviour to follow a healthier lifestyle?

Used in the right way, and in combination with other support, research suggests that health apps (also called mobile health apps or ‘mHealth’ apps) can help encourage us to change our behaviour towards leading healthier lives. The most commonly used apps aim to:

• Manage our weight
• Reduce alcohol consumption
• Improve mental health
• Manage our weight
• Help us quit smoking
• Increase our physical activity.

 

Manage your weight

Recent evidence suggests that mobile apps may be useful when combined with conventional weight-management strategies, although they may not be as effective as stand-alone approaches to losing weight.

A lack of motivation and high drop-out rates are associated with these mobile apps, and this may limit their effectiveness.

Reduce alcohol consumption

A 2020 review of 21 studies that evaluated 19 different smartphone apps developed to help with reducing alcohol consumption showed that the results from the seven apps designed specifically for use by young people were inconclusive, although there was no clear benefit compared to a control group.

However, the 12 apps for adults appeared more promising, but also with mixed results. Only eight of the apps tested in this study were available in commercial app stores, and only four of these had been shown to be effective for helping to reduce alcohol consumption.

Improve mental health

In a review of seven analyses of pooled data, studies focusing on mobile apps for anxiety or depression, or stress and quality of life, showed them to be moderately effective. Stand-alone apps were less effective. The studies mostly found that there were still beneficial effects of using the apps at the 11-week follow-up.

Quit smoking

There is moderate evidence of higher quitting rates for automated text-message-based interventions compared to minimal support. This finding was demonstrated in a 2019 review of 26 studies that involved nearly 34,000 participants. Furthermore, the combination of text-messaging interventions with other smoking cessation support gave moderately better outcomes than other smoking cessation support alone.

However, there wasn’t enough reliable evidence to determine whether the use of smartphone apps was helpful for people trying to quit smoking.

Increase physical activity 

A 2019 pooled analysis of six randomised controlled trials involving 1,740 participants showed modest evidence of the effectiveness of smartphone apps to increase participants’ average number of steps per day. The apps were more effective in the short term (less than three months), and they were also more effective when they targeted physical activity alone rather than in combination with diet. 

 How do health apps work?

Since a large number of health apps are designed to encourage a change in behaviour, many of them use one or more well-known behaviour-change techniques such as:

• Feedback and self-monitoring
• Goals and planning
• Associations
• Shaping knowledge
• Personalisation

A review of studies from 2010 to 2021 reported that outcomes are more effective than ineffective with many of these techniques. However, there is insufficient evidence to suggest that the techniques themselves are responsible for these changes.

Cognitive behavioural therapy (CBT) apps

In addition, mental health apps may use specific behavioural therapies, such as cognitive behavioural therapy (CBT) to improve outcomes.

Gaming apps

‘Gamification’ – defined as the use of rewards, challenges and competitions etc. in activities that are not commonly associated with games – has also been used as a behavioural-change technique in health apps.

A 2020 pooled analysis of data from 17 studies involving 33,108 participants reported that players of the mobile reality game Pokémon Go – which requires players to travel to different locations to capture virtual characters – showed an increase in walking duration, distance walked and number of steps/day compared to non-players of the game. The players were also found to engage in less sedentary behaviour.

One challenge to such a technique, however, is to maintain this increase in physical activity once the initial novelty has worn off.

 

Can health apps really change our behaviour?

An evidence review published in 2020 analysed 52 randomised control trials of a range of different health apps that focused on physical activity, diet (or both), drug and alcohol use, and mental health.

Overall, only about one-third of the studies found some evidence of effectiveness compared to controls, and there was very little evidence to support a change in the participants’ health outcomes. Although physical activity and dietary habits showed the most evidence of behavioural change, the number of studies was small. Relatively high study completion rates and good ease-of-use ratings were found in those studies that measured them.

These findings contrast with earlier systematic reviews which reported that the majority of apps reviewed were effective at improving health-related behaviours. However, the studies so far have only been based on small sample sizes and have been short term. 

Further rigorous research is needed to determine whether health apps really can change our behaviour.

 

What factors affect consistent use of health apps?

 

Research has shown that up to 80% of participants who use health apps use them at a minimum level, don't log into the app more than once, and don’t use the app consistently in the long term. This section looks at some of the factors affecting our use of health apps.

The design of the app

Both the design of the app and the characteristics of the users are important factors that affect whether users consistently engage with health apps. A 2022 review of 99 studies to investigate such factors identified four app-related factors as generally having positive effects on adherence:

• Personalisation or tailoring of the content to the individual needs of the user
• Reminders – individualised messages that pop up on your mobile
• User-friendly and technically stable app design
• Personal support

Social media and gamification

Social media and gamification features also contributed to the consistent use of several health apps.

Lack of skills and knowledge

Low adherence to health apps was associated with users’ lack of technical competence, low health literacy, low expectations of the app, privacy concerns, and a lack of time. 

These findings suggest that the future design of health apps should involve feedback from potential users to optimise adherence.

 

What are the risks?

Few health apps have been adequately tested for their effectiveness. This leads to questions around both their stated benefits and the risk of their potential harm.

Privacy concerns

Concerns around mental health apps relating to the privacy of personal data, and safety issues (adverse events), have been reported. For example, in 2019, almost half of depression and smoking-cessation apps were found to transmit data to Facebook and Google services without disclosing this in a privacy policy.

Harmful content

Less research has been carried out on the possible adverse effects of mental health apps compared to privacy issues. Particular safety concerns are harmful content, and a lack of scientific evidence supporting the effectiveness of mental health apps.

A 2019 analysis of the descriptions of 73 mental health apps available on Google Play and iTunes showed that the majority (64%) claimed effectiveness at diagnosing or improving mental health symptoms. Many of these claims used scientific language to support them, but only two provided supportive (low-quality) evidence.

Ethical issues

There have also been several reported ethical issues related to the use of gamification in health and fitness apps, including dependence, addiction, and psychological and physical harm. This has led one research group to revise and develop a framework to help designers address these ethical issues.

Unintended consequences

It is also possible that any kind of health-related behaviour-change app could have the opposite effect to the one intended.

A Swedish study published in 2014 tested the effectiveness of two smartphone apps in reducing risky alcohol intake among Swedish university students at social occasions. Male users of one of the tested apps actually increased the frequency of their drinking, with researchers speculating whether the real-time use of a smartphone app might trigger men to compete with others as part of a drinking game.

 

How can I choose an app that may work for me? 

Most importantly, choose an app whose effectiveness is based upon reliable scientific evidence.

 

For example, apps recommended by the NHS, unlike some of the publicly available apps, are thoroughly assessed for supporting evidence, but also for other factors such as safety, and data protection.

 

If you engage with your chosen health app frequently, and, as it has been designed for such use, over time you should be able to identify whether it is having a positive outcome.

 

Conclusions 

There is no strong evidence in support of the effectiveness of mobile apps in improving health behaviours or outcomes because few studies found significant differences between the app and control groups. National Library of Medicine (2020)

 

• Health apps seem to be most effective for people who are already committed to making changes to their lifestyle, those who use their app regularly, and those who use apps alongside other interventions, such as counselling or motivational emails.
• The design of the app, and the characteristics of the users, are factors that affect the consistent and successful use of health apps.
• More research is needed to identify which specific apps and behaviour-change techniques are most effective for improving health in each area and to identify the optimal amount of contact time required.
• Given the number of apps available to download, and to help people make informed choices, there is a need for a more robust system for categorising which apps are based on solid evidence.

 

Barbara Baker, September 2023. Next review date, August 2027