Content Analysis of Paid Health and Fitness Apps - Journal of ...

Original Paper

There?s an App for That: Content Analysis of Paid Health and Fitness Apps

Joshua H West¹, PhD, MPH; P. Cougar Hall¹, PhD; Carl L Hanson¹, PhD; Michael D Barnes¹, PhD; Christophe Giraud-Carrier², PhD; James Barrett¹, BS

¹Computational Health Science Research Group, Department of Health Science, Brigham Young University, Provo, UT, United States
²Computational Health Science Research Group, Department of Computer Science, Brigham Young University, Provo, UT, United States

Corresponding Author:
Joshua H West, PhD, MPH

Computational Health Science Research Group
Department of Health Science
Brigham Young University
221 Richards Building
Provo, UT, 84602
United States
Phone: 1 801 422 3444
Fax: 1 801 422 0273
Email:

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ABSTRACT

Background: The introduction of Apple?s iPhone provided a platform for developers to design third-party apps, which greatly expanded the functionality and utility of mobile devices for public health.
Objective: This study provides an overview of the developers? written descriptions of health and fitness apps and appraises each app?s potential for influencing behavior change.
Methods: Data for this study came from a content analysis of health and fitness app descriptions available on iTunes during February 2011. The Health Education Curriculum Analysis Tool (HECAT) and the Precede-Proceed Model (PPM) were used as frameworks to guide the coding of 3336 paid apps.
Results: Compared to apps with a cost less than US $0.99, apps exceeding US $0.99 were more likely to be scored as intending to promote health or prevent disease (92.55%, 1925/3336 vs 83.59%, 1411/3336; P<.001), to be credible or trustworthy (91.11%, 1895/3336 vs 86.14%, 1454/3349; P<.001), and more likely to be used personally or recommended to a health care client (72.93%, 1517/2644 vs 66.77%, 1127/2644; P<.001). Apps related to healthy eating, physical activity, and personal health and wellness were more common than apps for substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health. Reinforcing apps were less common than predisposing and enabling apps. Only 1.86% (62/3336) of apps included all 3 factors (ie, predisposing, enabling, and reinforcing).
Conclusions: Development efforts could target public health behaviors for which few apps currently exist. Furthermore, practitioners should be cautious when promoting the use of apps as it appears most provide health-related information (predisposing) or make attempts at enabling behavior, with almost none including all theoretical factors recommended for behavior change.

(J Med Internet Res 2012;14(3):e72)
doi:10.2196/jmir.1977

KEYWORDS

mHealth; iPhone; app

The use of mobile devices in supporting health behavior change is promising. Aside from expanded opportunities for users to access health information, mobile devices are becoming useful for facilitating the ongoing collection of personal data and cueing behavior change at the most appropriate times [1]. One of the earliest applications was in 1998 when wristwatches were used to cue recovering addicts to complete logs regarding their behavior and feelings [2]. The most recent health applications have focused on a simple message system [3], mostly related to diabetes management [4-6] and smoking cessation [4,7]. Clinical care applications are most prevalent with fewer targeting preventive health behaviors [4].

The recent emergence of smartphones has greatly enlarged both the reach and realm of possibilities for health purposes. In particular, it has provided a platform for developers to design third-party applications (apps), which expand the functionality and utility of these mobile devices. Apps are software programs designed specifically to run on mobile devices. In the ?health and fitness? category in Apple?s App Store, developers have created thousands of downloadable apps for Apple?s mobile devices, which include the iPhone, the iPad, and the iPod touch. Since the launch of the Apple App Store in the US in July of 2008, more than 500,000 apps have become available with nearly 25 billion downloads [8]. By 2016, it is estimated that more than 44 billion apps will have been downloaded?which is equivalent to 6 app downloads for every person in the world [9].

There is growing interest and inquiry in understanding how mobile devices may influence health behavior [10]. Fogg introduced the idea of the functional triad [11]. The triad is a framework that delineates the role of devices in the human?device interaction. According to the triad, devices can be tools, mediums, or social actors. This triad is similar to widely accepted constructs pertaining to the Precede-Proceed Model (PPM) [12], namely predisposing, enabling, and reinforcing factors (Figure 1). Tools, which are similar to predisposing factors, increase the user?s capability. Mediums, which are similar to enabling factors, facilitate an authentic experience for users. Lastly, social actors, akin to reinforcing factors, assist the user in establishing and strengthening relationships. For example, mobile devices become tools or predisposing factors when used to diffuse health information. Similarly, these devices serve as mediums or enabling factors when used by an individual to collect data regarding one?s personal health behavior. Apps can be considered social actors or reinforcing factors because they allow users to interact with social support networks or resources.

Physicians and other health care professionals have begun using many of these apps in their practices, primarily as reference tools [13,14]. As these technologies become more accessible to patients, practitioners may wish to recommend one of the many health and fitness apps to their clients [15,16]. There is currently little analysis in the scholarly literature about the quality of these apps [17]. The purpose of this study was to conduct a content analysis of app developers? written descriptions of health and fitness apps, which interface with the iPhone. Recognizing that an analysis of these written descriptions falls short of a study design that might entail purchasing, downloading, and using the thousands of health and fitness apps available, the scope of this study aimed to analyze the same information that is available to consumers when considering an app purchase. Many companies develop apps for a variety of mobile devices, including makers of the Android operating system, which now sells more devices than Apple?s iPhone [18]. iPhone apps were chosen for this study because Apple?s App Store still provides the largest selection of apps for download and iPhone users download apps at about twice the rate of Android users, Apple?s closest competitor in the app marketplace [18]. Additionally, this study sought to analyze the written description for each health and fitness app to appraise its potential for influencing behavior change.

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