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Systematic Review and Scientific Rating of Commercial Apps Available in India 2 for Diabetes Prevention

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Systematic Review and Scientific Rating of Commercial Apps Available in India 2 for Diabetes Prevention medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 1 Systematic Review and Scientific Rating of Commercial Apps Available in India 2 for Diabetes Prevention 3 H Ranjani1, S Nitika1, R Hariharan1, H Charumeena1, N Oliver2, R Pradeepa1, J C 4 Chambers3,4, R Unnikrishnan1, V Mohan1, P Avari 2, RM Anjana1 5 1Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, 6 Chennai 7 2Department of Metabolism, Diabetes and Reproduction, Imperial College London, 8 London, UK 9 3Department of Epidemiology and Biostatistics, Imperial College London, London W2 10 1PG, UK 11 4Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 12 308232, Singapore 13 Key words: Systematic review; mhealth; apps; quality; scientific rating; diabetes prevention 14 15 Word Count: Abstract –283 Manuscript –3254 16 17 ADDRESS FOR CORRESPONDENCE: 18 RANJANI HARISH, CDE, PhD 19 Sr. Scientist and Head- Translational Research 20 Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre 21 WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control 22 IDF Centre for Education 23 No:6B, Conran Smith Road, Gopalapuram 24 Chennai, India Pin:600086 25 Ph:91-44-43968888, Fax:91-44-28350935 26 Email : [email protected] 27 Website: www.drmohansdiabetes.com, www.mdrf.in 28 *The abstract of this manuscript has been presented as part of a poster discussion at 29 the Advanced Technologies and Treatment for Diabetes (ATTD), 2020, which was held 30 from 19th – 22nd February 2020 in Madrid, Spain. 31 32 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 33 ABSTRACT 34 BACKGROUND 35 Scientific evidence for digital health applications (apps) which claim to help in the 36 prevention and management of Type 2 diabetes (T2D) is limited. 37 OBJECTIVES 38 We aimed to evaluate the quality of currently available health apps for prevention of T2D 39 amongst Asian Indians. 40 METHODS 41 Using the keywords, ‘diabetes prevention’, ‘healthy lifestyle’ and ‘fitness’, a total of 1486 42 apps available in India via Google Play were assessed for eligibility by two independent 43 reviewers. After initial screening using specific inclusion and exclusion criteria, 50 apps 44 underwent a pre-specified rating based on user reviews, number of downloads and app 45 size. Sixteen apps that scored ≥ 9 were shortlisted for further review using the Mobile App 46 Rating Scale (MARS). MARS contains 2 main categories: Category I (Application Quality) 47 and Category II (Application Subjective Quality). The mean MARS scores were used to 48 identify the top ranked apps. 49 RESULTS 50 The mean score for Category I of MARS rating was highest for ‘Google Fit: Health and 51 Activity Tracking’ (4.55/5). This was followed by ‘Healthifyme - Diet Plan, Health and 52 Weight Loss’ (4.45/5). For Category II of MARS, ‘Diabetes M’, ‘Google Fit: Health and 53 Activity Tracking’ and Calorie Counter- My fitness pal’, ‘Healthifyme - Diet plan, Health 54 and Weight Loss’ all scored equally well. On comparing the advantages and 55 disadvantages of each of these applications, ‘Google Fit: Health and Activity Tracking’ 56 and ‘Healthifyme - Diet plan, Health and Weight Loss’ again ranked the best. 57 58 2 medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 59 CONCLUSIONS 60 Our review identifies two commercially available apps ‘Google Fit: Health and Activity 61 Tracking’ and ‘Healthifyme - Diet plan, Health and Weight Loss’ as being user friendly 62 and good quality. Although encouraging, further research is needed to evaluate the 63 efficacy of these apps for prevention of diabetes. 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 3 medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 81 Introduction 82 Mobile technology has changed the life of millions of people around the world [1]. Smart 83 phones provide an ideal combination of user-accessibility with high functionality of 84 customized content. These have already achieved high penetration across Asia. India 85 accounts for 20% of the global smart phone market with approximately 370 million users 86 [2]. It is estimated that the number of smartphone users in India will double to reach 87 between 650 million and 700 million by 2023 [2] rendering mobile health (mHealth) an 88 indispensable component of health care [3]. 89 90 The term mHealth refers to clinical and public health activities, made available through 91 smartphone devices, which offer health related information and services to people 92 anywhere, anytime [4]. mHealth encourages users to be part of their own health 93 management plan, particularly when it relates to prevention and/or self-management for 94 chronic conditions [5]. The increase in usage of smartphones has led to the rapid 95 development of many mHealth applications. The number of mHealth apps available at 96 Google Play in the first quarter of 2020 was 43285, compared to 23955 in the first quarter 97 of 2015 [6]. These mHealth apps allow people to be connected with their health care 98 providers like never before [7]. International guidelines support the use of mHealth apps 99 for prevention of type 2 diabetes (T2D) and cardiovascular disease (CVD) in high-risk 100 individuals [8 ,9]. However, little information on the quality of apps is available, and merely 101 selecting health apps on the basis of popularity does not provide any meaningful 102 information on app quality [10,11]. 103 104 Hence, in this study we aimed to collate data on currently available commercial health 105 apps and evaluate their potential quality as tools for prevention of T2D, with particular 106 reference to Asian Indians. 107 108 4 medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 109 Methodology 110 The systematic review process comprised of three stages: 111 Stage 1: Searching the Android platform 112 Two independent primary reviewers searched for health applications commercially 113 available in India on the android platform (Google Play store) on 3rd June 2020 using 114 three key phrases: ‘diabetes prevention’, ‘healthy lifestyle’, and ‘fitness’. Other key words 115 such as “exercise” and “physical activity” were not included, as these searches yielded 116 apps focusing on exercise routines, strategies related to athletic training and had no link 117 to diabetes prevention. Using the key word “diabetes” alone, yielded apps which helped 118 to diagnose and/or manage diabetes. Thus, we focused primarily on the key words 119 ‘diabetes prevention, healthy lifestyle and fitness’ as they yielded the apps that were 120 relevant to diabetes prevention. In total, 1486 apps in the Google Play store matched with 121 the keywords; 500 apps using the keyword “diabetes prevention”, 498 apps for “healthy 122 lifestyle” and 488 apps for “fitness” (Figure 1). These were assessed for eligibility by the 123 primary reviewers, with each reviewer assessing approximately 750 applications. 124 125 Inclusion criteria were an average user rating ≥ 3, more than 10,000 downloads, minimum 126 50 user reviews, app updated in the last 6 months and available in the English language. 127 As we were looking for apps which could be used across the country, we preferred to 128 select apps available in English which is the link language across urban India. Exclusion 129 criteria were medical apps providing diagnostic or clinician-led healthcare (for example, 130 ‘DIABNEXT- Make your diabetes management easy’ and ‘Diabetes Diagnostics’), apps 131 with consultation provided (‘Gadge Diabetes Care’), pharmacy apps, non-Asian food 132 charts (apps that focused on American/ western diets and not relevant to Indian cultural 133 preferences or habits), apps with quotes on lifestyle (‘Best Life tips’), apps on 134 unconventional diets for weight loss (‘Total Keto Diet’), apps promoting a specific 135 organization or products (‘Medworks Management of Diabetes’, ‘Lefum Health’, ‘Lenovo 136 life’) and promotional apps (e.g.: Fitness bands, Fitness centres).Premium features 137 requiring payment from the user were excluded, however apps providing a basic version 138 without additional cost were included. Based on these exclusion criteria, reviewer 1 and 5 medRxiv preprint doi: https://doi.org/10.1101/2021.02.15.21251723; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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