“If you build it, they will come.”  That seems to be the mantra of the tech startups that are churning out health tracking apps for our phones. But aside from the worried well of the Quantified Self movement, will Real Live Patients actually use these apps to improve health outcomes? That’s what Consumer Health Information Corporation (CHIC) wanted to find out when they surveyed about 400 smartphone owners to evaluate the likelihood of patient adherence.*

What we know so far is that we tend to exhibit a bit of a kid-in-a-candy-store initial infatuation with new and sparkly things. 

A consumer survey, for example, found that 26% of apps are downloaded and used only once.  Of the people who do confirm using their apps more than once, 74% drop out by the 10th use.  And only 5% of all apps – including health apps – are still in use 30 days after download.

Here’s an example of the top reasons offered for losing interest in smartphone apps:

In general, ease of navigation (90.9%) was the top feature that made apps usable.  The vast majority of surveyed consumers stated that they would be most interested in using a health app to gain information (91.1%).

The majority of surveyed consumers reported that they would be more likely to use an interactive app that can analyze logged information and provide feedback (79.9%).

But health apps should also comply with proven public health guidelines.

Another study that looked at smoking cessation apps found that the majority were neither evidence-based nor rooted in proven methods of usefulness for smokers.  Of the 47 smoking apps identified and analyzed in the study, none met the guideline recommendations.**

For health apps to be successful self-tracking tools for patients, they should follow established evidence-based guidelines.

That sounds like a no-brainer, but an Ohio State University study led by Dr. Lorraine Wallace that analyzed health apps found, for example,  that only 27 percent had any input from physicians during their development.

In a related commentary.about the CHIC survey, researchers at the U.S. National Cancer Institute also warned that users and health professionals should not be “overly optimistic” about smartphone apps, because many have not been tested for their scientific benefits.

For example, 6 per cent of the apps in this survey use hypnosis techniques to encourage people to quit smoking.  But as University of Sydney public health researcher Simon Chapman observes:

“Any claims that you can be hypnotized through your iPhone is codswallop.”

Still, Chapman does promote the use of apps for smoking cessation, as they can be a “really efficient way” to remind people of the benefits of quitting. Several randomized controlled studies found that some smokers may be more likely to quit when they receive regular anti-smoking text messages.

Having said that, however, well over two-thirds of people who quit smoking do so without any assistance at all from targeted treatments, says Chapman. In other words, you don’t need a smartphone (or a patch, pills or gum, despite what drug companies promise you) in order to butt out successfully – as the majority of new non-smokers have already discovered.

Happtique’s Health App Certification Program is a voluntary program that claims to one day help both health care providers and consumers identify medical, health and fitness apps that:

• deliver credible content
• contain safeguards for user data
• function as described

This sounds great – although, as MobiHealthNews reported in May, corporate budget cuts and high-level staffing shakeups (including the resignation of its CEO and a number of other senior execs) have recently accompanied a Happtique announcement that the company is now “refocusing” on its hospital customers.

The CHIC survey also found that:

• Consumers were most likely to use a health app to find information about drugs (42%) or disease states (26%).

• The majority of consumers were either somewhat influenced by (55.8%) or very much influenced (32%) by consumer ratings of apps.

• 33% of consumers preferred health apps to be free but the majority were willing to pay, with 31% willing to pay $1.00-$5.99.

• In terms of preference for health-related task reminders, consumers did not want phone calls, drug vials, or email reminders.

Ultimately, it’s the patients who decide whether or not they will continue to use an app or take a drug.  The survey found that patients want something that is convenient and will help them simplify their health-related tasks.

And does this even include technology in the first place? As I wrote about earlier,  when Pew Research Center’s Internet & American Life Project released its health tracking report earlier this year, tech hypemeisters beamed that 69 per cent of people surveyed keep track of things like their weight, exercise, heart rate, food, stress or other health indicators. But the Pew results also include almost half of self-reporting trackers who, according to Pew’s Susannah Fox, track these health indicators for themselves or others  – but only in their heads.

Surprisingly, very few headlines ran the real news from the report, which was:

“Only 21% Use Technology to Self-Track!” 

After the Pew report came out, Fard Johnmar wrote in his DigiHealth Pulse column:

“The disconnect between consumers’ low appetite for technology and the activities of these developing new self-tracking technology tools has some wondering whether technology will ever ‘win the hearts and minds’ of most.

And if you’re among the minority using technology, it is not even enough to have a health app that merely helps to manage or keep track of one’s health; patients also want feedback.  Such an app should also be accurate and follow clinical and behaviour modification guidelines.

The high dropout rate with smartphone apps is concerning to the health care industry.

A pharmaceutical industry report by Ernst & Young, for example, revealed that new initiatives in health technology by pharmaceutical companies had increased by 78% during the previous year.  A staggering 41% of those new initiatives were smartphone apps.

It’s not surprising that Big Pharma is climbing onboard the self-tracking technology train. About 50% of patients with chronic conditions stop taking their prescribed drugs, and one-third of all prescriptions are never filled in the first place. This lost sales opportunity costs the pharmaceutical industry an estimated $564 billion in lost revenues worldwide.   (See also: Has Industry Co-Opted Patient Engagement?)

Considering that kind of money at stake, and the time and resources invested so far in health technology, you’d think that Big Pharma would want to ensure that their investments in phone apps do not fall into that 26% category of apps that are used only once and then trashed.

And of course, all smartphone apps will be effective only if they are able to retain consumer loyalty and survive past the infatuation stage.

Resource:  Consumer Health Information Corporation

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* “Motivating Patients to Use Smartphone Health Apps” – Consumer Health Information Corporation, April 21, 2011

** “iPhone Apps for Smoking Cessation” – American Journal of Preventive Medicine. Volume 40, Issue 3 , Pages 279-285, March 2011. DOI: 10.1016/j.amepre.2010.10.032

See also:

• An open letter to mobile health app developers and their funders
• “If you’re clueless and you know it”
• Self-tracking tech revolution? Not so fast…
• When does mindfulness become mind-numbing?
• Does knowing change behaving?
• The Quantified Self meets The Urban Datasexual
• When the elephant in the room has no smartphone (from my other site, Heart Sisters