Apps that promote good health and wellbeing are increasingly popular. But we don’t know if they are effective. 

The Healthy Living Apps guide aims to help users understand more about a selection of health and wellbeing apps that are available in app stores.


We selected apps that have been described as being able to help the user achieve a healthier lifestyle by:
  •  eating more healthily
  •  being more physically active
  •  quitting smoking
  •  drinking less alcohol
  •  improving mental wellbeing.

We rated each app according to its:

  •  functionality – is the app user-friendly?
  •  affect user behavior – does the app help users to adopt new activities to achieve a healthier lifestyle?

We averaged these two ratings to get an overall star rating out of 5. The best rating app achieved 3 out of 5 stars. Many apps rated well in terms of functionality but did not achieve a high rating on their potential to help users change their behaviour. 

We have included the behaviour change and functionality ratings as well as the overall star rating with the app reviews.  


Our reviewing and rating process

Selected apps were put through a six-step screening, review and rating process: 

1. Search app stores – for apps using terms 'health' and 'wellbeing'
2. Screen apps – for those recently updated, in English, and in healthy living category
3. Select apps that encourage behaviour change
4. Rate apps for functionality
5. Rate apps for potential to affect behaviour change

6. Calculate overall rating 


Review flowchart

Step 1: Search app stores

Between June and August 2016 we searched the Google Play™ and Apple iTunes® stores for apps with specific keywords in the title or description related to health, fitness or wellbeing.

Step 2: Screen apps 

Our search results were then filtered for apps:
  •  with an average user rating of at least 2.5 and a minimum of five user reviews
  •  that had been updated in last 18 months 
  •  in English.
The resulting apps were then categorised into one or more of VicHealth’s five focus areas: 
1. promoting healthy eating
2. encouraging regular physical activity
3. preventing tobacco use
4. preventing harm from alcohol
5. improving mental wellbeing.

Apps were filtered again, and excluded if we identified:
  • conflicts of interest e.g. apps promoting negative behaviour such as smoking 
  • the targeting of a specific clinical population e.g. people living with diabetes, or the treatment of psychological disorders 
  • low relevance to the Australian user e.g. currency other than Australian dollar, non-metric measures, gym franchise in countries other than Australia


Step 3: Select apps that encourage behaviour change 

Each app description was reviewed by two independent experts to determine if that app could be classified as behavior-changing. Behaviour change in this instance refers to new activities or actions done regularly to achieve a healthier lifestyle e.g. exercising, eating healthier food, or managing stress.

Apps were classified as behaviour change apps if their descriptions included mention of at least two of the following four behaviour change elements: 
  • setting goals for the actions you like to achieve
  • tailoring the app to suit you
  • sharing your progress with others (e.g. through connections with social media like Facebook)
  •  receiving rewards or acknowledgements when you complete activities or make progress toward your goal. 
Apps that provided information or connected users to a service or facility, but did not mention at least two of the four behaviour change elements listed above were not included for review. 


Steps 4 and 5: Review and rate apps 

The selected behaviour change apps were rated for:

1. functionality, and 

2. potential to affect behaviour change. 


Functionality review and rating 


We rated functionality using MARS (Mobile App Rating Scale), developed by the Queensland University of Technology and the Young and Well Cooperative Research Centre (Stoyanov et al. 2015). This rating scale was used to examine an app’s engagement, functionality, utility, aesthetics, and information.  MARS scores 22 items across 5 categories. Each item is scored using a series of questions with a 5-point ordinal scale response. An overall functionality score out of five is derived using this scale. 

All apps were scored by at least two experts. They used each app for about 10 minutes to familiarise themselves with its functionality and user experience. A small pilot group of apps was reviewed, and results compared to standardise the reviewers’ approaches. Reviewers tried to use all parts of each app and noted if the app crashed or its functions did not work. Where functionality scores differed, the reviewers considered the app and the different scores together, and a final score was determined. 

Behaviour change effectiveness review and rating


We rated behaviour change effectiveness using the CALO-RE Taxonomy, developed by Michie and colleagues from University College, London (Michie et al., 2011).  This rating scale examines an app’s potential to affect behaviour change in relation to factors such as goal setting, action planning, barrier identification and problem solving, tailoring the app to suit you, self-monitoring and feedback. A behaviour change score out of 40 was calculated, then converted into an overall score out of 5.

All apps were reviewed and scored by at least two public health experts. Reviewers familiarised themselves with the features and interface of each app. They used all of its functions, including images, cartoons, videos, record keeping, calendars and reminders. A total score out of 40 was calculated by adding the item scores. The total score was then converted into a score out of 5. 

Step 6: Overall app rating

The overall app rating score was calculated by averaging the functionality and behaviour change effectiveness scores into one score out of five. 

All three scores for each app (functionality, behaviour change effectiveness and the overall rating) were then rated using a 5-star rating system. 

Information provided about each app
As well as ratings and a description, information provided about the app include:
  • requires add-ons to use the app, and whether this is a one-off purchase e.g. a fitness band, or an ongoing purchase e.g. subscription
  • has a publicly available privacy statement/policy
  • requires login
  • can be password protected
  • asks permission to send push notifications 
  • has in-app advertising 
  • has in-app purchases i.e. product purchases made within the app such as extra features e.g. unlocking additional videos, or removing ads
  • allows data exports 
  • has social media integration i.e. allows sharing to Facebook, Twitter, other social media channels
  • has an associated app community 
  • sends reminders


References

Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile App Rating Scale: A New Tool for Assessing the Quality of Health Mobile Apps. JMIR mHealth uHealth 2015;3(1):e27. DOI: 10.2196/mhealth.3422

Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011 Nov;26(11):1479-98. doi: 10.1080/08870446.2010.540664. Epub 2011 Jun 28.



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Disclaimer:

Please note that the apps were reviewed, assessed and rated by experts on behalf of VicHealth  using the MARS (Mobile App Rating Scale), developed by the Queensland University of Technology and the Young and Well Cooperative Research Centre (Stoyanov et al. 2015) and the CALO-RE Taxonomy, developed by Michie and colleagues from University College, London (Michie et al., 2011).  

While care has been taken to ensure the accuracy and quality of the ratings, VicHealth makes no representations or warranties about the accuracy, completeness, quality, reliability or suitability of the ratings or apps for any purpose. All users, especially those with special health care and/or wellbeing requirements, should assess the accuracy and relevance of this information for their personal circumstances as the ratings do not take into account your health condition(s), objectives or needs. The app ratings should be used as a guide only and neither the ratings nor the apps themselves should be relied upon as a substitute for professional medical advice.  VicHealth does not recommend or endorse the purchase or download of the rated apps and ratings are subject to change.

VicHealth does not warrant that the apps are free from viruses or defects which may corrupt or damage property.

VicHealth is not liable for any loss or damage you suffer arising out of the use of or reliance on the app ratings or any other information provided as part of the review of healthy living apps, except that which cannot be excluded by law. VicHealth recommends that you consult your doctor or other qualified health professional if you have questions or concerns about your or your family’s health.