Tiffany Brooks, Blasi Paula, Catz Sheryl L, McClure Jennifer B
Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States.
JMIR Mhealth Uhealth. 2018 Sep 4;6(9):e11432. doi: 10.2196/11432.
There has been an increase in consumer-facing mobile health (mHealth) apps in recent years. Prior reviews have characterized the availability, usability, or quality of popular mHealth apps targeting a range of health behaviors, but none has examined apps that promote better oral health care. Oral disease affects billions of people worldwide and mobile phone use is on the rise, so the market for well-designed and effective oral health apps is substantial.
We examined the content and usability of popular oral health promotion apps to better understand the current state of these self-help interventions and inform the need and opportunity for future app development.
Between February and March 2018, we identified oral health-focused apps that were designed for Android or iOS, available in English, and targeted adult consumers (as opposed to children or dental health professionals). The sample was limited to the most popular and highly rated apps on each platform. For each app reviewed, we assessed its basic descriptive characteristics (eg, platform, cost), evidence of a theoretical basis or empirical validation, key program functionality, and the extent to which the app addressed diet and tobacco and alcohol use as risk factors for oral disease. We characterized the framing (ie, gain vs loss) of all persuasive messaging and conducted a heuristic analysis to assess each app's usability as a persuasive health technology.
Thirty-three apps were eligible for review based on the selection criteria. Two-thirds (22/33, 67%) were geared toward the general public as opposed to dental clinic patients, insurance plan members, or owners of specific electric toothbrushes. Most (31/33, 94%) were free to download, and a majority (19/33, 58%) were sponsored by software developers as opposed to oral health experts. None offered any theoretical basis for the content or had been empirically validated. Common program features included tools for tracking or reminding one to brush their teeth and assistance scheduling dental appointments. Nineteen apps (58%) included educational or persuasive content intended to influence oral health behavior. Only 32% (6/19) of these included a larger proportion of gain-framed than loss-framed messaging. Most of the apps did not mention diet, alcohol or tobacco-important risk factors for oral disease. Overall, the apps performed poorly on standard usability heuristics recommended for persuasive health technologies.
The quality of the reviewed apps was generally poor. Important opportunities exist to develop oral health promotion apps that have theoretically grounded content, are empirically validated, and adhere to good design principles for persuasive health technologies.
近年来，面向消费者的移动健康（mHealth）应用有所增加。先前的综述描述了针对一系列健康行为的流行mHealth应用的可用性、易用性或质量，但没有一项研究考察过促进口腔健康护理的应用。口腔疾病影响着全球数十亿人，且手机使用呈上升趋势，因此设计精良且有效的口腔健康应用市场潜力巨大。
我们研究了流行的口腔健康促进应用的内容和易用性，以更好地了解这些自助干预措施的现状，并为未来应用开发的需求和机会提供参考。
在2018年2月至3月期间，我们确定了面向安卓或iOS系统、以英文提供、面向成年消费者（而非儿童或牙科保健专业人员）的专注于口腔健康的应用。样本仅限于每个平台上最受欢迎和评分最高的应用。对于每款被审查的应用，我们评估了其基本描述特征（如平台、成本）、理论基础或实证验证的证据、关键程序功能，以及该应用在多大程度上涉及将饮食、烟草和酒精使用作为口腔疾病风险因素的内容。我们对所有说服性信息的框架（即收益与损失）进行了特征描述，并进行了启发式分析，以评估每款应用作为一种有说服力的健康技术的易用性。
根据选择标准，有33款应用符合审查条件。三分之二（22/33，67%）的应用面向普通公众，而非牙科诊所患者、保险计划成员或特定电动牙刷的所有者。大多数（31/33，94%）应用可免费下载，且大多数（19/33，58%）由软件开发人员赞助，而非口腔健康专家。没有一款应用为其内容提供任何理论基础或经过实证验证。常见的程序功能包括用于跟踪或提醒刷牙的工具以及协助安排牙科预约。19款应用（58%）包含旨在影响口腔健康行为的教育或说服性内容。其中只有32%（6/19）包含的收益框架信息比例高于损失框架信息。大多数应用未提及饮食、酒精或烟草——这些都是口腔疾病的重要风险因素。总体而言，这些应用在针对有说服力的健康技术推荐的标准易用性启发式评估中表现不佳。
所审查的应用质量普遍较差。开发具有理论基础内容、经过实证验证且遵循有说服力的健康技术良好设计原则的口腔健康促进应用存在重要机遇。
