法国可用的慢性病自我管理应用程序的行为改变内容、可理解性和可操作性：系统搜索和评估。

Behavior Change Content, Understandability, and Actionability of Chronic Condition Self-Management Apps Available in France: Systematic Search and Evaluation.

机构信息

Équipe d'Accueil 7425 Health Services and Performance Research, Université de Lyon, Lyon, France.

Équipe d'Accueil 4163 Groupe de Recherche en Psychologie Sociale, Psychology Institute, Université Lumière Lyon 2, Bron, France.

出版信息

JMIR Mhealth Uhealth. 2019 Aug 26;7(8):e13494. doi: 10.2196/13494.

DOI:10.2196/13494

PMID:31452522

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6735304/

Abstract

BACKGROUND

The quality of life of people living with chronic conditions is highly dependent on self-management behaviors. Mobile health (mHealth) apps could facilitate self-management and thus help improve population health. To achieve their potential, apps need to target specific behaviors with appropriate techniques that support change and do so in a way that allows users to understand and act upon the content with which they interact.

OBJECTIVE

Our objective was to identify apps targeted toward the self-management of chronic conditions and that are available in France. We aimed to examine what target behaviors and behavior change techniques (BCTs) they include, their level of understandability and actionability, and the associations between these characteristics.

METHODS

We extracted data from the Google Play store on apps labelled as Top in the Medicine category. We also extracted data on apps that were found through 12 popular terms (ie, keywords) for the four most common chronic condition groups-cardiovascular diseases, cancers, respiratory diseases, and diabetes-along with apps identified through a literature search. We selected and downloaded native Android apps available in French for the self-management of any chronic condition in one of the four groups and extracted background characteristics (eg, stars and number of ratings), coded the presence of target behaviors and BCTs using the BCT taxonomy, and coded the understandability and actionability of apps using the Patient Education Material Assessment Tool for audiovisual materials (PEMAT-A/V). We performed descriptive statistics and bivariate statistical tests.

RESULTS

A total of 44 distinct native apps were available for download in France and in French: 39 (89%) were found via the Google Play store and 5 (11%) were found via literature search. A total of 19 (43%) apps were for diabetes, 10 for cardiovascular diseases (23%), 8 for more than one condition in the four groups (18%), 6 for respiratory diseases (14%), and 1 for cancer (2%). The median number of target behaviors per app was 2 (range 0-7) and of BCTs per app was 3 (range 0-12). The most common BCT was self-monitoring of outcome(s) of behavior (31 apps), while the most common target behavior was tracking symptoms (30 apps). The median level of understandability was 42% and of actionability was 0%. Apps with more target behaviors and more BCTs were also more understandable (ρ=.31, P=.04 and ρ=.35, P=.02, respectively), but were not significantly more actionable (ρ=.24, P=.12 and ρ=.29, P=.054, respectively).

CONCLUSIONS

These apps target few behaviors and include few BCTs, limiting their potential for behavior change. While content is moderately understandable, clear instructions on when and how to act are uncommon. Developers need to work closely with health professionals, users, and behavior change experts to improve content and format so apps can better support patients in coping with chronic conditions. Developers may use these criteria for assessing content and format to guide app development and evaluation of app performance.

TRIAL REGISTRATION

PROSPERO CRD42018094012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94012.

摘要

背景

慢性病患者的生活质量在很大程度上取决于自我管理行为。移动健康（mHealth）应用程序可以促进自我管理，从而有助于改善人群健康。为了发挥其潜力，应用程序需要使用适当的技术针对特定行为进行目标定位，这些技术支持改变，并且用户可以理解并根据他们与之交互的内容采取行动。

目的

我们的目的是确定针对慢性病自我管理且在法国可用的应用程序。我们旨在研究它们包含哪些目标行为和行为改变技术（BCT），它们的可理解性和可操作性如何，以及这些特征之间的关联。

方法

我们从 Google Play 商店中提取了标签为“Medicine”类别的“Top”应用程序的数据。我们还提取了通过 12 个常见术语（即关键词）针对 4 个最常见慢性病组（心血管疾病、癌症、呼吸疾病和糖尿病）以及通过文献搜索找到的应用程序的数据。我们选择并下载了在法国可用的、针对这 4 个组中的任何一种慢性病的原生 Android 应用程序，并提取了背景特征（例如，星级和评分数量），使用 BCT 分类法对目标行为和 BCT 的存在进行编码，并使用视听材料患者教育材料评估工具（PEMAT-A/V）对应用程序的可理解性和可操作性进行编码。我们进行了描述性统计和双变量统计检验。

结果

共有 44 个不同的原生应用程序可供下载，并且可以在法国和法语环境中使用：其中 39 个（89%）是通过 Google Play 商店找到的，5 个（11%）是通过文献搜索找到的。共有 19 个（43%）应用程序是针对糖尿病的，10 个是针对心血管疾病的（23%），8 个是针对这 4 个组中多种疾病的（18%），6 个是针对呼吸疾病的（14%），1 个是针对癌症的（2%）。每个应用程序的目标行为中位数为 2 个（范围 0-7），BCT 中位数为 3 个（范围 0-12）。最常见的 BCT 是行为结果的自我监测（31 个应用程序），而最常见的目标行为是症状跟踪（30 个应用程序）。可理解性中位数为 42%，可操作性中位数为 0%。具有更多目标行为和更多 BCT 的应用程序也更易理解（ρ=.31，P=.04 和 ρ=.35，P=.02，分别），但不具有显著更高的可操作性（ρ=.24，P=.12 和 ρ=.29，P=.054，分别）。

结论

这些应用程序的目标行为较少，且包含的行为改变技术较少，限制了它们改变行为的潜力。虽然内容是中等程度可理解的，但很少有明确的关于何时以及如何采取行动的说明。开发者需要与卫生专业人员、用户和行为改变专家密切合作，以改善内容和格式，从而使应用程序能够更好地帮助患者应对慢性病。开发者可以使用这些标准来评估内容和格式，以指导应用程序的开发和评估应用程序的性能。