Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.
JMIR Mhealth Uhealth. 2020 Feb 19;8(2):e15364. doi: 10.2196/15364.
Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies.
This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles.
English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads).
A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer's email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads.
Gaps in the disclosure of the developer's qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps.
由于智能手机的普及以及帮助用户实现个性化医疗保健管理的能力，智能手机应用程序在糖尿病自我管理中得到了越来越多的应用。近年来，糖尿病应用程序的数量迅速增加，但只有一小部分风险较高的应用程序受到政府机构的监管。对于提供医疗保健建议且不受政府机构监管的应用程序，其信息来源的透明度和可靠性尚不清楚。
本研究旨在根据健康网络代码（HONcode）原则，通过 8 项标准评估通过糖尿病应用程序传播的信息的透明度和可靠性。
于 2018 年 6 月 12 日在市场探测器（42matters）上搜索英语相关的糖尿病术语。下载具有药物和血糖管理功能的应用程序，并根据从 8 项 HONcode 原则改编的 App-HONcode 标准进行评估：权威性、互补性、隐私性、归因、合理性、透明度、财务披露和广告政策。应用程序按照操作系统（即 Android 和 iOS）和下载次数（即仅 Android：≥100000 次下载和<100000 次下载）进行分类。
共下载并评估了 143 个应用程序（81 个 Android 和 62 个 iOS）以评估改编后的 App-HONcode 标准。Android 和 iOS 平台上的大多数应用程序都满足 2 到 6 项标准，但很少（20/143，14.0%）的应用程序提到了对应用程序开发做出贡献的个人的资格。不到一半（59/143，39.2%）的应用程序声明提供的信息或应用程序功能不替代医疗保健提供者的建议。与 Android 应用程序相比，满足 5 项或更多 App-HONcode 标准的 iOS 应用程序比例更高。然而，与 iOS 应用程序相比，Android 应用程序更有可能在应用程序商店中列出开发人员的电子邮件（Android：75/81，98%；和 iOS：52/62，84%；P=.005）。在所评估的 Android 应用程序中，具有较高下载量的应用程序更有可能具有隐私和保密条款（高下载量：15/17，88%；和低下载量：33/64，52%；P=.006），并且更有可能讨论其财务来源（高下载量：14/17，82%；和低下载量：32/64，50%；P=.03）与下载量低的应用程序相比。
发现开发者资质、资金来源和应用程序在疾病管理中的互补作用方面存在披露空白。应用商店、开发者和医疗服务提供者应合作弥补这些空白，为应用程序用户提供更多的透明度和可靠性。未来的工作可以进一步研究这些应用程序的数据收集同意过程、数据管理政策、广告内容的适当性以及隐私条款的清晰度。
