Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review

"It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements and help developers to improve the designs of their existing or future mobile apps to further enhance quality."

Mobile health (mHealth) apps can potentially prevent disease, as exchanged texts can promote communication, storage of information, and message delivery that drives users to make healthy lifestyle change use. However, a major concern is the possible dissemination of misinformation that could harm app users. This study aims to analyse and evaluate the contents and features of COVID-19 mobile apps. The findings could be of interest to healthcare professionals seeking to identify suitable mobile apps for COVID-19 self-monitoring and education, as well as to mobile app developers working to modify their existing mobile app designs to achieve optimal outcomes.

First, a search for COVID-19 mobile apps was conducted from April 18 2020 to May 5 2020 in the App Store (for Apple devices) and the Google Play Store (for Android devices). The search of the App Store was performed in the United States (US), and a virtual private network (VPN) app named Touch VPN was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities.

Key findings for the evaluation of the 30 mobile apps from the App Store and 28 mobile apps from the Play Store that met inclusion criteria include:

• In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points - indicating that, perhaps during the accelerated time frame imposed by the pandemic emergency, mobile app developers did not manage to create fully comprehensive mobile apps.
• A majority of the apps from the App Store (29/30, 96.7%) and Google Play (26/28, 92.9%) require internet connectivity to be accessed.
• Most of the apps have a storage size of less than 50 MB.
• The App Store offers more apps that provide educational content and advice on COVID-19 than Google Play, but there are more mobile apps from the Google Play Store that enable data to be exported (e.g., health records to be sent to a healthcare provider) and offer automated data entry in comparison to the App Store.
• The outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to Android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points).
• Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content.
• More than half of the included mobile apps are official apps maintained by a health authority for COVID-19 information provision.
• 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function.

The report offers a detailed review of selected apps from both the App Store and the Google Play Store. Overall, "only a few apps can be used globally for COVID-19 education and self-monitoring." Most Apple apps incorporate infographic mapping of COVID-19 cases, while most Android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19.

Based on the research, recommendations for mobile app developers include:

• A health-related app should be maintained by a health authority to avoid the spread of misleading information to the public. A collaboration with the health authorities to create a mHealth app can increase the reliability of the app, which will encourage more users to be engaged in its use.
• To increase the engagement rate of the public, a mobile app should contain background information on COVID-19, guidelines, and preventive measures instead of only a focused feature related to COVID-19 (e.g., a symptom-tracking feature).
• mHealth apps should have a small storage size (most of the apps in the study had a storage size of less than 50 MB), as taking up a lot of phone storage space can result in reduced performance.
• An app should be available for universal use instead of only for residents in a specific country.
• Apps should not require payment to make them more accessible.
• Including real-time or near-real-time updates of statistical analytics with geographical information of positive cases, recovered cases, and a death toll would allow users to be informed about the COVID-19 situation worldwide.
• To ensure that users can safely share their personal details, the app should be secure and able to provide assurance to the user that all shared information is kept confidential.
• Other advanced features that could improve the quality of an app include the addition of a feature that can report crowded places to alert users about areas to be avoided, a quarantine attendance status, online consultation with healthcare professionals, and tracing of the whereabouts of positively infected app users.
• It is crucial to categorise mobile apps into appropriate categories (e.g., Health and Fitness and Medical) to enable users to find an app easily and thus improve its user engagement rate.
• An advanced integration of an mHealth app with a health device that can monitor a user's health, such as a digital thermometer, could enhance the self-monitoring feature of the app.