Do they REALLY work? iPhone apps in the health & fitness, lifestyle, and medical categories account for 7.7% of downloads* and promise to help you get fit, lose weight, quit smoking, improve your sleep, among many other benefits. In a recently published paper in the American Journal of Preventive Medicine, Lorien Abroms and colleagues at George Washington University School of Public Health set out to determine if iPhone apps for smoking cessation followed established best practice guidelines for treating tobacco dependence (1).
As I’ve dicussed in previous posts, iPhone and other smartphone applications have the potential to support behaviour change, for smoking and other health related lifestyle factors. The ability to track behaviours (e.g. number and time of cigarettes smoked), monitor outcomes (e.g. the amount of money saved since quitting), or send reminders are some of the means by which phones can help create new feedback loops that facilitate making healthy lifestyle choices. At present, there is limited research examining if these apps will meet the promises they make. What is the quality of content provided by these apps? This is the question asked by Abroms and colleagues.
For the study, the authors identified 47 apps for the iPhone aimed at helping individuals quit smoking. Apps were categorized based on the method used to support smoking cessation, including:
- calculators: apps that count money saved or tracked health benefits of quitting
- calendars: keep record of the number of days since quitting
- hyponosis: provided hypnotic therapy
- rationing: limits cigarettes, times and places to smoke, to help slowly decrease dependency
- other: apps that did not fit into any of the above categories
To determine if the content of these apps was likely to be beneficial to those that download and use the apps, the authors compared the apps features and functions to the 2008 U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Using an index of 20 items, modified from Bock et al., (2), each app was ranked on a scale of 0-3, where 0 indicated the guideline was not present in the app and a score of 3 indicated it was fully present, giving a maximum possible score of 60 points. Factors used to assess the quality of content included establishing initial tobacco use status, assessing willingness to quit, helping establish a plan, incorporating strategies to enhance motivation, referring users to a quit line, and recommending counseling and medication.
The highest score for adherence was 30 (going to Quit Smoking-Cold Turkey), a mere half of the maximum possible. The average score for all apps was 7.8. Several apps scored zero. Of the different strategies, calculator type apps were the most likely to adhere to some of the guidelines. The authors also looked at the popularity of each app, finding that the apps that were most frequently downloaded were also the ones with the lowest adherence to established smoking cessation guidelines.
What does this mean? The bottom line is that while mobile technologies hold the promise of tremendous opportunity to help individuals change health behaviours, current apps promoting support for tobacco cessation fail to follow evidence based guidelines. A next step might be to conduct an intervention to further study a smaller selection of the identified apps. The current paper also did not assess usability, an important determinant affecting regular use of an app. Additionally, these results highlight an opportunity for developing an app that is based on established best practice guidelines. For now, those looking to quit smoking may be best off with established programs, such as these resources provided by Health Canada.
*as of May 16, 2011
Abroms LC, Padmanabhan N, Thaweethai L, & Phillips T (2011). iPhone Apps for Smoking Cessation A Content Analysis. American Journal of Preventive Medicine, 40 (3), 279-85 PMID: 21335258
2. Bock B, Graham A, Sciamanna C, et al. (2004) Smoking cessation treatment on the Internet: content, quality, and usability. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 6(2):207-19. PMID: 15203794