Content and Functionality Features of Voiding Diary Applications for Mobile Devices in Brazil: A Descriptive Analysis - Beyond the Abstract

Although the voiding diary has been extensively used in clinical practice and clinical trials,1 and has shown to be a valid and reliable tool to assess lower urinary tract symptoms (LUTS),2 in real life the researchers of our group face some difficulty in using it with some patients. The voiding diary is an example of a tool that should preferably be filled out at the moment the events occur, thus reducing the risk of recall bias and the risk of forgetting to input information, which could mislead the evaluation of the patient and even diagnosis.

This is the main reason why we think that electronic devices could potentially help. The use of mobile devices has grown exponentially worldwide in the latest years3 and can improve patient care and information collection, facilitate adherence to treatment, and speed up the arriving at the correct diagnosis. A report from World Health Organization found that over 5 billion wireless subscribers and over 70% of them reside in low- and middle-income countries and that commercial wireless signals cover over 85% of the world’s population.4 In this direction, the use of applications in mobile devices targeted to the practice of medical and public health (m-Health) may help improve monitoring and clinical data collection, since they are literally at hand. This could facilitate the access of the voiding diary and, therefore, reduce missing data and input errors. With the increase in the use of smartphone technology, electronic urine diaries could be more patient-centered for the diagnosis and treatment of voiding dysfunction and might be more effective in providing patients educational material and greater autonomy over their treatment.

Another aspect that could benefit from this type of data collection is that mobile devices apps can easily provide reports from the input data, which facilitates that health providers access the data, whether for analysis or even to guide patients with difficulties and errors during the filling process.

In our paper, we provided a descriptive analysis and qualitative comparison of free-of-charge voiding diaries for mobile applications for adults available in Brazil. The analysis included the app functionality features and voiding diary topics and an objective rating of the apps. We found 55 apps but only 28 were eligible. Of these, we had to exclude 12 apps, mainly because of technical errors that occurred when the researchers tried to use the apps.

This is related to a valid point we would like to highlight: the quality of the available apps in the platforms. The quality control and evaluation of mobile applications in the current market are poorly regulated.5 App stores provide guidelines on content, privacy, and data security; however, these guidelines are not a quality control assessment of the available applications. This makes it difficult for users to choose and makes it difficult for healthcare professionals to recommend high-quality applications to their patients.5 In our study, only half of the analyzed apps contained a privacy policy.

Another point to be discussed about this field is the scarcity of scientific studies on health applications, specifically talking about the subject of this study. Health applications can provide information and intervention, therefore, there should be national guidelines and evidence-based theoretical-practical references to guide them. The Mobile Health Evidence Assessment and Reporting Checklist (mERA) was developed to standardize the report of scientific evidence on mobile health.6 However, in our study we were not able to find scientific papers that reported on the apps included in this study. When we are talking about using the m-Health technology to improve health care, we believe that this issue should be given more attention.

Finally, we would like to highlight the use of a specific tool to objectively evaluate the mobile device applications included in our study. This evaluation was performed with a tool developed and published by Stoyanov et al,7 named Mobile App Rating Scale (MARS). The MARS tool for app evaluation was developed by a multidisciplinary team and evaluates the quality of the app for several aspects of the apps such as engagement, functionality, aesthetics, information quality. In our opinion, the MARS tool expressed objectively what the appraisers in our study encountered in their subjective evaluation of the apps. We believe that this tool could be helpful in standardizing the evaluation of mobile devices apps in further studies, once we talked about quality and scientific reports on mobile device apps.

Written by: Leda Tomiko Yamada da Silveira, Department of Physiotherapy, Communication Sciences & Disorders, and Occupational Therapy. Faculdade de Medicina, Universidade de São Paulo and Elizabeth Alves Gonçalves Ferreira, Department of Physiotherapy, Communication Sciences & Disorders, and Occupational Therapy. Faculdade de Medicina, Universidade de São Paulo

References: 

  1. Bright E, Cotterill N, Drake M, Abrams P. Developing a validated urinary diary: phase 1. Neurourol Urodyn. 2012 31(5):625-33. doi: 10.1002/nau.21254
  2. Bright E, Cotterill N, Drake M, Abrams P. Developing and validating the International Consultation on Incontinence Questionnaire bladder diary. Eur Urol. 2014 66(2):294-300. doi: 10.1016/j.eururo.2014.02.057
  3. Furlong LM, Morris ME, Erickson S, Serry TA. Quality of Mobile Phone and Tablet Mobile Apps for Speech Sound Disorders: Protocol for an Evidence-Based Appraisal. JMIR Res Protoc. 2016 29;5(4):e233. doi: 10.2196/resprot.6505
  4. WHO Global Observatory for eHealth. (‎2011)‎. mHealth: new horizons for health through mobile technologies: second global survey on eHealth. World Health Organization. ISBN 978 92 4 156425 0 https://apps.who.int/iris/handle/10665/44607
  5. Myint M, Adam A, Herath S, Smith G. Mobile phone applications in management of enuresis: The good, the bad, and the unreliable! J Pediatr Urol. 2016 12(2):112.e1-6. doi: 10.1016/j.jpurol.2015.09.011
  6. Agarwal S, LeFevre AE, Lee J, et al. WHO mHealth Technical Evidence Review Group (2016) Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist. BMJ. 17;352:i1174. doi: 10.1136/bmj.i1174
  7. Stoyanov SR, Hides L, Kavanagh DJ, et al. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth 2015 3(1):e27. doi:10.2196/mhealth.3422
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