Analysis Of Smartphone Apps For Lifestyle Medicine Behavior Change Potential

Lifestyle factors account for up to 80% of chronic disease risk, but many Americans do not incorporate recommended behaviors related to lifestyle medicine. Smartphone use has become integral to everyday life and the health and fitness category of apps is robust and growing. However, the potential for these apps to affect health behavior change is not well understood. PURPOSE: To evaluate smartphone apps in the health and fitness category for incorporation of evidence-based behavior change strategies related to the 6 pillars of lifestyle medicine and to assess the relationship between strategy inclusion and app store ranking as well as that of the written app description and the app experience. METHODS: The top 100 “free” apps in the health and fitness category of the U.S. Apple App Store related to lifestyle behaviors were scored for evidence of health behavior change strategies using the App Behavior Change Scale (ABACUS). Prevalence of 21 items across 4 categories (knowledge/information; goals/planning; feedback/monitoring; and action) were calculated and Pearson correlations were estimated for the relationship between description of evidence-based strategies and the experience using the app as well as the number of evidence-based strategies and App Store ranking. Significance was set at p < 0.05. RESULTS: 53 app were identified related to physical activity (90.57%), nutrition (56.60%), avoidance of risky substances (3.77%), sleep (30.19%), healthy relationships (62.26%), and stress management (71.69%). Of those, 56.6% incorporated knowledge and information, 37.7% incorporated goals and planning, 30.18% incorporated feedback and monitoring, and 7.5% incorporated action. There was a moderate direct correlation between ABACUS scores of descriptions and app experience (r = 0.61, p = < 0.01) but no significant correlation between ABACUS score and app store ranking (r = 0.02, p = 0.90). CONCLUSIONS: Physical activity, nutrition, and stress management were the most common health behaviors addressed by apps. The most prevalent strategies were related to knowledge/information and goals/planning. The written descriptions in the App Store are likely to provide a reliable preview of the experience using the app, but the ranking is likely not a good indicator of effectiveness in supporting health behavior change.