Evidence-Based Diet+Acne App Gains Traction

Ken Terry

June 10, 2014

A free mobile app that conveys evidence-based content on diet and acne has been downloaded from the iTunes store to more than 5500 devices in 98 countries, according to the Chicago researchers who created the app.

In a research letter published online March 12 in JAMA Dermatology, the app's developers suggest that apps based on peer-reviewed literature "may be an effective method to disseminate medical information to a large and diverse population." Moreover, an app focused on acne is an especially promising tool for reaching "the predominantly adolescent and young adult acne population that increasingly uses smartphones," they write.

Diana K. Cohen, MD, from the Northwestern University Feinberg School of Medicine and the University of Illinois at Chicago, and colleagues searched PubMed to identify peer-reviewed studies related to diet and acne. They summarized the evidence from the studies in consumer-friendly language for the app, said coauthor Roopal Kundu, MD, associate professor of dermatology at the Northwestern University Feinberg School of Medicine.

After the app was made available in the iTunes store, the researchers decided to do a study of the people who were downloading it. They inserted a link into the app that users could use to take a voluntary survey. The updated version of the app was downloaded more than 2200 times, and 110 people completed the survey.

The researchers found that 80.7% of the respondents were between the ages of 18 and 25 years, and three quarters were women. Most characterized their acne severity as "moderate." More than a third had not seen a physician about their condition.

Dr. Kundu said there was no indication these respondents were using the acne app as a substitute for a physician visit, but whether they did or not, she said, the point of designing this app was to ensure they would have accurate, useful information that is "scientifically based and peer reviewed."

None of the other acne apps in the Apple store, she added, included content that was written at this level of scientific rigor. Whether or not her team's app achieved its educational goals was unclear, however: 63.7% of the survey respondents said they had either not looked at the app or had spent only 5 minutes on it.

That's "very typical" for such apps, said Joseph Kvedar, MD, president of the Center for Connected Health at Partners Healthcare in Boston, Massachusetts. "It's a recognized challenge that with bite-sized pieces of information that people download, they often use them very little."

Nevertheless, Dr. Kvedar, who is a dermatologist, said that the researchers' app would probably stand out in the field of 220 acne apps in the various app stores. "Most of this stuff is written by laypeople. If the source of the content is literature that's evidence-based, they probably have a leg up. As long as they can translate it into consumer-speak, it probably would stand out as valuable."

Many physicians are reluctant to "prescribe" mHealth apps to their patients because they do not know how reliable they are. Dr. Roopal said physicians would be more likely to prescribe apps that were based on solid evidence and had the imprimatur of their specialty society. "Most professional societies have published literature that physicians can purchase or download, and this might be the next medium for disseminating those kinds of materials."

Dr. Kvedar agreed. "It's like the electronic version of your office handout," he said.

The numbers seem to support that view. A recent IMS Health report that analyzed data about Android apps in the Google Play store showed that the majority of healthcare apps were downloaded very few times: Half were downloaded fewer than 500 times, and just 5 apps accounted for 15% of the 660 million downloads of Android health apps.

The challenge is to figure how to "monetize" these elaborately researched apps, Dr. Kvedar said. "The stuff in dermatology offices is sanctioned by the American Academy of Dermatology, so part of our membership dollars goes to pay for that. That's one revenue model." Another model is for pharmaceutical companies to sponsor the apps. However, Dr. Kvedar cautioned that under those circumstances, patients "might feel they're getting a sales pitch," making the content less credible to them.

The big problem for patients is to wade through all of the apps for a particular condition, Dr. Kvedar added. The Center for Connected Health has started an offshoot called Wellocracy that "curates" apps for consumers, but it has gotten through only a tiny fraction of them so far, he said.

In an invited commentary on the Chicago app study, Ashish Bhatia, MD, from the Department of Dermatology, Feinberg School of Medicine, Northwestern University, and the Dermatology Institute–Naperville, DuPage Medical Group, Illinois, urged specialty societies to create similar evidence-based tools but noted that that was only the first step. Dermatologists must also inform their patients that these apps exist and suggest that they download them, he said.

Dr. Kundu said she has done that herself with patients who ask about the connection between diet and acne. "I tell them it's a free app and that it's been vetted." Some patients, she noted, have downloaded it during the visit.

The authors have disclosed no relevant financial relationships.

JAMA Dermatol. Published online March 12, 2014. Letter extract, Commentary extract

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