Wykes T, Schueller S. (2019). Why reviewing apps is not enough: Transparency for Trust (T4T) principles of responsible health app marketplaces. Journal of Medical Internet Research. 21(5): e12390. doi: 10.2196/12390
Researchers developed a set of Transparency for Trust (T4T) principles to guide presentation of efficacy and privacy practices and inform consumer choice in commercial health applications (apps). Predicated on experimental study, systematic review, and patient-concern data, the 4 principles include Privacy and Data Security, Development Characteristics, Feasibility Data, and Benefits. Researchers retrieved and evaluated T4T-pertinent information from 4 commercially available health apps: BlueIce, Calm, My Fitness Pal (MFP), and Dario Diabetes Management (DDM). Analysis revealed BlueIce’s strong evidence base and robust privacy protection. BlueIce allowed only the smartphone user access to user data, while Calm and DDM allowed third party access and MFP permitted affiliate, vendor, and social network access. BlueIce stored all user data on the user’s smartphone and also gave users data ownership, while the other apps either provided no information on user data storage (Calm) or stored user data on company servers (MFP, DDM). Almost all BlueIce users continued use after 2 weeks (93%) and reported no serious adverse events. BlueIce significantly reduced most users’ self-harm, depression, and anxiety. Calm, MFP, and DDM provided no information on retention, adverse events, or clinical outcome research. An evidence-based, clinically prescribed app, BlueIce’s exceptional outcome and privacy transparency may be due to its National Health Service (NHS) patient-provider co-design. A T4T-structured health app market may protect and promote health in individuals who use health apps, allow customers to select app interventions most suited to individual health needs and privacy/security concerns, and incentivize app developers to design T4T principle-driven apps.