An Evaluation of Interactive mHealth Applications for Adults Living with Cancer

Round 1

Reviewer 1 Report

This is a very well written manuscript. The goal is very clear, the topic is important to the field, and the methodology is sound. I have only a few comments that I think the authors should consider:

Major:

Despite the authors' efforts to evaluate the app with two relatively objective instruments, what healthcare professionals experience with the app (what is useful, what attracts users, etc.) may still be very different from actual cancer patients. I wonder if the authors have thought about whether this might affect the usefulness of the assessment. I am especially concerned that the apps we rated as most useful might not be that useful to patients. Have you thought about doing a brief analysis of the user ratings of these apps and even reading into some user comments?

I still do not understand why the authors want to exclude the paid apps from the review. Yes, some of them are paid and may not be available to everyone, but I think most of them you can try at least for a few days and even if you have to pay for it, the cost is not very high. And sometimes a paid app can be much better than the free version because it is maintained more often and has more incentives to meet the users' needs. Can the authors elaborate on this?

It is very strange that the authors decided to include a limitations section in the conclusion, which in 99% of cases should be at the end of the Discussions section. What was the rationale for this? Also, the Strength paragraph is missing and should be added.

 

Minor:

The Apple Store was not mentioned in the Abstract section, only the Google Play Store and Google Web, why?

Author Response

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Reviewer 2 Report

This study aims to “objectively” evaluate mHealth applications for patients for adults with cancer. The authors used the previously developed Mobile App Rating Scale (MARS) and created a checklist of unmet needs to address. This study has several strengths including a topic that has limited evidence and use of the PRISMA reporting framework.  Yet several concerns limit the value of this paper.

Selection of apps:

Is Google the only way to identify apps? 

Unclear justification for selecting only free/ publicly available apps.  Ngoo et al. (cited in this paper) evaluated apps that were free or required some payment. Further they reported that half of the apps for primary and secondary prevention of melanoma required some payment. I

Inclusion criteria in the early time frame is restricted to only English and in the second timeframe is English or French why is there this difference?  (figure 1)

 

Evaluation:  

A limitation of the MARS tool is that it relies largely on subjective assessment regarding functionality, aesthetics, engagement, and subjective quality.  These aspects should be evaluated by end users and not a research team.

 

The “usefulness” assessment (would prefer the term Support Domains) was developed a priori from assessing literature on unmet needs.  It would have been helpful to have a list of these unmet needs as an appendix.  But these may not be unmet needs as much as ongoing support needs.  This classification does not make clinical sense as shown on Table 2.  For example, the usefulness category of physical health – this is a misnomer.  In cancer patients it should relate to disease-specific clinical care or information.  The factors are scattered all of the categories in Table 2. 

Similarly, the category of emotional health makes sense but inappropriately includes with financial assistance and peer matching services.  The practical concerns category includes diverse factors many of which are specific to cancer management including keeping a log of symptoms and medications as well as logistics of cancer treatment – so should be under disease-specific care.

Regarding practical concerns - l what is the reading level of these apps? This should been considered under the discussion of learning styles.

The authors focus on whether the apps have an evidence-basis. Does that mean having references for information provided in the app? They note that apps need to be evaluated in high-quality randomized controlled trials. It would be helpful to know what kinds of trials these are and what the outcomes would be.  Reference 25 by Osborne evaluated outcomes from studies of mHealth apps for patients with cancer – were these apps in this study?

Finally, the authors state that they use transparent reproducible methods. I would differ with that since the so-called usefulness categorization does not make clinical sense and I don’t see how it was developed.  The subjective nature of the MARS assessment and the odd categorization of the usefulness measure compromise the conclusions of this study.

No concerns about English

Author Response

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Reviewer 3 Report

This manuscript describes mHealth apps in patients living with cancer. Focus was made on free, interactive, cancer apps (paid apps were excluded). The apps to be investigated were selected based on PRISMA system and evaluated using MARS system.

 

The value of the research is its focus on interactive apps.

The originality of the research reported is the venturesome use of PRISMA-like procedure, originally used for reviewing literature, in reviewing apps. Preceding studies used PRISMA recommendations for evaluating literature reporting apps, not apps themselves appear in Google Play or Apple Stores.

 

The major concerns are follows.

1)     Figure 1 tells that 2020 search resulted in 12 apps and 2020 search resulted in 7 apps, no overlapping. It seems that the meaning of quality-check the author claims (line 94), are not replicative study. Adding more information on the position of the authors dealing with these two searches is encouraged.

 

Minor points are raised below.

 

2)The meaning of [4] appears in line 105 is unclear. The article [4] does not support the description here.

3) As the result section is too concise, adding more qualitative aspects of the selected apps can add value to the study.

Author Response

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Reviewer 4 Report

The authors attempted to evaluate the quality and usefulness of free and available mHealth apps for adults with cancer.

The work has merit and is structured. Nevertheless, I do believe that it can and should be enhanced.

In the title: there is no need to use the abbreviation in the title: mHealth is sufficient and there is no need to use the word mobile health.

The abstract has obvious grammar and technical issues and is difficult to read through and needs to be rewritten.

Consider revising sentence from line 57-60 (starting with discerning).

Overall authors have done a great work in providing the results.

English writing and grammar should be carefully checked. Consider editing the paper again.

English writing and grammar could be improved.

Please consider editing the paper again. There are some minor grammar errors. The authors would want to carefully check the paper again for any issues.

Author Response

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Round 2

Reviewer 1 Report

The authors have addressed my concerns adequately. Good luck.

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Reviewer 2 Report

The paper is much improved - but the last para of the results largely repeats findings by integrating the two metrics and should be integrated into the discussion. 

 

minor issues: Line 150 HCP spell out; line 332: adherence not adherent; line 361 "to palliate to this limitation" rewrite

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Reviewer 3 Report

Adequate explanations were added to the revised manuscript. Now the paper seems to be of the best quality possible in relation to the planned research design. 

Minor editing may be necessary.
1) Line 62: There is a lengthy compound sentence. Rephasing is encuraged.

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Reviewer 4 Report

The authors have included comments and revised manuscript accordingly. No further revisions needed.

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