Worth the upgrade? : A preliminary study on diabetes self-care support functions in freemium health apps

Abstract

Health apps hold enormous potential to improve chronic diseases care particularly diabetes, yet are hampered by poor regulations and comprehensive research efforts. This study aims to rectify the knowledge gap in app quality assessment in terms of self-care functions, focusing on app pricing especially the relatively unexplored freemium category. Self-care functions of 294 free, freemium and paid apps were assessed using criteria based on existing diabetes management guidelines. Optional add-on functions in freemium apps were profiled on possible health behaviour influence using an established taxonomy of behavioural change techniques. Freemium apps supported more self-care domains compared to free and paid apps, with significant coverage differences in Medication Management, Blood Glucose Monitoring, Blood Pressure and Weight Management. Add-ons functions were mostly limited to one per app and some showed aspects of behavioural change techniques. The majority included functions with no link to behavioural change. Out of all pricing categories, freemium apps were the best at covering self-care domains in breadth, but not necessarily in depth. Monetisation rather than influencing health behaviour seemed to be the rationale behind most optional upgrades. The lack of transparency in app markets was further confirmed, urging for future research and regulation efforts.