Development of the mHealth App Trustworthiness checklist

BACKGROUND: Mobile health applications (mHealth apps) currently lack a consensus on substantial quality and safety standards. As such, the number of individuals engaging with untrustworthy mHealth apps continues to grow at a steady pace. OBJECTIVE: The purpose of this study was to investigate end-users’ opinions on the features or actions necessary for trustworthy mHealth apps; and to convey this information to app developers via a succinct but informative checklist: the mHealth app trustworthiness checklist. METHODS: The checklist was formulated in three stages: (a) a literature review of studies identified the desirable features of the most prolific mHealth apps (health and fitness apps); (b) four focus group sessions with past or current users of these apps (n = 20); and (c) expert feedback on whether the checklist items are conceivable in a real-life setting (n = 6). RESULTS: Five major themes emerged from the focus group discussions: informational content, organizational attributes, societal influence, technology-related features, and user control factors. The mHealth app trustworthiness checklist was developed to incorporate these five themes and subsequently modified following expert consultation. In addition to the trustworthiness themes, we identified features that lie between trust and mistrust (limited digital literacy and indifference) as well as 10 features and actions that cause end-users to mistrust mHealth apps. CONCLUSION: This study contributes to the evidence base on the attributes of trustworthy mHealth apps. The mHealth app trustworthiness checklist is a useful tool in advancing continued efforts to ensure that health technologies are trustworthy.