3 Pitfalls to Avoid When Developing Health Apps

Ralph Waldo Emerson said in 1860, "The first wealth is health." Yet nowadays, for many of us, it seems like there are various headwinds when it comes to staying healthy both physically and mentally. That is probably why so many of us seek outside help when it comes to maintaining or improving our well-being. While price used to be a significant barrier to obtaining wellness services, advances in health technology have made access to health and wellness support more scalable and affordable than ever before. 

In fact, recent growth in this category is remarkable. There are now over 350,000 health-related apps aimed at helping users improve their diet, increase their fitness level, become more mindful, and treat specific health conditions (ailments ranging from depression to diabetes). Pick any area of health, and there is bound to be an "app for that". And while the consensus is that most of these apps are relatively harmless, critics of the space suggest that many of these products don't actually help people reach their intended health goals. At their worst, some of the apps available today actually do harm. 

With this being true, what do entrepreneurs and developers of wellness apps need to consider to create products that actually make a positive impact? Here are three pitfalls to look out for when developing or refining a digital health offering. 

A challenge for any app designer is that ultimately their product will compete for our attention with every other app that lives on our phone. Accordingly, many health-related apps are built with notification engines, allowing the product to send a steady stream of alerts and reminders to increase our engagement. Unfortunately, for wellness apps, this can be counterproductive. For instance, a meditation app sending continual unprompted notifications to practice being calm can have the opposite effect when the notifications become overwhelming.

Researchers have investigated the effects of push notifications on task performance. By looking at brainwaves, it was found that push notifications on smartphones likely negatively influence cognitive function and concentration. Traditional app designers often measure their product's success based on engagement, making notifications a useful tool to interrupt our attention and potentially return us to the app. Since the goal of any health app should be to help us improve our ability to live well, its development requires unique design considerations. Furthermore, the success of any health app should be measured by its ability to develop health outcomes (rather than engagement and usage).

As such, the best-designed health apps provide the minimum effective dose of engagement needed to maximize the user's desired health outcome—fulfilling the app's promise without the need for excessive activity.

As the market for health apps continues to grow, so does the concern that many health apps don't follow good science. For instance, wellness apps that focus on food or fitness usually reward users for reducing caloric intake, increasing energy expenditure, or setting increasingly extreme weight loss goals—activities that all have the potential to exacerbate eating disorders. 

The clinical psychologist Dr. Sarah Allen put it this way, "I'm not sure apps really give people the control over health they promise. Rather, they offer the illusion of control." The illusion of control can be a dangerous thing. Eating disorders can thrive in people who feel desperate to control at least one aspect of their lives. The illusion of control can also lead to overestimating the success of a particular outcome, ultimately leading to negative mental and physical health effects. 

Moreover, research shows that developers of health apps need to be more conscientious of the unintended consequences of over-quantification. Research in this area suggests a disconnect between app developers and the psychology community. This emphasizes the need for what Dr. Elizabeth Eikey calls "a fundamental shift in how diet and fitness apps promote health, with mental health at the forefront."

Whatever the desired outcome is with a specific health app, it's always best to ground the app's development in good science. Make sure that whatever is being prescribed or promised through the app is not only scientifically sound but also does not pose the risk of making the treated condition worse. 

The placebo effect is a commonly understood concept. The nocebo effect, conceptualized by Walter Kennedy in 1961, is a lesser-known phenomenon. The Oxford English Dictionary defines a nocebo as "a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis."

Health technology has the potential to do harm through the nocebo effect if there is an over-emphasis on informing the user they might be unwell, especially when the advice coming from the app is conjecture. For instance, a sleep app that assigns you an arbitrary poor sleep score for lack of deep sleep, priming the false belief your day cannot be productive (even though that is not objectively true). 

To mitigate the nocebo effect, be mindful of how data is used to inform users about their health. Are you using objective, empirically validated measures? Or are you using subjective criteria that run this risk of misinterpretation? If the latter, consider ways of improving what information gets presented. Are you giving users ample control over how data gets communicated? As Dr. Jordan Etkin put it, "One thing that device designers can certainly do is encourage consumers to be more intentional in their decisions to review any quantitative feedback." Well-designed health apps give users the flexibility to adjust feedback suitable to what works best for them.

Health technology holds the potential to democratize aspects of health care in ways that were once unimaginable—globally improving health equity and access to care. Because of this, we must do our best to avoid design pitfalls—not only to benefit users but to increase overall consumer confidence and reduce the need for regulatory oversight. The best health apps are built using design thinking rooted in truly understanding the app's specific users and the challenges they face. This is achievable by getting the app's intended users involved early in the design process. Building health apps through empathic design, being considerate of applicable science, and designing for maximum end-user impact will go a long way in improving quality and ensuring the best possible outcomes for the users the app serves.