Patient involvement at the New Zealand health app library
The charity running the health app library in New Zealand, supported by the Ministry of Health, builds patient views and needs in a number of ways:
- Firstly, involving patient groups as advisors to the library, and the charity
- Secondly , building in patient reviews as part of their core evaluation process
- Lastly, making sure the app is relevant to guidelines, products and measures that patients and clinicians use in the country.
Check 1: How does the app library build in advice from patient groups?
To being with, in the case of the New Zealand app library, as well as consumers, one of the core advisors of the library is from the patient group, the Mental Health Foundation. Other patient groups also act as advisors to the charity. They run the library, including Arthritis New Zealand.
Check 2: How does the app evaluation process build in patients?
The app library has a five-step process including:
- Scoring the app in a ‘formal review’ on four dimensions – engagement; functionality; aesthetics and information quality
- Clinical review by healthcare professionals to gauge the app’s clinical value, relevance and safety.
Crucially patient and carer views are addressed at the “user review” stage, which the charity says aims to:
“…get the users’ opinion of the app. Did the app do what they expected, what they liked about the app, and their dislikes.”
Check 3: How is the library supported by government?
Following on, the support for the app library from the country’s national health service is essential if patients are going to find the library, and trust it.
In the case of New Zealand, the app is part of the Health Navigator website. This is run by a charity set up to ensure that:
“All New Zealanders have free access to independent online health information they can rely on to help prevent disease and minimise the effects of ongoing health conditions.”
With this in mind, the site is supported by a range of local health boards. They are primary and secondary providers and universities. The app library has some specific funding from the Ministry of Health. The library is also cited in the Ministry’s current work on developing guidelines to evaluate health apps.
Is there an advantage to the library being run by a charity rather than by a national health service? It looks like there is a strong balance between clinical and patient evaluation of apps. Possibly, by being one step removed from the health service, this may make it easier to hit the balance between clinician and patient views.
Check 4: How does it reflect the patient experience in the country?
The final step in the library’s evaluation is `New Zealand relevance.’ This is intended to highlight aspects of the app that may not be relevant to patients in New Zealand. For example, the group says:
“…information related to the management of a health condition covered by the app may not be appropriate, or align well with New Zealand guidelines, if apps are designed for an overseas market.”
Other common issues include foods and products that are not available in New Zealand, and clinical measures that vary between countries.
How are patients involved in national app libraries?
In conclusion, we can probably learn three things from recent history:
- Firstly, to be successful, app libraries supported or endorsed by national governmental health bodies have to be well resourced.
- Secondly, evaluation and assessment processes need to be fast and simple enough to cope with the rapid pace of app development, and balance the perspectives of all stakeholders including payer, clinician. and patient and carer.
- And lastly, there is a huge amount of work in parallel globally on evaluating health apps. It’s unlikely that one size will fit all, but patients must be centre stage in the evaluation process.