An “App” a Day Keeps the Doctor Away? A Systematic Review of the Mobile Phone Application in Primary Prevention.

Background: Primary prevention is one of the most important areas of action for improving the population’s health condition and general well-being. It consists of measures taken to prevent diseases or injuries rather than curing them or treating the symptoms. The great diffusion of modern technologies calls for the adoption of new strategies and methods of communication for modifying bad and unhealthy habits in order to obtain permanent changes in people’s behaviour and lifestyle. Very little is known about the usefulness of mobile phone applications (Apps) in health and even less about primary prevention Apps and their credentials or efficacy. The aim of the study was to perform a systematic review of scientific literature focusing on the various features of Apps in primary prevention. Methods: We searched two electronic databases (Pubmed, Embase) and for grey literature on the Internet using Google’s tool (Google Scholar), with no publication time limits. We focused specifically on Apps dealing with primary prevention, and we selected articles with original data, in order to review all the available data regarding this topic. To perform the review we used different search-terms because of the extremely widespread diffusion of this topic and in order not to miss any pertinent studies. The search-terms used were: “primary prevention and mobile phone”, “prevention and cell phone application(s)”, “prevention and mobile phone applications/apps”, ”prevention and smartphone”, “Iphone/I phone app(s) or applications”, “Mhealth” and “Mhealth and prevention”. We included all articles relevant to the subject of the research and we considered only articles in English that had the abstract or full text available. We excluded articles dealing with other strategies for promoting healthy behaviour (e.g. text messaging). We scanned the reference lists for relevant articles up to the first level, and we considered the “related articles” of relevant ones in the PubMed database. Results: Applying Prisma Statement Checklist we obtained 4904 records and the screening of these led to 19 articles fitting the inclusion criteria. The number of articles with original data included in the review is very low compared to the large number of editorials and comments. Such a drop in numbers could depend mainly on the use of multiple key words, which are often very similar, but were used in order not to miss any pertinent studies. This resulted in a notable “noise effect”, thereby decreasing the specificity and increasing the sensitivity of our search strategy. The articles identified cover Apps on physical activity in 8 cases, weight management in 4 cases, wellness management in 4 cases, mental health management in 2 cases, and smoking cessation in 1 case. The results seemed to be concordant regarding the beneficial effects of these Apps on modifying lifestyle. It should be noted that permanent lifestyle changes undoubtedly take a long time, but most of the studies considered were performed on too small sample for too short a time to show the efficacy of the application. Conclusions: To date there is little scientific evidence about the usefulness and efficacy of Apps in primary prevention. []