title: Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps.
abstract: BACKGROUND
  There are a growing number of mobile phone apps available to support people in taking their medications and to improve medication adherence. However, little is known about how these apps differ in terms of features, quality, and effectiveness.
  
  
  OBJECTIVE
  We aimed to systematically review the medication reminder apps available in the Australian iTunes store and Google Play to assess their features and their quality in order to identify high-quality apps.
  
  
  METHODS
  This review was conducted in a similar manner to a systematic review by using a stepwise approach that included (1) a search strategy; (2) eligibility assessment; (3) app selection process through an initial screening of all retrieved apps and full app review of the included apps; (4) data extraction using a predefined set of features considered important or desirable in medication reminder apps; (5) analysis by classifying the apps as basic and advanced medication reminder apps and scoring and ranking them; and (6) a quality assessment by using the Mobile App Rating Scale (MARS), a reliable tool to assess mobile health apps.
  
  
  RESULTS
  We identified 272 medication reminder apps, of which 152 were found only in Google Play, 87 only in iTunes, and 33 in both app stores. Apps found in Google Play had more customer reviews, higher star ratings, and lower cost compared with apps in iTunes. Only 109 apps were available for free and 124 were recently updated in 2015 or 2016. Overall, the median number of features per app was 3.0 (interquartile range 4.0) and only 18 apps had ≥9 of the 17 desirable features. The most common features were flexible scheduling that was present in 56.3% (153/272) of the included apps, medication tracking history in 54.8% (149/272), snooze option in 34.9% (95/272), and visual aids in 32.4% (88/272). We classified 54.8% (149/272) of the included apps as advanced medication reminder apps and 45.2% (123/272) as basic medication reminder apps. The advanced apps had a higher number of features per app compared with the basic apps. Using the MARS instrument, we were able to identify high-quality apps that were rated as being very interesting and entertaining, highly interactive and customizable, intuitive, and easy to use and to navigate as well as having a high level of visual appeal and good-quality information.
  
  
  CONCLUSIONS
  Many medication reminder apps are available in the app stores; however, the majority of them did not have many of the desirable features and were, therefore, considered low quality. Through a systematic stepwise process, we were able to identify high-quality apps to be tested in a future study that will provide evidence on the use of medication reminder apps to improve medication adherence.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Karla
authors.identifier: http://orcid.org/0000-0001-9047-8865
authors.initials: K
authors.lastname: Santo
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Sarah S
authors.identifier: http://orcid.org/0000-0002-4270-0748
authors.initials: SS
authors.lastname: Richtering
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-9931-0580
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.|Cardiology Department, Westmead Hospital, Sydney, Australia.|Westmead Institute for Medical Research, Sydney, Australia.
authors.forename: Aravinda
authors.identifier: http://orcid.org/0000-0002-7763-7806
authors.initials: A
authors.lastname: Thiagalingam
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.|Cardiology Department, Westmead Hospital, Sydney, Australia.|Charles Perkins Centre Westmead, Sydney, Australia.
authors.forename: Clara K
authors.identifier: http://orcid.org/0000-0003-4693-0038
authors.initials: CK
authors.lastname: Chow
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Julie
authors.identifier: http://orcid.org/0000-0001-8707-5563
authors.initials: J
authors.lastname: Redfern
keywords: medication adherence; medication compliance; mobile applications; mobile apps; mobile phone; smartphone