title: The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder.
abstract: The delivery of mobile health (mHealth) services is acceptable to mental health consumers. However, despite the benefits of accessibility, cost-effectiveness, anonymity, and ability to tailor content to individual needs, consumer engagement remains a hurdle for uptake and continued use. This may be unsurprising as few studies have examined app content from the consumer perspective or assessed consumer preferences for the content of apps for mental health management. An opportunity to examine consumer perspectives exists in using naturally generated data that is publically available in the Google Play and Apple app stores. Whereas commercial developers routinely use this data, to date there has been no in-depth evaluation within scientific research.
  
  
  
  The aim of our study was to explore what consumers consider useful content for mental health management apps, identify unmet needs, and understand user expectations of mental health apps within the context of apps for bipolar disorder.
  
  
  
  Publically available English language consumer reviews of 48 apps for bipolar disorder were used as data, providing a total of 2173 reviews. Review text was coded and analyzed using a team approach to qualitative content analysis. Results were presented in 2 forms: (1) a quantitative summary of the 9 major and minor themes and (2) a qualitative synthesis of key thematic findings.
  
  
  
  The majority of reviews were for symptom monitoring apps (87.94%, 1911/2173). The qualitative content analysis revealed 5 main themes: (1) laudatory talk, comments regarding the app's benefits including helpfulness and successful design features (74.00% of reviews, 1608/2173); (2) unfavorable feedback, negative reviews largely concerning unmet needs, privacy and technical issues, and potential dangers of app use (25.54%, 555/2173); (3) conceptions of community, referring to both communities of users with mental ill-health accessed via the app and a community created among app users and developers (24.25%, 527/2173); (4) wishlist features, app features requested by users (17.53%, 381/2173); and (5) apps and therapy, app use within clinical care (10.58%, 230/2173). Four minor themes were also identified: (1) app cost, (2) privacy and data security, (3) comparisons with traditional monitoring, and (4) evidence-based mHealth.
  
  
  
  Although mostly positive, the proportion of reviews containing wishlist requests indicates consumer needs are not adequately addressed by currently available disorder management apps. Consumers value content that is helpful, supportive, and easy to use, and they are integrating apps into their health management and clinical care without necessarily considering the evidence-base or clinical effectiveness of the tool. User expectations regarding developer responsiveness to their needs has implications for community-based participatory research and integrated knowledge translation. However, this expectation is incompatible with current mHealth funding structures.
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.|School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Jennifer
authors.identifier: 0000-0003-1889-1107
authors.initials: J
authors.lastname: Nicholas
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.
authors.forename: Andrea S
authors.identifier: 0000-0002-2939-7027
authors.initials: AS
authors.lastname: Fogarty
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.
authors.forename: Katherine
authors.identifier: 0000-0002-1464-8532
authors.initials: K
authors.lastname: Boydell
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia.
authors.forename: Helen
authors.identifier: 0000-0003-0435-2065
authors.initials: H
authors.lastname: Christensen
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis*; D003258:Consumer Behavior; D003625:Data Collection; D006801:Humans; D008603:Mental Health / Q000193:education*; D063731:Mobile Applications / Q000592:standards* / Q000706:statistics & numerical data; D036301:Qualitative Research; D000068997:Smartphone / Q000592:standards* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000592:standards* / Q000706:statistics & numerical data
keywords: bipolar disorder; mobile applications; qualitative research; smartphone; telemedicine