Mobile applications date back to the end of the 20th century and were typically novel additions to the core phone functions, such as a calculator or a small arcade game. But from around 2007, when Apple released the iOS operating system, these applications started to take off. Connection to the internet, using a WiFi connection or mobile data, meant that phones were able to synchronise data easily to browse the web, manage an online diary, send and receive emails.
The Apple App Store was opened in July 2008, and a quarter of the 550 apps available at the time were free. Within 3 months, 100 million downloads of the 3000 available apps had taken place. After 4 months, the Google Play Store (Android Market) opened. By July 2013, the Google Play Store had more than 50 billion downloads (Strain, 2015).
What is the difference between Apple (iOS) and Android?
iOS and Android are two different operating systems—the software that drives the device. iOS is the mobile operating system created and developed by Apple Inc distributed exclusively for Apple hardware, and Android is the system developed and used by Google. There are other operating systems used by other phones; however, Android and iOS are the most popular. Other than the operating system, they essentially do similar things; you can make calls, send texts, download music and apps, send and receive emails, use the camera and much more. Another notable difference is cost: Apple devices tend to be more expensive than Android and so do its apps. There are also many manufacturers of devices that run Android; whereas Apple limits the design of its devices alongside its operating system.
It is worth noting that developers do not always make an app for both iOS and Android. However, there is usually an alternative on the other platform.
Are all health apps good apps?
Health-related apps can sometimes be misleading and contain insufficient or even false information. There are laws and regulations in place to attempt to provide consumer safety but they only apply to a limited number of apps (Albrecht et al, 2014). Apps that offer advice according to information that is input by the user are on the borderline of being classified as a medical app. For example, an app that tells you what dosage of medication to take/prescribe, or calculates your/your patient's heart rate are defined as medical apps. Apps that have an administrative purpose such as recording information or booking appointments are not classed as medical apps. Medical apps should be CE marked to certify that they are credible; however, even if they are CE marked it does not necessarily guarantee that the app meets best practice, has been tested for accuracy or benefits in clinical use, or is applicable to the patient/decision for which it is being used (Royal College of Physicians, 2015).
Pregnancy-related apps
The Apple App Store and Google Play currently offer 1915 and 302 pregnancy-related apps, respectively—with that many to choose from, how do we know which ones are safe to recommend to women? In 2013, the NHS Commissioning Board for England launched the Health Apps Library with the aim of making it simpler for people to easily find safe and trusted apps to help manage their health (NHS England, 2015a). Apps are submitted by the developers to then go through a review process to ensure they are clinically safe, relevant to people living in England, use information from a trusted source (e.g. NHS Choices) and comply with the Data Protection Act (NHS England, 2015b). Other categories on the website include conditions (e.g. autism, cancer, epilepsy); healthy living (e.g. mental health, sexual health, nutrition) and health information (e.g. personal health record, service finder) (NHS England, 2015c). All apps that appear in the library have gone through the review process before they are displayed. The ratings that appear for each app have been assigned by users of the app and you can also read about their experiences. It is important to remember that the ratings are not set by the reviewers. The website also has a useful frequently asked questions page. Table 1 provides examples of pregnancy apps and other apps that may be useful for women in your care.
| App | Developer's description | App user rating (as of 19/5/15) | Price |
|---|---|---|---|
| RSB! The Ready Steady |
‘This free app from NHS Scotland is packed with the latest health information and advice for pregnant women, dads and partners. It complements, the Ready Steady Baby! website and book given to all pregnant mothers in Scotland. |
Not yet rated | Free |
| Pregnancy + | ‘Pregnant and want to see beautiful, interactive images for every week of pregnancy? Join more than 2 million users who already use this app to follow their pregnancy. |
5 stars | Free |
| My Pregnancy Today | ‘BabyCentre's My Pregnancy Today app supports you through your pregnancy, day by day, with evidence-based, accessible health information. By entering your baby's due date, the app turns your phone into an expert guide. Feel more prepared for your baby's birth and get the answers you need. See your baby grow with our fetal images developed by medical illustrators. Access a to-do list filled with activities and reminders to keep you on track with decisions, antenatal appointments and more. Watch what's happening inside your uterus with 3-D videos. Get tips and recipes to help you eat well. Our app is reviewed by the BabyCentre Medical Advisory Board.’ | 4.5 stars | Free |
| FitMama | ‘FitMama—5 Minute Fitness App For New Mums – free app with in-app purchases is available for iOS on the App store and Android on Google Play. FitMama's 5 and 10-minute workouts are designed especially for new mums, helping to address one of their biggest concerns—getting back in shape. |
Not yet rated | Free |
The future of apps
Apps are ubiquitous, cheap (or even free) and here to stay—the question is whether this is a good or a bad thing for maternity care. The Code (Nursing and Midwifery Council, 2015) stipulates that midwives must make women's care and safety a priority and practise effectively using the best available evidence. There are thousands of apps available and while the Health Apps Library is an excellent resource identifying safe and trusted apps, there remain thousands of apps that have not be scrutinised in this way. In terms of use by health professionals, the Royal College of Physicians (2015) suggests that professional judgement should always be exercised before relying on information from an app. Midwives should ensure women in their care are aware that not all apps are good apps and signpost them to the Health Apps Library as a trusted resource.
Conclusion
As a society we are gadget-rich and time-poor and, consequently, convenience is king. However, convenience should not take precedence over the safety, health and wellbeing of mother and baby. Women should be made aware that apps are not a like-for-like replacement for the advice and support offered by their midwife. High-quality, individualised midwifery care is priceless, irreplaceable and definitely not available from the App Store.