Ever since the first iPhone was introduced in 2007, smartphones have become an indispensable part of our world – and also our healthcare. Over the years, the availability of mobile health applications increased considerably, with about 50.000 available apps for Apple and Android smartphones in 2021 . Since 2019, validated health applications can even be prescribed as medical products in Germany .
Bringing health communication directly to users in form of apps results in a democratization process: it breaks up the information monopoly formerly held by well-trained experts to lay people – who now have the key to their personal health at their fingertips. However, there is a reason that becoming a healthcare professional requires extensive training and education: specifically health information often is complex and involves uncertainty, as for example probabilities for medication side-effect or genetic test results. While enabling patients to make informed decisions and give informed consent already is an integral part of ethical medical practice , it now also becomes an important consideration in health apps. When communicating health information to lay people in order to empower them to take action – which may include consulting an expert – the information needs to be comprehensible and to correspond to their level of health literacy.
This project aims to make the comprehensibility of health information communication by digital means measurable and monitorable. As a first step, comprehension of app-based health information communication needs to be assessed, which could for example be achieved via multiple-choice questionnaires. Defining the key knowledge to be communicated could also be seen as part of the design process, analogous to test-driven development in software engineering. Additionally, screen interaction or facial expressions could be utilized. A software component will be developed, the CHIC platform, that leads developers through the questionnaire creation and will enable them to monitor achieved comprehension in their health apps.
The approach will be developed in the context of different use cases and will be tested in controlled evaluation studies. In the main use case, we focus on the communication of genetic testing results with regard to pharmacogenomics: implications of genetic information on medication effects. A second validation use case is planned that shall demonstrate the transferability of the communication measurement approach.
In the future, if comprehension can be measured, content could also be personalized accordingly – therefore measures for personalization other than comprehension, e.g., health literacy or other demographic information, could be assessed and correlated to comprehension. A component similar to A/B testing could be incorporated for this in the CHIC platform.
Ultimately, this project shall bring forward the comprehensibility of health apps by supporting developers in the design, monitoring, and validation of their products – to empower people to take their health literally in their own hands.
 Statista (https://www.statista.com/statistics/779910/health-apps-available-ios-worldwide/ and https://www.statista.com/statistics/779919/health-apps-available-google-play-worldwide/, accessed December 01, 2021)
 Digitale Gesundheitsanwendungen-Verordnung (https://www.gesetze-im-internet.de/digav/DiGAV.pdf, accessed December 07, 2021)
 Guidance on professional standards and ethics for doctors: Decision making and consent (https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---decision-making-and-consent-english_pdf-84191055.pdf, accessed December 07, 2021)