Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder

Published in: BMJ Evidence-based mental health

Mobile health offers many opportunities; however, the ‘side-effects’ of health apps are often unclear. With no guarantee health apps first do no harm, their role as a viable, safe and effective therapeutic option is limited.

In this study we assessed the quality of apps for chronic insomnia disorder, available on the Android Google Play Store, and determine whether a novel approach to app assessment could identify high-quality and low-risk health apps in the absence of indicators such as National Health Service (NHS) approval.

In order to do this we used a subset of 24 questions from the Organisation for the Review of Care and Health Applications OBR, concerning data privacy, clinical efficacy and user experience, answered on a ‘yes’ or ‘no’ and evidence-driven basis, and applied this to 18 insomnia apps identified via the Android Google Play Store, in addition to the NHS-approved iOS app Sleepio.

We found that 63.2% of apps (12/19) provided a privacy policy, with seven (36.8%) stating no user data would be shared without explicit consent. 10.5% (2/19) stated they had been shown to be of benefit to those with insomnia, with cognitive behavioural therapy apps outperforming hypnosis and meditation apps (p=0.046). Both the number of app downloads (p=0.29) and user-review scores (p=0.23) were unrelated to ORCHA-24 scores. The NHS-approved app Sleepio, consistently outperformed non-accredited apps across all domains of the ORCHA-24.

Apps for chronic insomnia disorder exhibit substantial variation in adherence to published data privacy, user experience and clinical efficacy standards, which are not clearly correlated with app downloads or user-review scores. In the absence of formal app accreditation, the ORCHA-24 could feasibly be used to highlight the risk–benefit profiles of health apps prior to downloading.


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