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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Founded by NHS clinicians, ORCHA is the world’s leading digital health evaluation and distribution organisation. We provide services to national health bodies across three continents, including the NHS in 50% of UK regions, delivering national accreditation frameworks, bespoke Digital Health Libraries, and professional recommendation tools, specific to the needs of our clients. ORCHA’s unique Review Engine assesses digital health solutions against more than 350 measures across Clinical/Professional Assurance, Data u0026amp; Privacy, and Usability u0026amp; Accessibility, plus additional criteria depending on needs.