Digital Health Solutions for Chronic Illnesses: A Systematic Review of Mobile Health Apps and Quality Analysis with Mobile App Rating Scale
Round 1
Reviewer 1 Report
The authors propose a study to this study is to evaluate the characteristics and quality of the existing mHealth apps for patients with chronic conditions. To carry out systematic review processes is necessary to follow well-known guidelines, I suggest following the process proposed by Kitchenham [1]. Also. I suggest using the newest version of the PRISMA flow diagram by using the following paper [2].
I recommend the following improvements:
1 The topic is quite actual and has important consequences on the overall healthcare assistance framework; however, one of the main problems of this paper is represented by the lack of innovation with respect to current literature. It is necessary to emphasize the main difference between this paper from similar ones.
It is necessary to include research questions this systematic literature review intends to answer.
In the first paragraph of section 2.2, the authors mentioned that three healthcare experts searched for the apps in the Apple App Store. While in section 5, they indicated that three independent researchers participated in the evaluation process. In both mentions, are they the same researchers? I suggest being specific and adding the specialty of the external experts or researchers.
Although it was pointed out that applications designed for patients with chronic conditions were evaluated, it was not mentioned if the study focused on a specific condition. Even in the results, it was not mentioned if there is a tendency for chronic conditions. Therefore, I recommend reinforcing this information.
I consider adding the references of the 29 applications evaluated in this study and the corresponding citation in the document.
Regarding Figure 1, I suggest restructuring it to be clear about each stage of the methodology.
There are some spelling and punctuation mistakes and some typographical errors throughout the manuscript.
References:
[1] Barbara Kitchenham, Pearl Brereton. (2013). A systematic review of systematic review process research in software engineering, Information and Software Technology, Volume 55, Issue 12, Pages 2049-2075, ISSN 0950-5849, https://doi.org/10.1016/j.infsof.2013.07.010
[2] Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Dear Authors, first of all, I would like to thank you for being able to review the submitted manuscript. The paper is well written, easy to understand and follows a clear thread.
However, I have some concerns with the manuscript in its current form.
The main issue is, that the authors only evaluated iOS mHealth applications. This is a huge drawback. Although the authors mention this issue as a limitation in the manuscript, I still think this should be addressed in another way (i.e., evaluating apps from the Google Play Store as well). The authors claim, that iOS has about 50% share in the US and 30% worldwide and therefore their results apply worldwide. I would disagree and would encourage the authors to consider Android and iOS apps for their analysis.
Furthermore, the authors state, that their "app reviewers" have "expertise in healthcare", but it is not clear, whether the reviewers are properly trained to apply the MARS rating scale in a suitable way. As the MARS rating is subjective in various way, it would be good to indicate in which categories the app reviewers diverge from each other and how the conflict was resolved.
Did the reviewers buy the commercial apps in order to properly test them? In general, the "limitations" section is very (!) short, considering these issues discussed.
The authors claim that they searched the US Apple iOS App Store, but still discuss the German Digital Healthcare Act in various parts of the paper.
From looking at Table 2, most of the apps look identical / similar (i.e., every app has a "+" in every cell). Can the authors improve the table so that the reader is able to extract more information? Are the only distinct values really "+" and "" (nothing)?
The "Discussion" contains an unfinished sentence (i.e., line 198).
Minor:
- Table 1: please left-align the text
- All table look different (i.e., font size, font style, ...)
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
The authors have addressed all my comments. The paper has been restructured and it has been improved. This paper in this present form is ready for publication.
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Reviewer 2 Report
Dear authors,
thank you very much for revising your manuscript and providing an updated version.
Still, I disagree with your arguments, that you only consider iOS apps because they cover “nearly 60% of the US market and 1/3 worldwide”.
Can you please elaborate, how the differences / conflicts in respective MARS categories (i.e., entertainment, quality) were addressed and resolved?
All the best
Author Response
Please see the attachment.
Author Response File: Author Response.docx
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
