Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder

BACKGROUND: 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.

OBJECTIVE: To assess 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 NHS-approval.

METHODS: The ORCHA-24, 24 app-assessment criteria concerning data privacy, clinical efficacy, and user experience, answered on a ‘yes’ or ‘no’, evidence-driven basis; was applied to assess 18 insomnia apps identified via the Android Google Play Store, in addition to the NHS-approved iOS app Sleepio™.

FINDINGS: 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 CBT 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.

CONCLUSION: 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.

CLINICAL IMPLICATIONS: In absence of formal app accreditation, the ORCHA-24 could feasibly be used to highlight the risk-benefit profiles of health-apps prior to downloading.