Trust and Use of Recommendations for Health Apps Among European Residents: Cross-Sectional Survey

Key findings from this study

This research indicates that:

• Health professionals, pharmacists, and government authorities are most trusted for health app recommendations, yet informal sources are used more frequently in practice.
• Public support exists for government-led review and rating systems to guide health app selection.
• The gap between trusted and used sources indicates barriers to accessing professional recommendations at the point of app download.

Overview

A multilingual cross-sectional survey conducted across 33 European countries examined which sources European residents use and trust when selecting health apps, alongside public attitudes toward government-led app review and rating systems. The study recruited 1228 respondents from the European Economic Area, the United Kingdom, and Ukraine between December 2022 and February 2023. The survey assessed patterns of health app usage, sources consulted for recommendations, trust in those sources, and support for regulatory oversight. The research was conducted as part of the Horizon Europe Label2Enable project, which aims to promote the CEN-ISO/TS 82304-2:2021 health app quality framework.

Methods and approach

The study deployed an 11-item online survey available in 26 languages through the Castor electronic data capture system. Professional translators adapted the survey from English into 25 additional languages, covering 22 official EU languages plus Norwegian, Ukrainian, Arabic, and Turkish. Native speakers with digital health expertise validated all translations. The survey was disseminated through the Label2Enable project website, partner organizations including the European Patients' Forum and EuroHealthNet, and social media channels. Recruitment targeted diversity across countries, age, gender, and education level. Only fully completed responses were analyzed. Descriptive statistics summarized demographics and response patterns. Subgroup analyses tested associations between trust in specific sources and demographic variables including gender, age group (18-65 versus over 65 years), and education level (high school or less versus bachelor's degree or higher). Fisher exact test was applied for gender; chi-square tests for age and education. A Bonferroni-adjusted significance threshold of p less than 0.0038 controlled for multiple comparisons. Open-ended comments underwent thematic analysis following the Braun and Clarke six-step approach.

Results

The sample comprised 1228 respondents from 33 countries, with median age 47 years and 14.5% aged 65 or older. Female respondents represented 64.1% of the sample. Education levels skewed high, with 81.5% reporting bachelor's or higher degrees. Self-reported health was good or very good for 69.7% of respondents. A quarter provided informal care at least occasionally.

Health professionals, pharmacists, and government or health authorities received the highest trust ratings when respondents considered health app recommendations. Despite this high trust, professional sources were used less frequently than informal sources in actual decision-making. Clear public support emerged for government-led review and rating schemes designed to guide consumer choice in health apps. Demographic subgroup analyses revealed some differences by age and education for select sources. The gap between which sources respondents trusted most and which they actually consulted for recommendations highlighted a disconnect in current information-seeking behavior.

Implications

The discrepancy between trusted and used sources suggests structural barriers prevent European residents from accessing recommendations from health professionals, pharmacists, and government authorities at the point of app selection. Health care professionals may lack adequate time, training, or access to trustworthy information resources needed to recommend high-quality health apps to patients. The limited availability of reliable information at the point of download beyond app store descriptions and star ratings likely contributes to reliance on informal sources that may not assess clinical validity or safety.

Strong public support for government review and rating schemes indicates readiness for regulatory frameworks that provide standardized quality assessments. Making trustworthy, easily accessible information available during app store browsing could bridge the gap between trusted sources and actual usage patterns. Supporting health care professionals with tools, training, and curated resources for app recommendation may align information-seeking behavior with expressed trust preferences. Implementation of quality frameworks such as CEN-ISO/TS 82304-2:2021 could address the current deficit in decision support for European health app consumers.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.