{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:19:11Z","timestamp":1789154351425,"version":"build-2803163510"},"reference-count":29,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n There is growing recognition of the role of health apps in addressing health care system challenges, yet app quality and evidence vary widely, and consumers have little decision support at the point of download.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to explore which sources of recommendations European residents use and trust when choosing health apps and whether residents support government review and rating of health apps.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a cross-sectional online survey (December 7, 2022, to February 16, 2023) in 26 languages targeting residents of the European Economic Area, the United Kingdom, and Ukraine. The survey contained 11 questions covering demographics, types of apps used, sources of advice used and trusted, and views on government review and rating. We included only fully completed responses (N=1228). Descriptive statistics are presented as counts and percentages. For subgroup analyses, we dichotomized trust responses (\u201cI trust\u201d\n vs other responses) and tested associations with gender (Fisher exact test), age group, and education level (chi-square test); an adjusted significance threshold was applied (\n P<\/jats:italic>\n <.004) to account for multiple testing. We followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines for reporting online surveys and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations for observational studies.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 1228 respondents from 33 countries completed the survey; 1110 (90.4%) reported using one or more health apps. COVID-19 apps (763\/1228, 62.1%) and activity apps (737\/1228, 60.0%) were the most frequently used, whereas disease management (86\/1228, 7.0%), diagnostic (77\/1228, 6.3%), and treatment apps (70\/1228, 5.7%) were the least used. Sources used to choose apps included family and friends (434\/1228, 35.3%), health professionals (412\/1228, 33.6%), and government or health authorities (358\/1228, 29.2%). The most trusted sources were health professionals (987\/1228, 80.4%), pharmacists (750\/1228, 61.1%), and government or health authorities (736\/1228, 59.9%). No statistically significant differences in trust by gender were observed (all\n P<\/jats:italic>\n >.0038). Some differences by age and education were observed for select sources (eg, government or health authorities:\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n 1<\/jats:sub>\n =8.546;\n P<\/jats:italic>\n =.003; family and friends:\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n =19.133;\n P<\/jats:italic>\n <.001). Overall, 1060 (86.3%) of 1228 \nrespondents\n supported government review and rating of health apps (either directly or by commissioning another organization).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this large multilingual European survey, most respondents reported experience with health apps and placed greatest trust in health professionals, pharmacists, and government or health authorities, yet professional recommendations were used less often than informal sources. There is clear public support for government-led review and rating schemes to guide consumer choice. Efforts to make trustworthy, easy-to-find information available at the point of download and to support health care professionals in recommending high-quality apps could help bridge the gap between trusted and used sources.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/64468","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:57:57Z","timestamp":1775761077000},"page":"e64468-e64468","source":"Crossref","is-referenced-by-count":1,"title":["Trust and Use of Recommendations for Health Apps Among European Residents: Cross-Sectional Survey"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3052-2606","authenticated-orcid":false,"given":"Mariam","family":"Shokralla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2038-8175","authenticated-orcid":false,"given":"Romy Fleur","family":"Willemsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7751-7516","authenticated-orcid":false,"given":"Marise Jeannine","family":"Kasteleyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8607-9199","authenticated-orcid":false,"given":"Niels","family":"Chavannes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9917-9052","authenticated-orcid":false,"given":"Esther","family":"Talboom-Kamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"issue":"5S","key":"R1","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1016\/j.pmrj.2017.02.018","article-title":"Consumer mobile health apps: current state, barriers, and future directions","volume":"9","author":"Kao","journal-title":"PM R"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1080\/01972243.2018.1438550","article-title":"Differences in mobile health app use: a source of new digital inequalities?","volume":"34","author":"Bol","journal-title":"The Information Society"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-13-23","article-title":"Why mobile health app overload drives us crazy, and how to restore the sanity","volume":"13","author":"van Velsen","journal-title":"BMC Med Inform Decis Mak"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1093\/jamia\/ocz175","article-title":"Safety concerns with consumer-facing mobile health applications and their consequences: a scoping review","volume":"27","author":"Akbar","journal-title":"J Am Med Inform Assoc"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.765993","article-title":"Evidence of user-expert gaps in health app ratings and implications for practice","volume":"4","author":"de Chantal","journal-title":"Front Digit Health"},{"key":"R6","unstructured":"How reviews and ratings affect app store optimization. Business of Apps. 2019. URL: https:\/\/www.businessofapps.com\/insights\/reviews-ratings-affect-app-store-optimization\/ [Accessed 14-03-2026]"},{"key":"R7","doi-asserted-by":"crossref","unstructured":"Kuehnhausen M Frost VS . Trusting smartphone apps? To install or not to install, that is the question. Presented at: 2013 IEEE International Multi-Cognitive Methods in Situation Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support (COGSIMA 2013); Feb 25-28, 2013; San Diego, CA. 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Consumers Health Forum of Australia; 2018."},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/43905","article-title":"What makes a quality health app-developing a global research-based health app quality assessment framework for CEN-ISO\/TS 82304-2: Delphi study","volume":"7","author":"Hoogendoorn","journal-title":"JMIR Form Res"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","first-page":"604","DOI":"10.22074\/cellj.2019.5992","article-title":"Why, when and how to adjust your P values?","volume":"20","author":"Jafari","journal-title":"Cell J"},{"issue":"5","key":"R17","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.4103\/jfmpc.jfmpc_105_20","article-title":"Role of digital therapeutics and the changing future of healthcare","volume":"9","author":"Dang","journal-title":"J Family Med Prim Care"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/34882","article-title":"Use of smartphone health apps among patients aged 18 to 69 years in primary care: population-based cross-sectional survey","volume":"6","author":"Paradis","journal-title":"JMIR Form Res"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"19","key":"R20","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.1001\/jama.2018.14378","article-title":"Health apps and health policy: what is needed?","volume":"320","author":"Bates","journal-title":"JAMA"},{"issue":"5","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/12390","article-title":"Why reviewing apps is not enough: Transparency for Trust (T4T) principles of responsible health app marketplaces","volume":"21","author":"Wykes","journal-title":"J Med Internet Res"},{"issue":"12","key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.2981","article-title":"Transparency of health-apps for trust and decision making","volume":"15","author":"Albrecht","journal-title":"J Med Internet Res"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-019-0212-z","article-title":"Beyond validation: getting health apps into clinical practice","volume":"3","author":"Gordon","journal-title":"NPJ Digit Med"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-019-0212-z","article-title":"Beyond validation: getting health apps into clinical practice","volume":"3","author":"Gordon","journal-title":"NPJ Digit Med"},{"key":"R25","unstructured":"NHS apps library retired. 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URL: https:\/\/www.nhs.uk\/ [Accessed 14-03-2026]"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/27173","article-title":"Influences on the uptake of health and well-being apps and curated app portals: think-aloud and interview study","volume":"9","author":"Szinay","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00573-1","article-title":"Health app policy: international comparison of nine countries\u2019 approaches","volume":"5","author":"Ess\u00e9n","journal-title":"NPJ Digit Med"},{"issue":"7-8","key":"R28","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s10354-021-00814-0","article-title":"The use of health apps in primary care-results from a survey amongst general practitioners in Germany","volume":"171","author":"Wangler","journal-title":"Wien Med Wochenschr"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.1000668","article-title":"One year of digital health applications (DiGA) in Germany - rheumatologists\u2019 perspectives","volume":"9","author":"Richter","journal-title":"Front Med (Lausanne)"}],"container-title":["JMIR mHealth and uHealth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mhealth.jmir.org\/2026\/1\/e64468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:30:25Z","timestamp":1785537025000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhealth.jmir.org\/2026\/1\/e64468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":29,"URL":"https:\/\/doi.org\/10.2196\/64468","relation":{},"ISSN":["2291-5222"],"issn-type":[{"value":"2291-5222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"article-number":"v14i5Se64468"}}