The development of a standardized health app quality label

Covid-19 has caused devastating effects around the globe, and health apps may be the frugal interventions that can provide some relief. The apps can  help prevent infection,  triage and monitor behaviour and symptoms,  educate citizens when to contact a health professional, and provide governments with data to guide policy making to curb the virus. Other apps enable monitoring of vulnerable patients at a distance, assisting with rehabilitation, and can even be used to help citizens and frontline healthcare staff work at their health (food, exercise, sleep, and mental health apps) to stay afloat and prevent heavy symptom burden if they do get infected. But which apps are fit for their purpose, their context of use and deliver on their promise? And among this diversity, how will people know how to choose the right one? The National eHealth Living Lab (NeLL) intends to pilot Covid-19 apps and investigate the understandability of and trust in a standardized health app quality  label in Mexico and Egypt, and compare the outcomes. 

eHealth Applications

NeLL is based in Leiden and facilitates long and short-term scientific research into eHealth. They are at the forefront in the development of validation methodologies and have a pioneering role in the development of internationally applicable eHealth standards.

A standardized health app quality label is currently being developed by NeLL. This label is an assignment given by the European Commission and currently under review by the International Organization for Standardization (CEN-ISO/DTS 82304-2). The aim of this project is to standardize quality labels of health applications, enabling users to make more informed decisions and trust apps, and hopefully increasing the uptake of mHealth.  Other partners connected to research program are the digital health specialists from the World Health Organization (WHO) and the International Telecommunication Union (ITU).


The next step

Students from CFIA’s minor Frugal Innovation for Sustainable Global Development are involved in this project and are assigned with tasks related to testing the feasibility of the standardized label for health apps in countries outside of Europe. The quality label is currently available in English and Arabic, and was tested with people with low health literacy in the Netherlands for adequate understanding. The task is to investigate the understandability of and trust in the label in two countries outside the European Union, namely, Mexico and Egypt, and compare the outcomes.

The initial part of the investigation involved acquiring a translation of the standardized label and then testing it with 5 low health literates in the above-mentioned countries using think aloud testing.

Interviews were conducted to investigate aspects of the lives of users that are of importance to the investigation. Some of these aspects might include who or what is trusted to make suggestions on health apps, possession of a smartphone, use of apps, healthcare access, and digital literacy.

Frugal Innovation aspect and objectives

The health app label is specifically designed to increase the use of good health apps that can have a positive influence on the health of people. Health apps in general also can make healthcare more accessible and cheaper, especially for people at the bottom of the pyramid and living in areas where healthcare is not easily accessible. It can thus help lessen the divide in health outcomes in between different socioeconomic statuses. Next to this, the label is also an attempt to overcome the digital skills gap. By making the quality and purpose of apps more visible and easier to understand, people with low digital skills might feel more secure in the usage of apps and know which health apps best meet their needs and health issues.


Project Team

LUMC-NeLL Health App

  • Mariam Shokralla, WHO Digital Health Consultant
  • Simona Pestina, International Communication Union (ICU)

Partner organizations

  • NeLL
  • LUMC
  • WHO
  • ICU

Academic Supervisor

  • Petra Hoogendoorn, National eHealth Living Lab (NeLL)

Student Research Team

  • Max Mooij (TUD - Mechanical Engineering)
  • Julia van Lent (EUR - Econometrics)
  • Sophie Cleton (TUD - Industrial Design)