Challenges With Developing Secure Mobile Health Applications: Systematic Review (Preprint)

BACKGROUND Mobile health (mHealth) apps have gained significant popularity over the last few years due to their tremendous benefits, such as lowering health care costs and increasing patient awareness. However, the sensitivity of health care data makes the security of mHealth apps a serious concern. Poor security practices and lack of security knowledge on the developers’ side can cause several vulnerabilities in mHealth apps. OBJECTIVE In this review paper, we aimed to identify and analyze the reported challenges concerning security that developers of mHealth apps face. Additionally, our study aimed to develop a conceptual framework with the challenges for developing secure apps faced by mHealth app development organizations. The knowledge of such challenges can help to reduce the risk of developing insecure mHealth apps. METHODS We followed the systematic literature review method for this review. We selected studies that were published between January 2008 and October 2020 since the major app stores launched in 2008. We selected 32 primary studies using predefined criteria and used a thematic analysis method for analyzing the extracted data. RESULTS Of the 1867 articles obtained, 32 were included in this review based on the predefined criteria. We identified 9 challenges that can affect the development of secure mHealth apps. These challenges include lack of security guidelines and regulations for developing secure mHealth apps (20/32, 63%), developers’ lack of knowledge and expertise for secure mHealth app development (18/32, 56%), lack of stakeholders’ involvement during mHealth app development (6/32, 19%), no/little developer attention towards the security of mHealth apps (5/32, 16%), lack of resources for developing a secure mHealth app (4/32, 13%), project constraints during the mHealth app development process (4/32, 13%), lack of security testing during mHealth app development (4/32, 13%), developers’ lack of motivation and ethical considerations (3/32, 9%), and lack of security experts’ engagement during mHealth app development (2/32, 6%). Based on our analysis, we have presented a conceptual framework that highlights the correlation between the identified challenges. CONCLUSIONS While mHealth app development organizations might overlook security, we conclude that our findings can help them to identify the weaknesses and improve their security practices. Similarly, mHealth app developers can identify the challenges they face to develop mHealth apps that do not pose security risks for users. Our review is a step towards providing insights into the development of secure mHealth apps. Our proposed conceptual framework can act as a practice guideline for practitioners to enhance secure mHealth app development.