Translation study MARS

The MARS (Mobile Application Rating Scale; Stoyanov, 2015) was developed to enable multidimensional measurement of the quality of health apps by experts. The MARS rating aims to achieve greater objectivity, reliability, and validity in the quality assessment of health apps, as user ratings are only meaningful to a limited extent. The MARS-G represents the German version of this rating scale and captures the following dimensions: Engagement, Functionality, Aesthetics, Information, Subjective Quality, and App-Specific Quality.

The study is completed and was published in 2020 (see Publications).


Translation study ENLIGHT

The ENLIGHT is a validated measurement tool for determining the quality of healthcare software and measures the scales: App Description, Ease of Use, Visual Design, User Engagement, Therapeutic Persuasion, Therapeutic Relationship, and overall subjective assessment of program potential. Furthermore, the ENLIGHT has checklists on the topics: Credibility, Evidence-Based, Privacy, and Basic Safety. The ENLIGHT has been translated into German twice and back-translated again twice and finally merged into the ENLIGHT- German. The ENLIGHT-German is currently being evaluated for its psychometric properties.


Anxiety app study

Next to depression, anxiety disorders are the most common mental disorders. Anxiety disorders are associated both with a high level of suffering and with enormous social costs. M-health apps could complement standard care in the future, as they could offer low-threshold and location-independent support.

At the moment, however, health apps are not yet subject to any technical controls. This will change with the implementation of the IEC 82304 Health Software Regulation. Then at least the technical safety of apps must be ensured, as this amendment concerns any "software specifically intended to be used in the management, maintenance or improvement of the health of individuals or the provision of care". However, the technical merit of these apps continues to go unevaluated. There is very little research on the effectiveness of apps. Our own systematic evaluation of apps for use with depression showed that German-language apps for depression are only of medium quality and only 4 of 1156 apps can be recommended (conditionally) for use with patients with the disease (Terhorst et al., 2018).
In this project, all apps available in Germany from iTunes, Google Play and Windows store, which have been developed to support anxiety disorders, are evaluated by two independent experts using the MARS rating (Stoyanov, 2015). The aim of this rating is to scientifically investigate and evaluate the quality of available m-health apps.


Depression app study

In Germany, approximately 4.9 million people suffer from depression. Depression is associated with enormous burdens for those affected and for society. Health apps have the potential to improve the care situation. The aim of this systematic review is to examine the quality, content, and practical relevance of German-language apps for depression.

The German Google Play and iTunes stores were systematically searched for depression apps selected according to previously defined criteria. Apps were rated using a quality assessment scale (Mobile Application Rating Scale [MARS]) by two independent raters. Apps with above-average ratings were assessed by two practicing behavioral therapists for their usefulness in clinical practice.
Of the 1156 apps identified, 38 were included. The content ranged from informational to intervention apps. The apps had a medium overall quality (M=3.01, SD=0.56). Four above-average apps were reviewed by two psychotherapists and rated as conditionally recommendable for clinical practice. No efficacy study is available for any included app.
German-language depression apps often have qualitative deficiencies. In addition, there is a lack of clinical studies on benefits and risks, which is why their use in clinical practice can only be recommended to a limited extent. A seal of approval for high-quality and practice-relevant health apps could protect users from misinformation and misuse and substantially facilitate the use of digital media by health care providers.


"Move it!": Standardized quality ratings of apps to promote physical activity

Physical inactivity is a major factor in the development and maintenance of chronic disease. Apps that aim to promote physical activity could help people make lifestyle changes. In this research project, 160 apps available in the app stores ( Google PLAY and iTunes) were assessed for their quality by two independent researchers using the MARS (Mobile Application Rating Scale, Stoyanov et al., 2015; Messner et al., under revision). The agreement between the reviewers was good and a medium average quality of the sports apps was found. While the functionality subscale was rated high on average, deficiencies were evident in terms of promoting engagement, aesthetics, and information quality. In summary, there are still major deficiencies in available sports apps with regard to data protection and application security.


Mindfulness via app: contradiction or helpfulness?

Mindfulness-based interventions are in the public spotlight right now as potentially helpful stress management measures. To assess the quality of available apps designed to increase mindfulness, app stores were searched for mindfulness apps. We were able to include 103 apps that addressed mindfulness in their descriptive text. At the moment, these apps are evaluated in terms of their quality using the MARS scale (Stoyanov et al., 2015; Messner et al., under revision).


Digital in old age: apps for older people

Due to the shortage of caregivers and the ever-increasing proportion of older people in our population, there are hopes that people will be able to live independently for longer through technical support. In this study, the question will be addressed to what extent existing apps are suitable to support older people in everyday life. Furthermore, the quality of the included apps will be investigated. At the moment, these apps are evaluated with regard to their quality using the MARS scale (Stoyanov et al., 2015).


"Ouch!": Apps to help with chronic pain

Around 10-20% of the German population currently suffer from chronic pain. Almost half of those affected have to wait more than a year for a diagnosis and 19% of those affected do not feel they are being treated appropriately. This suggests that sufferers are resorting to self-treatment measures such as using an app. In this study, apps available in the app stores in the context of chronic pain will be evaluated with regard to their quality and possible risks of use.


"When the stomach hurts": quality ratings of apps for people with gastrointestinal complaints

Non-specified gastrointestinal complaints are a common phenomenon and their frequency of occurrence is between 15% and 22% in Germany. However, only about 20% of those affected seek medical attention. It can be assumed that a substantial proportion of those affected rely on self-help. One possibility of self-help is the use of apps. In this study, the quality of apps available in the app stores for the relief of gastrointestinal complaints will be evaluated.


Post-traumatic stress disorder

Post-traumatic stress disorder can develop after witnessing or experiencing one or more traumatizing events. Affected individuals experience intrusive thoughts and memories, symptoms of overexcitement (such as sleep disturbances and irritability, etc.), and emotional numbness. With the help of this study, apps that are available in the app stores and claim to be suitable for the treatment of post-traumatic stress disorder will be evaluated in terms of their quality.


Anxiety and depression apps for kids and teens

Children and adolescents exhibit a high affinity for technology. Therefore, it is obvious to conclude that psychotherapy should be augmented by technology. This research project will evaluate the quality of apps available in app stores that target children and adolescents with anxiety or depression symptoms.


Oncology Apps

Every year, around half a million Germans are diagnosed with cancer. In order to evaluate the quality of apps available in the app stores, apps were sought that are aimed at patients, relatives or the general population. In addition to the quality, the area of application (prevention, treatment, aftercare) was also recorded.

International network

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Prof. Dr. Stephen Schueller

Northwestern University

The cooperation partner in America is Prof. Dr. Stephen Schueller from Northwestern University (Preventive Medicine). He is also director of Psyberguide ( and member of the Northwestern´s Center for Beahvioral Intervention Techniques (CBITs).

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Prof. Leanne Hides and Stoyan Stoyanov

University of Technology Brisbane

Prof. Leanne Hides ( and Stoyan Stoyanov ( from the University of Technology Brisbane (Australia), who developed the MARS (Stoyanov et al., 2015). Currently collaborating on standardization of rater training.

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Prof. Dr. David Kavanagh

Queensland University of Technology

Prof. Dr. David Kavanagh Research Professor from the Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling in the Faculty of Health at Queensland University of Technology (QUT) ( focuses his research activities on Internet and mobile-based psychotherapeutic interventions, as well as tele-treatment.

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Dr. Amit Baumel

Universität Haifa

Dr. Amit Baumelof the University of Haifa (Israel, is a clinical psychologist and software developer. He developed the ENLIGHT and focuses primarily on user engagement as a factor in mobile app effectiveness.

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Prof. Dr. Thomas Probst

Donau Krems Universität

Prof. Dr. Thomas Probst ( of Danube Krems University, Faculty of Health and Medicine, Department of Psychotherapy and Biopsychosocial Health is, among other things, concerned with the psychotherapeutic potential of m-Health apps.



Paganini, S., Terhorst, Y., Sander, L. B., Catic, S., Balci, S., Küchler, A.-M., … & Messner, E. M. (2021). Quality of physical activity apps: Systematic search in app stores and content analysis. JMIR mHealth and uHealth, in press.

DOI: 10.2196/23313

Portenhauser, A., Terhorst, Y., Schultchen, D., Sander, L. B., Denkinger, M. D., Stach, M., Waldherr, N., Dallmeier, D., Baumeister, H., & Messner, E. M.  (2021). Mobile apps for older adults: Systematic review and evaluation within online stores. JMIR Aging, in press. doi:10.2196/23313

DOI: 10.1080/20008198.2019.1701788

 Lasse Bosse Sander, Johanna Schorndanner, Yannik Terhorst, Kerstin Spanhel, Rüdiger Pryss, Harald Baumeister & Eva-Maria Messner (2020) ‘Help for trauma from the app stores?’ A systematic review and standardised rating of apps for Post-Traumatic Stress Disorder (PTSD), European Journal of Psychotraumatology, 11:1, DOI: 10.1080/20008198.2019.1701788 (

DOI: 10.2196/14479

Messner, E. M., Terhorst, Y., Barke, A., Baumeister, H., Stoyanov, S., Hides, L., ... & Probst, T. (2020). The German version of the Mobile App Rating Scale (MARS-G): Development and validation study. JMIR mHealth and uHealth, 8(3), e14479. (

DOI: 10.1109/CBMS49503.2020.00087

M. Stach et al., "Mobile Health App Database - A Repository for Quality Ratings of mHealth Apps," 2020 IEEE 33rd International Symposium on Computer-Based Medical Systems (CBMS), Rochester, MN, USA, 2020, pp. 427-432, doi: 10.1109/CBMS49503.2020.00087. (

DOI: 10.1007/s12529-020-09944-y

Schultchen, D., Terhorst, Y., Holderied, T., Stach, M., Messner, E.-M., Baumeister, H., & Sander, L. B. (2020). Stay Present with Your Phone: A Systematic Review and Standardized Rating of Mindfulness Apps in European App Stores. International Journal of Behavioral Medicine.

DOI: 10.1159/000501735

Messner E, -M, Sariyska R, Mayer B, Montag C, Kannen C, Schwerdtfeger A, Baumeister H: Insights: Anwendungsmöglichkeiten von passivem Smartphone-Tracking im therapeutischen Kontext. Verhaltenstherapie 2019;29:155-165. doi: 10.1159/000501735 (

DOI: 10.1159/000481692

Terhorst, Y., Rathner, E.M., Baumeister, H., & Sander, L. (2018). „Hilfe aus dem App-Store?“: Eine systematische Übersichtsarbeit und Evaluation von Apps zur Anwendung bei Depressionen. Der Verhaltenstherapeut. Doi10.1159/000481692 (


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