Content and Quality Analysis of mHealth Apps for Feeding Children with Autism Spectrum Disorder (Preprint)

BACKGROUND Approximately 1 in 100 children worldwide are diagnosed with Autism Spectrum Disorder (ASD), and 46% to 89% experience significant feeding difficulties. Mobile health applications (mHealth apps) are a potential tool for scalable support. However, there is nascent literature on the quality and relevance of mHealth apps for managing ASD-related feeding challenges. OBJECTIVE This study aimed to identify and evaluate the scope, content, and quality of free English-language mHealth apps available in the Africa region for addressing feeding difficulties in children with ASD. METHODS A systematic search was conducted on the Apple App Store and Google Play Store between September and October 2024. Applications were included if they were free, in English, updated within the past year, explicitly focused on feeding in children with autism, available in the Africa region, and had more than 100 downloads. We identified intervention strategies in the included apps using the Behavior Change Wheel (BCW) framework and evaluated their quality using the Mobile App Rating Scale (MARS). RESULTS Of the 326 applications identified, only two iOS apps (EduKitchen-Toddlers and Autism Food Coach 2) met all inclusion criteria. Relaxing the inclusion criteria did not yield additional results. EduKitchen–Toddlers Food Games provided child-centered interactive games and sensory-friendly visuals, while Autism Food Coach 2 provided structured caregiver tools, visual meal plans, and progress tracking. Both apps aligned with multiple BCW intervention functions. EduKitchen–Toddlers provided education, training, enablement, incentivization, and modeling intervention functions, while Autism Food Coach 2 provided education, training, enablement, persuasion, incentivization, and environmental restructuring based on the Behavior Change Wheel framework. The apps received MARS scores of 3.7 and 3.9, respectively, indicating acceptable to good usability and content quality. The apps’ shortcomings included limited customization for diverse user needs and the absence of documented clinical validation. CONCLUSIONS There is a critical shortage of mHealth apps for feeding difficulties in children with ASD that are both evidence-based and of high quality. Future development must integrate robust clinical validation and comprehensive, caregiver-centered support features to address this significant gap. CLINICALTRIAL Not applicable