JMIR Publications

ABSTRACT

Background:

Evidence suggests that mobile health app use is beneficial for the prevention and management of type 2 diabetes (T2D) and its associated complications; however, population-based research on specific determinants of health app use in people with and without T2D is scarce.

Objective:

This study aimed to provide population-based evidence on rates and determinants of health app use among adults without diabetes and with T2D thereby covering a prevention perspective and a diabetes management perspective, respectively.

Methods:

The study population was comprised of 2327 adults without a known diabetes diagnosis and 1149 adults with known T2D from a nationwide telephone survey in Germany conducted in 2017. Rates of smartphone ownership and health app use were estimated based on weighted sample proportions. Among smartphone owners, determinants of health app use were identified for both groups separately in multivariable logistic regression models. Sociodemographic factors, diabetes-related, psychological and health-related factors, and health care utilization were selected as potential determinants.

Results:

Among participants without known diabetes, 74.7% (n = 1690) were smartphone owners. Of those, 49.3% (n = 717) used health apps, most often to improve regular physical activity. Among participants with T2D, 42.3% (n = 481) were smartphone owners. Of those, 41.1% (n = 171) used health apps, most commonly to target a healthy diet. Among people without known diabetes, determinants significantly (all P < .05) associated with an increased likelihood of health app use compared to their reference group were: younger age, 18-44 or 45-64 years (odds ratios (ORs) 4.36; 1.90); overweight or obesity (ORs 1.56; 1.96); hypertension diagnosis (OR 1.31); former or current smoking (ORs 1.52; 1.60); family history of diabetes (OR 1.34); other chronic diseases (OR 1.48); and having received health advice from a physician (OR 1.45). Poor perceived health (OR 0.72), a slight or high perceived diabetes risk (ORs 0.76; 0.24), and more optimistic bias about developing diabetes (OR 0.79) were significantly associated with a decreased likelihood of health app use. Among people with T2D, younger/middle age (18-64 years, OR 1.76), female gender (OR 1.71), using a blood glucose meter as well as a glucose sensor (OR 6.58), and more optimistic bias about developing diabetes complications (OR 1.43) were significantly positively associated with health app use.

Conclusions:

In terms of T2D prevention, age, diabetes-related risk factors, psychological and health-related factors, as well as health care factors may inform app development for specific target groups. Additionally, health professionals may encourage health app use when giving advice on health behaviors. Concerning T2D management, only a few determinants seem relevant for explaining health app use among people with T2D, indicating a need for more future research on which people with T2D use health apps and why.