JMIR Publications

ABSTRACT

Background:

Mobile health technologies (mHealth) provide a unique opportunity to share and gather information about health and disease. In the context of public health, mHealth is particularly suited for patient education, disease self-management, and remote monitoring of patients. mHealth also takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner compared to traditional epidemiological methods. However, although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use for vector-borne diseases research has not been yet fully exploited.

Objective:

In this study, we report on the development and implementation of a smartphone application, The Tick App, which is the first tick research-focused app in the United States.

Methods:

We used an iterative mixed-methods approach, including qualitative and quantitative methods, to develop and evaluate the implementation of The Tick App. This app was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure, while simultaneously raising awareness among the general public by engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors; daily surveys to collect data on human activities and tick encounters (“Tick Diaries”); a survey to enter the details of tick encounters coupled with tick identification services (“Report a Tick”); and educational material.

Results:

Between May and September 2018, 1468 adult users enrolled, and approximately half were recurring users of the app. They were equally represented in gender and age, peaking at 37 and 55 years old. Most users owned a pet, did frequent outdoor activities (occupational, recreational and/or peridomestic) and lived in the Midwest and Northeast regions, increasing significantly in counties with high Lyme incidence or with recent increase in the number of reported cases in low incidence counties. Recurring users had a similar demographic profile to all users but participated in outdoor activities more frequently. The number of active users peaked in June and July, consistent with Ixodes scapularis nymphal activity. Although the “Tick Diary” was the most frequently used feature, the median number of submissions per user was 2 (IQR=1–11), falling short of the target of 15. The number of “Tick Diaries” submitted per user was higher for older age groups and in the Midwest, while the number of tick reports increased with the frequency of outdoor activities.

Conclusions:

This assessment allowed us to identify what fraction of the population used The Tick App which would allow us for a better interpretation of the external validity of the findings derived from the app-collected data, as well as to tailor the design of potential future tick prevention interventions to the users’ characteristics.