Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 13, 2019
Date Accepted: Jul 4, 2019
Is user engagement of a mobile health app for gout associated with improvements in self-care behaviours? A randomized controlled trial
ABSTRACT
Background:
Background:
Mobile health apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We wanted to examine the efficacy of a recommended commercially available gout self-management app for improving self-care behaviours, as well as assess self-reported user engagement of the app in a sample of adults with gout.
Objective:
Objective:
Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) compared to a dietary app (active control group) over two weeks as well as examine any differences in self-care behaviours and illness perceptions.
Methods:
Methods:
Seventy-two adults with gout were recruited from the community and from three primary and secondary clinics and randomized to trial one of the apps over two weeks. Participants were randomized to either Gout Central (n=36), a self-management app, or the Dash Diet Plan (n=36), an app based on a diet developed for hypertension. The user-version of the Mobile Application Rating Scale (uMARS, 1 to 5 scale) was completed after two weeks to assess self-reported user-engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviours (1-5 scale for medication adherence and diet and 0-7 for exercise) and illness perceptions (0-10 scale) at baseline and after the two-week trial. Independent samples t-tests and ANCOVAs were used to examine differences between groups at baseline and post-intervention.
Results:
Results:
Participants rated the gout app as more engaging (mean [95% CI] difference -0.58, [-0.96, -0.21]) and more informative (mean difference -0.34 [-0.67, -0.01]) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference -0.64 [-1.27, -.003]) and higher knowledge/understanding of gout (mean difference -0.70 [-1.30, -0.09]) than the diet app group at follow-up. There were no significant differences in self-care behaviours between the two groups post-intervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference -2.43[-3.68, -1.18]), stronger beliefs regarding severity of symptoms (mean difference -1.97 [-3.12, -0.82]), and a stronger emotional response to gout (mean difference -2.38 [-3.85, -0.90]) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information.
Conclusions:
Conclusions:
Participants found the commercially available gout app more engaging. However these findings did not translate into differences in self-care behaviours. The gout app group also demonstrated stronger negative illness perceptions at follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centred approach with a focus on daily, long-term self-care behaviours as well as modifying illness beliefs. Clinical Trial: Australian New Zealand Clinical Trials Registry (ANZCTR) (registration number ACTRN12617001052325).
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