Accepted for/Published in: JMIR Formative Research
Date Submitted: May 15, 2020
Date Accepted: Jul 22, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The feasibility of self-monitoring with a smartphone app in Rheumatoid Arthritis: app development and results of two pilot studies
ABSTRACT
Background:
Several mobile applications (apps) exist to monitor symptoms of rheumatoid arthritis (RA), but a recent systematic review indicated high-quality apps are lacking. When patients self-monitor their own disease with patient reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of clinic visits, with benefits to healthcare burden and costs. We developed an app for this purpose (MijnReuma Reade app) and performed two pilot tests with weekly self-monitoring.
Objective:
The objective of the study was to evaluate if the designed app was ready for a definitive trial to support PRO self-monitoring of disease activity in patients with RA. In this article we describe its feasibility in terms of satisfaction, usability and engagement.
Methods:
The app was designed in collaboration with patients, rheumatologists and IT-experts. Building the app involved multiple stages of development, evaluation and redesign. Two one-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100) and engagement (% completed questionnaires) were assessed. After pilot study two, semi-structured interviews were performed to determine promotors and barriers of usage.
Results:
In the first and second pilot study respectively, 42 and 24 patients were included. Adherence declined over time with 31 (61%) resp. 19 (36%) completing the final weekly questionnaire. Overall patients were satisfied (median 8, respectively 7) and found the app usable (mean system usability score of 76 and 71). The studies identified technical problems, internal resistance (respondent fatigue, the app reminded them of their disease) and a lack of symptoms as barriers for usage and more grip on disease and better communication with the physician as promoters. Pain positively mediated usage, i.e.: more pain promoted and less pain discouraged usage.
Conclusions:
This study illustrates the feasibility of the MijnReuma Reade app that could enable self-monitoring, promote self-initiated care and improve patient-physician interaction. To test these hypotheses a randomized controlled trial is planned.
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