Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 10, 2020
Date Accepted: Sep 22, 2020
The relationship between patient engagement and depressive symptoms among people living with HIV in a mobile health intervention: a secondary analysis of a randomized controlled trial
ABSTRACT
Background:
Association between higher levels of patient engagement and better health outcomes has been found in face-to-face interventions. However, findings on patient engagement and health outcomes have been mixed in mobile-based interventions.
Objective:
The objective of this study is to investigate the relationship between patient engagement and depressive symptoms in a mobile Health (mHealth) intervention using 4 time-point repeated measurements of both patient engagement and patient outcome.
Methods:
A randomized controlled trial (RCT), Run4Love, was conducted to exam the efficacy of an mHealth intervention in reducing depressive symptoms among people living with HIV and elevated depressive symptoms (PLWHD). This study is a secondary analysis of the data from the RCT to investigate the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received adapted cognitive-behavioral stress management (CBSM) courses and physical activity promotion. Depressive symptoms were repeatedly measured by the Patient Health Questionnaire (PHQ-9) at baseline, 1, 2, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of materials completed, and time spent on the program at 1, 2, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points of the intervention.
Results:
The mean PHQ-9 scores were 10.2 (SD=4.5), 7.7 (SD=4.8), 6.5 (SD=4.7), and 6.7 (SD=4.1) at baseline, 1, 2, and 3 months respectively. The mean completion rates were 50.6% (SD=31.8%), 51.5% (SD=32.2%), and 50.8% (SD=33.7%) at 1, 2, and 3 months; the average frequency of materials completed were 18.0 (SD=14.6), 32.6 (SD=24.8), and 47.5 (SD=37.2) at 1, 2, and 3 months; and the mean time spent on the program were 32.7 (SD=66.7), 65.4(SD=120.8), and 96.4 (SD=180.4) minutes at 1, 2, and 3 months. LGCMs showed good model fit and indicated a significant relationship between patient engagement and depressive symptoms. Specifically, a higher completion rate (β3=-2.184, P=.048) and a greater frequency of material completed (β3=-0.018, P=.04) were associated with less depressive symptoms only at 3 months. Though not significant, similar trends were found in the above relationships at 1 and 2 months. There was no relationship between time spent on the program and depressive symptoms.
Conclusions:
This study revealed a positive association between patient engagement and health outcome at 3 months of an mHealth intervention using LGCMs and repeated measurement data. The results underscored the importance of improving patient engagement in mHealth interventions to improve health outcomes of the participants. Clinical Trial: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showprojen.aspx?proj=21019
Citation
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