JMIR Publications

ABSTRACT

Background:

The dose-response relationships between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Existing studies have evaluated dose-response relationship using pre- and post-intervention data or in a short period of time. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed.

Objective:

This study aimed to examine dose-response relationships between patient engagement and three psychosocial outcomes in an mHealth intervention, Run4Love, using repeat measurement of outcomes at baseline, 3, 6, and 9 months.

Methods:

This study is a secondary analysis using the longitudinal data of the Run4Love trial—a randomized controlled trial (RCT) with 300 people living with HIV and elevated depressive symptoms (PLWHD) to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (n=150), respectively, using 4 time-point outcome measurements. Patient engagement was assessed by the completion rate of course assignments and frequency of items completed. Cluster analysis was employed to categorize patients into high- and low-engagement groups. Generalized linear mixed-effects models (GLMMs) were conducted to investigate the dose-response relationships between patient engagement and outcomes.

Results:

The cluster analysis identified two clusters distinctively different from each other. The first cluster consisted of 72 participants with good compliance to the intervention, completing 52.5 intervention items (52.5/72, 73%), and 82 items on average when accounting for repeated visits. The second cluster consisted of 78 participants with low compliance to the intervention, completing 10.8 intervention items (10.8/72, 15%) and 14.50 items on average accounting for repeated visits. Results of LGMMs showed that compared to the low-engagement group, the high-engagement group significantly reduced more depressive symptoms (β=−1.93, P=.02) and perceived stress (β=−1.72, P=.01), and improved QOL (β=2.41, P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the two engagement groups were 0.8, 1.6, 2.3, and 3.7 points, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points; group differences in PSS: 0.9, 1.4, 2.3, and 3.0 points).

Conclusions:

This study revealed a positive long-term dose-response relationship between patient engagement and three psychosocial outcomes among PLWHD in an mHealth intervention during 9 months using 4 time-point repeat measurement data. High- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects. Clinical Trial: The trail was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012606).