JMIR Publications

ABSTRACT

Background:

SIMPLe is an internet‐delivered self‐management mobile app for bipolar disorder designed to combine technology with evidence-based interventions and facilitate access to psychoeducational contents. The SIMPLe app was launched to the real world to make it available worldwide within the context of bipolar disorder treatment.

Objective:

The main aims of the present work were as follows: (1) To describe app usage, engagement and retention rates based on server data. (2) To identify patterns of user retention over the first 6-month follow-up of usage. (3) To explore potential factors contributing to discontinuation app use.

Methods:

This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website and data-collection sources were: an online questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered by continuous app use, and the usage patterns captured by its server. Characteristics and engagement of regular users, occasional users and no users were compared using t tests or analysis of variance, or their non-parametric equivalent. Survival analysis and risk functions were applied on regular users to examine and compare usage time and user retention. Additionally, a user’s evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use.

Results:

We included 503 participants with data collected between 2016 and 2018. Of those, 390 used the app and among those 173 completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declines gradually over the first 6 months of use. The probability of retention for the regular users after one month of app use was 67.4% (95% CI 62.7 – 72.4%). Age (P=.002), time passed since illness onset (P<0.001) and years since diagnosis of bipolar disorder (P=.048) correlate with time of usage. Also, subjects who were suffering bipolar disorder for longer used the app for more days (mean 97.73; P=.002) than those who had a more recent onset (mean 66.49; P=.002) or those who were diagnosed more recently (mean 73.45; P=.013).

Conclusions:

The user retention of the app decreases rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, suffering from an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription and management.