Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 26, 2022
Date Accepted: Oct 19, 2022
Warning: This is an author submission that is not peer-reviewed or edited.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.
Mobile Health Applications as a Means to Patient-Centered Care: A Review of Rheumatoid Arthritis Applications for Engagement and Activation
ABSTRACT
Background:
Rheumatoid arthritis (RA) is highly dynamic and individualized disease in terms of its patterns of flare ups in symptoms and periods of remission. Patient-centered care (PCC) aligns patients’ lifestyle goals and their preferences for managing symptoms and side-effects with the selection of therapies appropriate for disease management. Mobile health (mHealth) applications hold the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC.
Objective:
This study systematically evaluated United States-based, RA mobile application features to assess functionality to facilitate engagement and activation related to PCC.
Methods:
A systematic search of mobile applications on two major United States app stores, (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along each dimension: engagement and activation.
Results:
A total of 202 mobile applications were initially identified, and 20 applications remained after PRISMA guidelines were applied. Two applications emerged with the greatest ability to facilitate PCC. Both applications were scored as having acceptable or good patient engagement according to the MARS. These two apps also had high patient activation according to social cognitive theory with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA.
Conclusions:
We found very few mobile applications available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile applications expands, the design of mobile applications needs to integrate patients to ensure their functionality promotes engagement and activation. More research is needed to understand how mobile application use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory.
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