JMIR Publications

ABSTRACT

Background:

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.

Objective:

This study used a person-centered care approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults, and evaluated the outcome differences (i.e. self-efficacy, levels of depression, and total health service utilizations) between those who continued to use the app.

Methods:

This was a three-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into three groups: mHealth (n=71), mHealth with interactivity (mHealth+I) (n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received eight proactive calls in three months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at pre-intervention (T1), post-intervention (T2), and at three months post-intervention (T3) to ascertain the sustained effect.

Results:

37.8% of mHealth+I and 18.3% of mHealth group subjects continued using the mHealth app daily until the end of the sixth month. The difference in app usage across the two groups between T2 and T3 was significant (χ2=6.81, p-value=.009). Improvements in self-efficacy (β=4.30 [95%CI of β, 0.25 to 8.35], p=.037) and depression levels (β=-1.98 [95%CI of β, -3.78 to -0.19], p=.030) from T1 to T3 were observed in the mHealth group subjects who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service utilization decreased for all groups from T1 to T2 (β=-1.38 [95%CI of β, -1.98 to -0.78], p<.001), with a marginal increase at T3.

Conclusions:

The relatively low rates of mHealth app usage at follow-up is comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Clinical Trial: This study was registered at clinicaltrials.gov (identifier: NCT03878212) on March 18, 2019 (https://clinicaltrials.gov/ct2/show/NCT03878212).