JMIR Publications

ABSTRACT

Background:

The use of electronic headache diaries via smartphone apps has several advantages over paper and pencil diaries. Still, adherence to electronic headache diaries is not always satisfactory. One potential strategy to improve adherence is the implementation of daily reminders, but their effect remains uncertain.

Objective:

The DMKG-App (the headache diary app of the German Migraine and Headache Society, DMKG) sends daily reminders to encourage user adherence. Due to a technical problem, reminders failed for a 14-day period in early 2023. This provided a unique opportunity to evaluate the effect of daily reminders on adherence.

Methods:

To this end, the failure period was compared to 14-day pre- and post-failure periods, and to the corresponding periods of the previous year.

Results:

The DMKG-App had 4248 active users before the reminders failed. During the failure period, the number of daily entries significantly declined by 5.0% (F = 79.2, df = 2, P<.001). The entry delay sharply increased, from 1.90 ± 0.12 days pre-failure to 2.78 ± 0.20 days during the failure, and returned to 1.85 ± 0.14 days post-failure (F = 155.4, df = 2, P<.001). In addition, an extra 1.2% of users ceased app use during the failure period without resuming afterwards, corresponding to a 30% increase in attrition rate (chi2 = 11.7, df = 2, P<.01). No significant differences between the corresponding periods were found in the previous year (without reminder failure).

Conclusions:

In summary, daily reminders increase adherence to a headache diary app. Especially, they reduce the entry delay, likely minimizing recall bias. Clinical Trial: German Clinical Trials Register (DRKS 00021081)