JMIR Publications

ABSTRACT

Background:

Suboptimal adoption and engagement rates of digital health applications present challenges to their effectiveness, particularly in chronic disease management like fibromyalgia. Up to half of the patients do not download prescribed digital health applications nor actively engage with them, making effective onboarding a critical opportunity for improvement.

Objective:

To investigate the impact of three different patient onboarding strategies on adoption, adherence and engagement with a digital health application for the symptom management of chronic pain syndromes.

Methods:

Patients (age ≥ 18 years) suffering from chronic musculoskeletal pain, fulfilling fibromyalgia criteria, were utilizing a new self-monitoring and management application in a four-week prospective study after receiving an onboarding to the application. This pain organizer and companion system (POCOS) consists of symptom reporting, symptom monitoring and an advice and exercise section. Participants in group 1 (standard) received an email onboarding with detailed instructions on application download, registration, usage, usability data capture, data security, and study procedures without any in-person assistance. Group 2 (video) received the same email plus a video tutorial explaining the application's use also without any in-person assistance. Group 3 (assisted) underwent an enhanced in-person onboarding, which included hands-on support for application setup and guided instructions from a health care professional (HCP). Primary outcomes included adoption rates, engagement, and adherence rates measured respectively by successful application download including login once, cumulative activations and connecting minimum once per week during the four weeks.

Results:

 A total of 48 patients were recruited (mean age; 45.7, range; 19-79). In the assisted group, 100% (15) of the participants downloaded the application compared to 62.5% (10) in the standard group and 76.5% (13) in the video group. A significant difference in adoption between the in-person onboarding (group 3) and the remote groups (1 & 2) with p = 0.009 was observed. Overall engagement, measured by cumulative app activation, ranged between 0 and 28 logins with mean logins not significantly different between the three groups (p = 0.183). The overall adherence rate was low with only 27% (13) and a survival rate of 45.8% for still being engaged in week four. Responses to the system usability scale (SUS) survey was limited with 8 responses but achieving a score of 70.31 indicating good usability of the application.

Conclusions:

Unassisted downloading and account creation for a health application appears to be a barrier for patients with chronic musculoskeletal pain in adopting a digital health app.