Abstract 37: Experiences and Perspectives of Low Income Patient Populations in Using a Mobile Health Application with Tailored Assistance of a Community Health Worker
Authors: Liu Patrick , Astudillo Katia , Velez Damaris , Kelley Lauren , Hutten Dave , Krumholz Leslie , Cobbs-Lomax Darcey , Spatz Erica 
Published: April 2019

Background:
Mobile applications (apps) are increasingly popular in healthcare settings. For low-income populations, however, barriers to utilization exist. To understand the challenges and catalysts for adoption, we evaluated the experiences of underserved patients engaged with a health app.

Methods:
We recruited patients from a primary care center and a community organization in a mobile health app (Hugo), which provides access to patient portals, health and activity monitoring, and participation in research. A community health worker (CHW) consented participants, downloaded the app on their mobile devices, connected them to portal(s), and instructed in using different features. The CHW provided ongoing tech support. Brief surveys about participants’ interests and concerns using health apps, data access and sharing, and participation in research were developed and cognitively tested, and sent via email or text, according to preference. Responses were archived in Hugo. Monetary incentives were provided at enrollment and three months.

Results:
Among 108 English-speaking patients and 52 Spanish-speaking patients approached for the study, 82 (75.9%) and 50 (96.2%) were enrolled, respectively. The most common reasons cited by 28 patients for declining were: didn’t own smartphone (14.3%), didn’t have email (21.4%), and not interested (60.7%). Technological challenges to enrollment included: insufficient storage; unfamiliarity with downloading apps; forgotten passwords to email accounts; infrequent email use (resulting in text option for communication); slow/absent WiFi connection. Survey response rates for English-speaking patients ranged from 48.2% (2-week survey) to 86.4% (12-week survey) of 82. Spanish surveys are ongoing and not reported. The majority were interested in monitoring their health through an app (74.4% of 43), connecting devices such as FitBits

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and blood pressure cuffs (78.9% of 52), being the owner of their health records (83.6% of 67) having their records in one place (92.4% of 66), and being able to view them on their phones or tablets (100% of 68). Most were somewhat/very concerned about sharing health information with research teams (66.7% of 48), and that information collected through an app would be sold/shared without their permission (85.9% of 47). However, 58.6% (of 70) reported being somewhat/very likely to share health data with a trusted research team. Compared with before the study, 67.4% (of 43) reported feeling more comfortable using health apps, and 76.2% (of 42) reported being more likely to participate in research using apps.

Conclusions:
Despite several barriers, low-income individuals were feasibly enrolled in a mobile health app with the assistance of a CHW. Participants were interested in using various app features, though had concerns about safety and privacy. The involvement of a CHW facilitated engagement, trust, and participation.