Determinants of use of health and fitness mobile apps by patients with asthma: secondary analysis of observational studies (Preprint)
Authors: Neves Ana Luísa , Jácome Cristina , Taveira-Gomes Tiago , Pereira Ana Margarida , Almeida Rute , Amaral Rita , Alves-Correia Magna , Mendes Sandra , Chaves-Loureiro Cláudia , Valério Margarida , Lopes Cristina , Carvalho Joana , Mendes Ana , Ribeiro Carmelita , Prates Sara , Ferreira José Alberto , Teixeira Maria Fernanda , Branco Joana , Santalha Marta , Vasconcelos Maria João , Lozoya Carlos , Santos Natacha , Cardia Francisca , Moreira Ana Sofia , Taborda-Barata Luís , Pinto Cláudia Sofia , Ferreira Rosário , Morais Silva Pedro , Monteiro Ferreira Tania , Câmara Raquel , Lobo Rui , Bordalo Diana , Guimarães Cristina , Espírito Santo Maria , Ferraz de Oliveira José , Cálix Augusto Maria José , Gomes Ricardo , Vieira Inês , da Silva Sofia , Marques Maria , Cardoso João , Morete Ana , Aroso Margarida , Cruz Ana Margarida , Nunes Carlos , Câmara Rita , Rodrigues Natalina , Abreu Carmo , Albuquerque Ana Luísa , Vieira Claúdia , Santos Carlos , Páscoa Rosália , Chaves-Loureiro Carla , Alves Adelaide , Neves Ângela , Varanda Marques José , Reis Bruno , Ferreira-Magalhães Manuel , Almeida Fonseca João 
Published: November 2020

BACKGROUND

Health and fitness apps have potential benefits to improve self-management and disease control in patients with asthma. However, inconsistent use rates have been reported across studies, regions and health systems. A better understanding of the characteristics of users and non-users is critical to design solutions that are effectively integrated in patients daily life, and to ensure that these equitably reach out to different groups of patients, improving rather than entrenching health inequities.

OBJECTIVE

To evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage.

METHODS

A secondary analysis of Inspirers observational studies was conducted using face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and/or depression, postcode, socio-economic index, digital literacy, health services use, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R.

RESULTS

A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were 40 years or less (66.4%), had at least 10 years of education (57.4%) and were in the three higher quintiles of the socio-economic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale-VAS > 70 in 93.1%) and the prevalence of anxiety and depression was, respectively, 34.3% and 11.9%. The proportion of participants that reported using health and fitness mobile apps was 41.1% (n=211). The multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted OR 2.22 (95%CI [1.05-4.75]) and 1.95 (95%CI [1.12-3.45]), respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third and fourth quartiles showing, respectively, adjusted ORs of 6.74 (95%CI [2.90-17.40]), 10.30 (95%CI [4.28-27.56]), and 11.52 (95%CI [4.78-30.87]). Participants with depression symptoms had lower odds of using mobile health and fitness apps (adjusted OR 0.32, 95%CI [0.12-0.83]).

CONCLUSIONS

A better understanding of the barriers and enhancers of app use by patients with lower education, lower digital literacy, or with depressive symptoms, is key to design tailored interventions to improve a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior, as well as their interest and concerns about digital tools specifically. These factors may impact both initial engagement and sustained use.

CLINICALTRIAL