Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies
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: June 2021

Background
Health and fitness apps have potential benefits to improve self-management and disease control among 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 nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities.

Objective
This study aimed 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 the INSPIRERS observational studies was conducted using data from 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 depression, postcode, socioeconomic level, digital literacy, use of health services, 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 old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). 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 odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 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 reporting aORs 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), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83).

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