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. 2021 Sep 22;23(9):e25472.
doi: 10.2196/25472.

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

Ana Luísa Neves #  1   2   3 , Cristina Jácome #  1   2 , Tiago Taveira-Gomes  1   2   4   5 , Ana Margarida Pereira  1   2   6 , Rute Almeida  1   2 , Rita Amaral  1   2   7   8 , Magna Alves-Correia  6 , Sandra Mendes  2 , Cláudia Chaves-Loureiro  9 , Margarida Valério  9 , Cristina Lopes  10   11 , Joana Carvalho  12 , Ana Mendes  13 , Carmelita Ribeiro  14 , Sara Prates  15 , José Alberto Ferreira  16 , Maria Fernanda Teixeira  17 , Joana Branco  18 , Marta Santalha  19 , Maria João Vasconcelos  20 , Carlos Lozoya  21 , Natacha Santos  22 , Francisca Cardia  23 , Ana Sofia Moreira  24 , Luís Taborda-Barata  25   26 , Cláudia Sofia Pinto  27 , Rosário Ferreira  28 , Pedro Morais Silva  29 , Tania Monteiro Ferreira  30 , Raquel Câmara  31 , Rui Lobo  32 , Diana Bordalo  33 , Cristina Guimarães  34 , Maria Espírito Santo  35 , José Ferraz de Oliveira  36 , Maria José Cálix Augusto  37 , Ricardo Gomes  38 , Inês Vieira  39 , Sofia da Silva  40 , Maria Marques  41 , João Cardoso  42 , Ana Morete  6   43 , Margarida Aroso  44 , Ana Margarida Cruz  45 , Carlos Nunes  46 , Rita Câmara  47 , Natalina Rodrigues  48 , Carmo Abreu  49 , Ana Luísa Albuquerque  50 , Claúdia Vieira  51 , Carlos Santos  52 , Rosália Páscoa  1   2   53 , Carla Chaves-Loureiro  54 , Adelaide Alves  55 , Ângela Neves  56 , José Varanda Marques  57 , Bruno Reis  58 , Manuel Ferreira-Magalhães  2   17 , João Almeida Fonseca  1
Affiliations

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

Ana Luísa Neves et al. J Med Internet Res. .

Abstract

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.

Keywords: asthma; mobile apps; patient participation; self-management; smartphone.

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Conflict of interest statement

Conflicts of Interest: JAF is the co-founder of the University of Porto Spin-off Medida that is co-responsible for the Inspirermundi app. The other authors have no conflicts to declare.

Figures

Figure 1
Figure 1
INSPIRERS studies flowchart.
Figure 2
Figure 2
Variables collected included predisposing factors, enabling factors, and need according to the Andersen et al [19]. MTUAS: Media and Technology Usage and Attitudes Scale; VAS: Visual Analog Scale.
Figure 3
Figure 3
Number of participating centres per district.
See this image and copyright information in PMC

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