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. 2023 Sep 27;23(1):194.
doi: 10.1186/s12911-023-02300-6.

A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study

Hani Salim  1 , Ai Theng Cheong  2 , Sazlina Sharif-Ghazali  2   3 , Ping Yein Lee  4 , Poh Ying Lim  5 , Ee Ming Khoo  6 , Norita Hussein  6 , Noor Harzana Harrun  7 , Bee Kiau Ho  8 , Hilary Pinnock  9 ; RESPIRE Collaboration
Affiliations

A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study

Hani Salim et al. BMC Med Inform Decis Mak. .

Abstract

Background: Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes.

Methods: We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively.

Results: We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members.

Conclusions: An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.

Keywords: Asthma; Feasibility study; Health literacy; Low-and-middle-income countries (LMIC); Mobile application; Self-management.

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Conflict of interest statement

HP, EMK, ATC, SSG, and NH report grants and HS received PhD sponsorship from the UK National Institute for Health and Care Research (NIHR) (Global Health Research Unit on Respiratory Health, RESPIRE); 16/136/109. HP reports personal fees from Boehringer-Ingelheim for a lecture on ‘Supported self-management for asthma’. EMK reports personal fees from AstraZeneca and is the President of the International Primary Care Respiratory Group and the Primary Care Respiratory Group Malaysia. All other authors had no competing interest in the conduct of this study.

Figures

Fig. 1
Fig. 1
Outline of the study phases
Fig. 2
Fig. 2
Flow of study participants
Fig. 3
Fig. 3
Graphical representation of the total number of app uses during and after the feasibility study
Fig. 4
Fig. 4
App usage data throughout the study period, N = 37
See this image and copyright information in PMC

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