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      Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial

      research-article
      , PhD 1 , , , MSc 1 , , MSc 1 , , MD 2 , , PhD 1 , , MD, FRACP 3
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      mobile apps, mHealth, gout, chronic disease, user engagement, illness perceptions

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          Abstract

          Background

          Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout.

          Objective

          Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions.

          Methods

          Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention.

          Results

          Participants rated the gout app as more engaging (mean difference –0.58, 95% CI –0.96 to –0.21) and more informative (mean difference –0.34, 95% CI –0.67 to –0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference –0.64, 95% CI –1.27 to –0.003) and higher knowledge/understanding of gout (mean difference –0.70, 95% CI –1.30 to –0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference –2.43, 95% CI –3.68 to –1.18), stronger beliefs regarding the severity of symptoms (mean difference –1.97, 95% CI –3.12 to –0.82), and a stronger emotional response to gout (mean difference –2.38, 95% CI –3.85 to –0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information.

          Conclusions

          Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs.

          Trial Registration

          Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.

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          Most cited references22

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          What is user engagement? A conceptual framework for defining user engagement with technology

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            Apps of steel: are exercise apps providing consumers with realistic expectations?: a content analysis of exercise apps for presence of behavior change theory.

            To quantify the presence of health behavior theory constructs in iPhone apps targeting physical activity. This study used a content analysis of 127 apps from Apple's (App Store) Health & Fitness category. Coders downloaded the apps and then used an established theory-based instrument to rate each app's inclusion of theoretical constructs from prominent behavior change theories. Five common items were used to measure 20 theoretical constructs, for a total of 100 items. A theory score was calculated for each app. Multiple regression analysis was used to identify factors associated with higher theory scores. Apps were generally observed to be lacking in theoretical content. Theory scores ranged from 1 to 28 on a 100-point scale. The health belief model was the most prevalent theory, accounting for 32% of all constructs. Regression analyses indicated that higher priced apps and apps that addressed a broader activity spectrum were associated with higher total theory scores. It is not unexpected that apps contained only minimal theoretical content, given that app developers come from a variety of backgrounds and many are not trained in the application of health behavior theory. The relationship between price and theory score corroborates research indicating that higher quality apps are more expensive. There is an opportunity for health and behavior change experts to partner with app developers to incorporate behavior change theories into the development of apps. These future collaborations between health behavior change experts and app developers could foster apps superior in both theory and programming possibly resulting in better health outcomes.
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              Co-design of eHealth Interventions With Children and Young People

              Co-design, defined as collective creativity across the entire design process, can lead to the development of interventions that are more engaging, satisfying, and useful to potential users. However, using this methodology within the research arena requires a shift from traditional practice. Co-design of eHealth interventions with children and young people has additional challenges. This review summarizes the applied core principles of co-design and recommends techniques for undertaking co-design with children and young people. Three examples of co-design during the development of eHealth interventions (Starship Rescue, a computer game for treating anxiety in children with long-term physical conditions, a self-monitoring app for use during treatment of depression in young people, and HABITS, the development of an emotional health and substance use app, and eHealth platform for young people) are provided to illustrate the value and challenges of this contemporary process.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                August 2019
                13 August 2019
                : 7
                : 8
                : e15021
                Affiliations
                [1 ] Department of Psychological Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
                [2 ] General Practice and Primary Healthcare, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
                [3 ] Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
                Author notes
                Corresponding Author: Anna Serlachius a.serlachius@ 123456auckland.ac.nz
                Author information
                http://orcid.org/0000-0002-4797-8351
                http://orcid.org/0000-0003-0473-9577
                http://orcid.org/0000-0001-7830-4205
                http://orcid.org/0000-0002-0451-9462
                http://orcid.org/0000-0002-6337-2480
                http://orcid.org/0000-0003-4632-4476
                Article
                v7i8e15021
                10.2196/15021
                6711037
                31411147
                2e1ba5c9-254d-4623-bbf6-5fc52805db7f
                ©Anna Serlachius, Kiralee Schache, Anel Kieser, Bruce Arroll, Keith Petrie, Nicola Dalbeth. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.08.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 13 June 2019
                : 2 July 2019
                : 4 July 2019
                : 4 July 2019
                Categories
                Original Paper
                Original Paper

                mobile apps,mhealth,gout,chronic disease,user engagement,illness perceptions

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