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      Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study

      research-article
      , Dipl-Psych, PhD 1 , , , MSc 1 , , Dipl-Psych, PhD 2 , , Dipl-Psych, PhD 1
      (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      JMIR Formative Research
      JMIR Publications
      multiple sclerosis, eHealth, mHealth, acceptability of health care, patient preference

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          Abstract

          Background

          Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance.

          Objective

          The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

          Methods

          Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0.

          Results

          A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience ( P=.04) and higher scores among current users ( P<.001). In multiple regression analysis ( R 2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue.

          Conclusions

          Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.

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          Most cited references65

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          Multiple sclerosis review.

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            Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial.

            Internet-based interventions (IBI) are effective in treating depression. However, uptake rates in routine care are still limited. Hence, this study aimed to (1) assess the acceptance of IBIs in primary care patients with depressive symptoms and to (2) examine the effects of a brief acceptance facilitating intervention in the form of an informational video on patients' acceptance of IBIs.
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              The Concept of eHealth Literacy and Its Measurement

              The objective of this study was to translate the eHealth Literacy Scale (eHEALS) into German, to evaluate this translation through psychometric testing in a German sample of adolescents, and to analyze whether the content-derived hypothesis of two eHEALS subscales was confirmed by the data. We hypothesized that the first subscale would cover self-perceived competence in seeking health information online, and the second subscale information appraisal of health information on the Internet. A cross-sectional survey among 18-year-old students ( N = 327) using our translation of the eHEALS was conducted. A confirmatory factor analysis compared the 1-factor model based on Norman and Skinners’ analyses with the a priori specified 2-factor model. The results indicated a better fit for the 2-factor model (chi-square difference of 150.93, p < . 0001), supporting the division into subscales.
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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                Jul-Dec 2018
                12 December 2018
                : 2
                : 2
                : e11977
                Affiliations
                [1 ] Department of Health Psychology Faculty of Psychology University of Hagen Hagen Germany
                [2 ] Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology Institute of Psychology University of Mainz Mainz Germany
                Author notes
                Corresponding Author: Jennifer Apolinário-Hagen jennifer.apolinario-hagen@ 123456fernuni-hagen.de
                Author information
                http://orcid.org/0000-0001-5755-9225
                http://orcid.org/0000-0001-7472-0690
                http://orcid.org/0000-0001-8780-9985
                http://orcid.org/0000-0002-5406-3168
                Article
                v2i2e11977
                10.2196/11977
                6334710
                30684408
                fe12d776-b056-4b2c-a9f7-032efb748e38
                ©Jennifer Apolinário-Hagen, Mireille Menzel, Severin Hennemann, Christel Salewski. Originally published in JMIR Formative Research (http://formative.jmir.org), 12.12.2018.

                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 Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org.as well as this copyright and license information must be included.

                History
                : 20 August 2018
                : 21 September 2018
                : 24 October 2018
                : 22 November 2018
                Categories
                Original Paper
                Original Paper

                multiple sclerosis,ehealth,mhealth, acceptability of health care,patient preference

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