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

用户参与移动健康应用治疗痛风与改善自我护理行为之间的关联: 随机对照试验

This is the first study to examine the impact of a commercially available gout app on health outcomes. This is also the first study to examine the utility of a commercially available gout app from the patient’s perspective, by examining user engagement. Our primary hypothesis was largely confirmed by the findings, with the gout self-management app demonstrating higher user engagement scores than the dietary app. However, this did not translate to improvements in self-care behaviors. The findings regarding illness beliefs at follow-up were more mixed, with the gout self-management app associated with stronger consequence beliefs, illness identity beliefs, and emotional response beliefs than the dietary app. Several possible reasons exist to explain why higher user engagement did not translate to improvements in self-care behaviors. First, despite higher uMARS scores, there was no difference in time that participants spent on or used to access the gout app compared with the dietary app during the study. The average number of days spent using the app (of 14 days) for both groups was only 8. Both the apps in this study provided no feedback or goal-setting functions, thus requiring the user to be intentional about their app usage and access it without personalized feedback or any specific behavior change strategies. Second, as suggested by the participant feedback, it is possible that participants determined that the gout app (Gout Central) would only be helpful during a gout flare and thus used it less. This explanation may provide insight into why there was no difference in usage time between the two apps and no changes in self-care behaviors. Even though the gout app was chosen because it was the best available app for gout, it may not provide all the appropriate tools necessary to manage gout when it is asymptomatic. Therefore, Gout Central may not meet the needs of users in terms of continuous self-management and care of the condition between flares. A third possible explanation is that there was little integration with daily self-management behaviors in gout. Many existing health apps focus on providing educational content, basic health monitoring, or various reminders, but fail to fully utilize the unique capabilities of smartphone technology (eg, real-time data collection and data visualization technology). For gout, specifically, this may mean daily medication reminders, flare diaries, visualizing serum urate fluctuations, and food diary capabilities, which encourage a user to engage with their self-care regardless of whether they are having a flare. Real-time data tracking would be especially desirable for people who are testing their serum urate levels using commercially available test meters that provide an immediate result, which would then allow for real-time serum urate tracking. Even though the gout app provided a wealth of information about gout as well as some opportunities for data tracking, real-time reminders and real-time data tracking were both missing.

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