Posted Jan 3 , 2018 04:43 AM

Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial

Thies K, et al. Journal of Medical Internet Research 2017;4:e24

What were the findings (excerpted from the Abstract)?

Thousands of mobile health (mHealth) apps have been developed to support patients’ management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers’ adoption of these technologies. The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful. We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to. This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users’ electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. Researchers should address these contextual factors in any trial and adoption of mHealth technologies.

Why is this important?

The number of ‘healthcare’ apps has increased to over a dizzying 315,000. Many of these apps are geared toward behaviors important to diabetes and/or hypertension. While the promise of mHealth in the diabetes realm has been touted in many studies, the effectiveness in actual practice is poorly documented (if at all). Some groups have attempted to evaluate some of these apps, and list the most promising (and validated) ones [see:]. Just as important as discerning which apps work is understanding why some don’t work in practice. This is a unique article about a failed pilot of one of these apps that provides insight into things that should be considered when initiating any healthcare app. Clearly it is important to address the contextual factor mentioned…and that takes time and effort!

Do you recommend ‘apps’ to your patients with diabetes and/or hypertension? Do the apps you recommend work well in your practice and integrate into your EHR?

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