TY  - JOUR
AU  - Wong, Arkers Kwan Ching
AU  - Bayuo, Jonathan
AU  - Wong, Frances Kam Yuet
AU  - Chow, Karen Kit Sum
AU  - Wong, Siu Man
AU  - Lau, Avis Cheuk Ki
PY  - 2023
DA  - 2023/5/1
TI  - The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e43678
VL  - 25
KW  - adults
KW  - application
KW  - apps
KW  - behavior
KW  - community
KW  - depression
KW  - diabetes
KW  - disease
KW  - hypertension
KW  - intervention
KW  - mHealth
KW  - older adults
KW  - proactive
KW  - program
KW  - self-efficacy
KW  - self-management
KW  - technology
KW  - usage
AB  - Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months’ postintervention (T3) to ascertain the sustained effect. Results: A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ21=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=–1.98, 95% CI –3.78 to –0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=–1.38, 95% CI –1.98 to –0.78, P<.001), with a marginal increase at T3. Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212 International Registered Report Identifier (IRRID): RR2-10.1159/000509129 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e43678
UR  - https://doi.org/10.2196/43678
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37126378
DO  - 10.2196/43678
ID  - info:doi/10.2196/43678
ER  -