Engagement with an Asthma App to Monitor Medication Adherence and Its Association with Patients’ Characteristics

We aimed to explore which patients’ characteristics were associated with a low engagement with the InspirerMundi app. A 1-month multicenter observational study was conducted with patients with persistent asthma from 26 secondary care centers from Portugal and Spain. During an initial in person visit, patients were invited by their physician to use the app daily to register their asthma medication intakes. Physicians reported whether it was a 1st or follow-up visit, current asthma treatment, number of exacerbations and healthcare use in the past year. Patients were asked about demographics, asthma control, anxiety, depression and health status. A total of 107 patients (median[P25-P75] 27[17-40] years, 59% female) were invited and 93% installed the app. Those not installing the app were more frequently the ones going to a 1st medical visit (p=0.021) and tended to be older (p=0.051). Patients interacted with the app a median of 9[1-24] days: 25% only one day and 10% all 31 days. Patients interacting only one day were more frequently male (p=0.040), had worse self-reported health (p=0.045) and had more exacerbations (p=0.039). Although not significant, these patients also had a higher number of unscheduled medical visits (p=0.053), had more frequently short-acting beta-agonists in their therapeutic plan (p=0.087) and depression symptoms (p=0.094). Median engagement with the InspirerMundi app is within the range described in digital health studies. Patients with low app engagement showed worse asthma outcomes. Our results highlight the importance of considering patients’ characteristics in the design of mHealth tools to improve its adoption and sustained use.