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
Open accessAbstract
BACKGROUND: 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. OBJECTIVE: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) 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. METHODS: 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. Interviews were not recorded. RESULTS: 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. CONCLUSIONS: 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. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies.
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Researchers evaluated a range of measures that aligned with their target chronic condition, such as blood glucose, weight, symptoms, patient-reported outcomes, diary entries, and steps.
“Researchers evaluated a range of measures that aligned with their target chronic condition, such as blood glucose [56,60,61,64,73], weight [56,73,74], symptoms [66,68,69], patient-reported outcomes [38,46,52,65,71], diary entries [47,66], and steps [51].”
From A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review (2019) · cites this paper as [73]
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- Authors
- Thies, K., Anderson, D., & Cramer, B.
- Affiliations
- Community Health Center (US)
- Western Michigan University (US)
- Corresponding author
- Thies, Kathleen
- Venue
- JMIR Human Factors
- Publisher
- JMIR Publications Inc.
- Published
- 2017-10-03
- Volume
- 4
- Issue
- 4
- Pages
- e24
- ISSN
- 2292-9495 (ISSN-L)
- PMC
- PMC5645643
- OpenAlex
- W2763828059
- Cited by
- 118
- References
- 14
- Citations by year
- 2026: 1 · 2025: 17 · 2024: 12 · 2023: 20 · 2022: 23 · 2021: 12 · 2020: 13 · 2019: 9 · 2018: 10 · 2017: 1
- FWCI
- 14.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Human Factors (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mobile health apps, diabetes self-management, hypertension self-management, app adoption, federally qualified health centers, usability, electronic health record integration, reimbursement, digital health literacy, implementation barriers, chronic disease management
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