Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 14, 2020
Open Peer Review Period: Dec 13, 2020 - Feb 7, 2021
Date Accepted: Apr 9, 2021
(closed for review but you can still tweet)
Feasibility and acceptability of an asthma app to monitor medication adherence: a mixed methods study
ABSTRACT
Background:
Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor adherence while turning into a positive experience through gamification and social support.
Objective:
This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication).
Methods:
A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other recipient) by using the image-based medication detection tool. At 1-month, patients were interviewed by phone and app satisfaction was assessed on a 1(low)-5(high) scale. Patients were also asked to point out the most and least preferred app features and to make suggestions for future app improvements.
Results:
A total of 107 patients (median 27[P25-P75 14-40] years) were invited, 99 (93%) installed the app and 79 (74%) completed the 1-month interview. Patients interacted with the app a median of 9[1-24] days. At least one medication was registered in the app by 77 patients (72%). Fifty-two (53%) participants registered all prescribed inhalers and 34 (34%) registered the complete asthma therapeutic plan. Median medication adherence was 75[25-90]% for inhalers and 82[50-94]% for other drug formulations. Patients were globally satisfied with the app, with 75% scoring ≥4, with the adherence monitoring, symptom monitoring and gamification features being the most highly scored components and the medication detection tool among the lowest scored (53% ≥4). 53% of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% would recommend the app to other patients. Patients’ feedback was reflected in four major themes: Medication-related features (n=67, 85%), Gamification and social network (n=33, 42%), Symptom monitoring and physician communication (n=21, 27, and Other aspects (n=16, 20%).
Conclusions:
The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patients’ feedback and to increase the registering of medications, the therapeutic plan registration and the medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
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