No abstract

Background: Mobile applications (apps) are increasingly popular in healthcare. For low-income populations, barriers exist, yet limited data are available about the challenges and catalysts for adoption. Methods and Results: We partnered with a primary care center and a community organization and recruited patients to use a health app. A community health worker (CHW) consented participants, downloaded the app and instructed on its use, and provided ongoing technical support. Bi-weekly surveys for three months were sent via email/text to assess participant experiences and perceptions. The majority (81 of 108 [75.0%] English language-preferred and 50 of 52 [96.2%] Spanish language-preferred) of patients approached were enrolled. Common reasons for declining were: did not own a smartphone (13.8%), did not have email (20.7%), and not interested (58.6%). Enrollment challenges included: insufficient storage, unfamiliarity with downloading apps, forgotten passwords to email accounts, and slow/absent WiFi connection - which the CHW and the app company were able to address. Most participants, English and Spanish language-preferred respectively, were interested in monitoring their health through an app (74.4%; 70.4%), connecting devices such as FitBits© and blood pressure cuffs (78.9%; 50.0%), and being the owner of their health records (83.6%; 95.6%). There were concerns about sharing health information with research teams (66.7%; 51.9%), and data being sold (83.0%; 70.4%). However, many (58.6%; 87.2%) reported being likely to share health data with a trusted research team. Compared with before the study, most felt more comfortable using health apps (67.4%; 82.1%) and more likely to participate in research using apps (76.2%; 72.4%). Conclusions: The assistance of a CHW facilitated the enrollment of low-income individuals in a mobile health app by fostering trust and sustained engagement. Participants were interested in having several app features. Despite concerns about data privacy, they demonstrated greater interest in mobile health app use and research participation at study conclusion.

Background: Mobile applications (apps) are increasingly popular in healthcare settings. For low-income populations, however, barriers to utilization exist. To understand the challenges and catalysts for adoption, we evaluated the experiences of underserved patients engaged with a health app. Methods: We recruited patients from a primary care center and a community organization in a mobile health app (Hugo), which provides access to patient portals, health and activity monitoring, and participation in research. A community health worker (CHW) consented participants, downloaded the app on their mobile devices, connected them to portal(s), and instructed in using different features. The CHW provided ongoing tech support. Brief surveys about participants’ interests and concerns using health apps, data access and sharing, and participation in research were developed and cognitively tested, and sent via email or text, according to preference. Responses were archived in Hugo. Monetary incentives were provided at enrollment and three months. Results: Among 108 English-speaking patients and 52 Spanish-speaking patients approached for the study, 82 (75.9%) and 50 (96.2%) were enrolled, respectively. The most common reasons cited by 28 patients for declining were: didn’t own smartphone (14.3%), didn’t have email (21.4%), and not interested (60.7%). Technological challenges to enrollment included: insufficient storage; unfamiliarity with downloading apps; forgotten passwords to email accounts; infrequent email use (resulting in text option for communication); slow/absent WiFi connection. Survey response rates for English-speaking patients ranged from 48.2% (2-week survey) to 86.4% (12-week survey) of 82. Spanish surveys are ongoing and not reported. The majority were interested in monitoring their health through an app (74.4% of 43), connecting devices such as FitBits © and blood pressure cuffs (78.9% of 52), being the owner of their health records (83.6% of 67) having their records in one place (92.4% of 66), and being able to view them on their phones or tablets (100% of 68). Most were somewhat/very concerned about sharing health information with research teams (66.7% of 48), and that information collected through an app would be sold/shared without their permission (85.9% of 47). However, 58.6% (of 70) reported being somewhat/very likely to share health data with a trusted research team. Compared with before the study, 67.4% (of 43) reported feeling more comfortable using health apps, and 76.2% (of 42) reported being more likely to participate in research using apps. Conclusions: Despite several barriers, low-income individuals were feasibly enrolled in a mobile health app with the assistance of a CHW. Participants were interested in using various app features, though had concerns about safety and privacy. The involvement of a CHW facilitated engagement, trust, and participation.