Effects of Adherence to an mHealth Tool for Self-Management of COPD Exacerbations

Abstract

Erik WMA Bischoff,1 Nikki Ariens,1 Lonneke Boer,2 Jan Vercoulen,2 Reinier P Akkermans,1 Lisette van den Bemt,1 Tjard R Schermer1,3 1Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; 2Radboud Institute for Health Sciences, Department of Clinical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands; 3Science Support Office, Gelre Hospitals, Apeldoorn, the NetherlandsCorrespondence: Erik WMA Bischoff, Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101 (117-ELG), 6500 HB Nijmegen, the Netherlands, Tel [phone], Email [email protected]: Poor adherence to COPD mobile health (mHealth) has been reported, but its association with exacerbation-related outcomes is unknown. We explored the effects of mHealth adherence on exacerbation-free weeks and self-management behavior. We also explored differences in self-efficacy and stages of grief between adherent and non-adherent COPD patients.Patients and Methods: We conducted secondary analyses using data from a recent randomized controlled trial (RCT) that compared the effects of mHealth (intervention) with a paper action plan (comparator) for COPD exacerbation self-management. We used data from the intervention group only to assess differences in exacerbation-free weeks (primary outcome) between patients who were adherent and non-adherent to the mHealth tool. We also assessed differences in the type and timing of self-management actions and scores on self-efficacy and stages of grief (secondary outcomes). We used generalized negative binomial regression analyses with correction for follow-up length to analyze exacerbation-free weeks and multilevel logistic regression analyses with correction for clustering for secondary outcomes.Results: We included data of 38 patients of whom 13 (34.2%) (mean (SD) age 69.2 (11.2) years) were adherent and 25 (65.8%) (mean (SD) age 68.7 (7.8) years) were non-adherent. Adherent patients did not differ from non-adherent patients in exacerbation-free weeks (mean (SD) 31.5 (14.5) versus 33.5 (10.2); p=0.63). Although statistically not significant, adherent patients increased their bronchodilator use more often and more timely, contacted a healthcare professional and/or initiated prednisolone and/or antibiotics more often, and showed at baseline higher scores of self-efficacy and disease acceptance and lower scores of denial, resistance, and sorrow, compared with non-adherent patients.Conclusion: Adherence to mHealth may be positively associated with COPD exacerbation self-management behavior, self-efficacy and disease acceptance, but its association with exacerbation-free weeks remains unclear. Our results should be interpreted with caution by this pilot study’s explorative nature and small sample size.Keywords: COPD, mHealth, adherence, exacerbations, self-management, self-efficacy, grief

Keywords

• copd
• mhealth
• adherence
• exacerbations
• self-management
• self-efficacy
• grief