Factors Affecting Usage of a Digital Asthma Monitoring Application by Old-Age Asthmatics Living in Inner Central Portugal

Abstract

Magda Ines Teixeira Abreu,1,* Adalberto Fernandes Santos,1– 3,* Jorge MR Gama,4 Salete Valente,1,5 Maria Jesus Valente,1,5 Henrique Pereira,6,7 Frederico Regateiro,2,8– 10 Bernardo Sousa-Pinto,11,12 Maria Teresa Ventura,13,14 Jean Bousquet,15– 17 Luis Taborda-Barata1,2,18,19 1Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; 2CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; 3Faculty of Medicine, Agostinho Neto University, Luanda, Angola; 4Center of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilhã, Portugal; 5Department of Pulmonology, Cova da Beira University Hospital Centre, Covilhã, Portugal; 6Psychology and Education Department, Faculty of Human and Social Sciences, University of Beira Interior, Covilhã, Portugal; 7The Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, Covilhã, Portugal; 8Institute of Immunology, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal; 9Centro de Neurociências e Biologia Celular, CIBB, University of Coimbra, Coimbra, Portugal; 10Allergy & Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 11MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; 12CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; 13Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy; 14Institute of Science of Food Production, National Research Council (Ispa-Cnr), Bari, Italy; 15Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; 16Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany; 17Department of Pulmonology, University Hospital Montpellier, Montpellier, France; 18UBIAir - Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, Covilhã, Portugal; 19Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal*These authors contributed equally to this workCorrespondence: Luis Taborda-Barata, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D, Covilhã, Henrique, 6200-506, Portugal, Tel [phone], Fax [phone], Email [email protected]: To analyse factors affecting the ability to use the digital asthma monitoring application Mask-Air® in old-age individuals living in inland Portugal.Patients and Methods: In this observational study, patients with medically confirmed asthma who agreed to participate were interviewed and subdivided into Non-users Group: those who could not use the application and Users Group: those who could. Sociodemographic and psychological data, comorbidities, and asthma status were compared between groups. Assessment of reasons for refusal was based on a 6-item questionnaire.Results: Among the 72 sequentially recruited patients (mean age±SD 73.26± 5.43 yrs; 61 women; 11 men), 44 (61.1%; mean age±SD 74.64± 5.68 yrs; 38 women; 6 men)) were included in Non-users Group and 28 (38.9%; mean age±SD 71.11± 4.26 yrs; 23 women; 5 men) in Users Group. Non-users Group patients were significantly older, had lower socioeconomic level, and more frequently had severe asthma (25% vs 3.6%; Odds ratio=0.08 (95% CI=0.01– 0.81; p=0.033)) and diabetes (32.6% vs 7.4%; Odds ratio=0.17 (95% CI=0.03– 0.80; p=0.025)) than Users Group. The main reasons for not using the App were “Lack of required hardware” (n=35) and “Digital illiteracy” (n=26), but lack of interest to use the App among those who had conditions to use it was uncommon.Conclusion: Most old-age asthmatics living in Beira Interior either lack a smartphone or digital skills, which are significant obstacles to implementing app-based monitoring studies.Plain Language Summary: This study was done to see whether it was possible to use a mobile phone application (App) to help old-age asthmatics living in inner Central Portugal better monitor and self-manage their disease.The researchers interviewed a group of 72 patients with proven asthma who agreed to participate in the study. This group was subdivided into two subgroups: Non-users Group (44 patients) included those who could not use the App because they did not have a smartphone; Users Group (28 patients) included those who had all the conditions to use the App. Patients were helped to download the App (called MASK-Air), were given a thorough explanation about it, and about how it should be used on a daily basis to monitor their asthma symptoms.The researchers found that patients in Non-users Group were significantly older, had worse socioeconomic conditions, and more often had severe asthma and diabetes. They also discovered that the main reasons for not using the App were lack of a smartphone and not knowing how to use a smartphone.These results show that lacking a smartphone and not knowing how to use digital tools are frequent situations in old-age asthmatics living in inner Central Portugal, and these may be obstacles for patients in monitoring their own asthma symptoms.Keywords: asthma, mHealth, digital literacy, disease monitoring, old-age

Keywords

• asthma
• mhealth
• digital literacy
• disease monitoring
• old-age