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
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it