Mobile Health Apps for Patient-Centered Care: Review of United States Rheumatoid Arthritis Apps for Engagement and Activation

Abstract

Background Rheumatoid arthritis (RA) is a highly dynamic and individualized disease in terms of its patterns of symptomatic flare-ups and periods of remission. Patient-centered care (PCC) aligns patients’ lifestyle goals with their preferences for managing symptoms and side effects through the selection of therapies appropriate for disease management. Mobile health (mHealth) apps have the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC. Objective The objective of this study was to evaluate the patient-centeredness of United States–based rheumatoid arthritis mobile apps in terms of patient engagement and activation. Methods A search of mobile apps on 2 major United States app stores (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA by adapting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for mobile health app screening based on the literature. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along 2 dimensions: engagement and activation. Results A total of 202 mobile apps were initially identified, and 20 remained after screening. Two apps emerged with the greatest ability to facilitate PCC. Both apps were scored as having acceptable or good patient engagement according to the MARS. These 2 apps also had high patient activation according to social cognitive theory, with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA. Conclusions We found very few mobile apps available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile apps expands, the design of mobile apps needs to integrate patients to ensure that their functionality promotes engagement and activation. More research is needed to understand how mobile app use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory.

Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases

“…Arthritis self-management programs improve therapy outcomes [75], and can be transformed into digital interventions [76][77][78][79][80][81]. Mobile apps for people living with RA (e.g., CareHand, LiveWith, The RAISE, RA Healthline, and ArthritisPower) differ in their content and quality [82][83][84][85]. These apps aim to improve patient outcomes with a variety of…”

“…Arthritis self-management programs improve therapy outcomes [75], and can be transformed into digital interventions [76][77][78][79][80][81]. Mobile apps for people living with RA (e.g., CareHand, LiveWith, The RAISE, RA Healthline, and ArthritisPower) differ in their content and quality [82][83][84][85]. These apps aim to improve patient outcomes with a variety of methods, such as tracking disease progression, providing patient education, encouraging healthy habits like physical exercise, and promoting social interactions and better nutrition.…”

Informing Patient-Provider Engagement for Shared Decision Making Through Mobile Health Applications

“… 19 , 20 This can lead to more frequent and efficient communication, facilitating timely interventions and improved disease management. 14 , 21 , 22 …”

“…10 By enabling people to access personalized information, monitor their progress, and actively participate in their care, mHealth apps can assist patients to have knowledge of their health and keep track of self-management. [11][12][13][14][15] From the patient's perspective, patients who are knowledgeable about their condition may have better control over their situation and are better equipped to deal with treatment and outcome uncertainties. [16][17][18] Additionally, knowing how chronic health issues and patient characteristics affect the use of mHealth apps might help develop targeted interventions to reduce inequalities and enhance healthcare outcomes.…”

“…12,13 The convenience, flexibility, and personalized nature of mHealth apps make them valuable tools for promoting collaborative and patient-centered care in managing chronic health conditions. 14 Furthermore, mHealth apps provide a convenient platform for individuals to communicate with their providers, share health information, ask questions, and receive guidance. 19,20 This can lead to more frequent and efficient communication, facilitating timely interventions and improved disease management.…”