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

• Published in: International journal of chronic obstructive pulmonary disease Vol. 18; pp. 2381 - 2389
• Main Authors: Bischoff, Erik W.M.A, Ariens, Nikki, Boer, Lonneke, Vercoulen, Jan, Akkermans, Reinier P, van den Bemt, Lisette, Schermer, Tjard R
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 30.11.2023; Dove; Dove Medical Press
• Subjects: adherence; Comparative analysis; copd; exacerbations; grief; Lung diseases, Obstructive; mhealth; Original Research; Prednisolone; self-efficacy; self-management
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S431199

Purpose: 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