With the rise of interest in self-management both in the academic circles and in day-to-day life, apps promising support to self-manage have increased significantly with mixed results and some promising tendencies.
Self-management of a chronic disease is a worthy goal but can be hard to reach. The development of self-management apps promises to ease self-management but despite the continuous development and some promising results there is still mixed evidence on the effectiveness of self-management apps.
The development of self-management apps has come with the promise of delivering self-management interventions with lower costs, easily accessible and potentially adaptable to the user (Whitehead & Seaton, 2016). And indeed, mobile technologies have been increasingly introduced into daily practice, particularly for patient communication, monitoring, and education, and to facilitate adherence to chronic disease management (Hamine, et al., 2015). Patients also seem to be interested in the trend. A recent systematic review (Hamine et al., 2015) that focused on interventions in supporting the adherence (“mAdherence”) found that the usability, feasibility and acceptability or patient preferences was generally high in the 107 studies analysed.
Variability in results
Despite the raising interest and use, the evidence is still mixed. The above mentioned systematic review found that only 39% of the RCTs that measured effects on clinical outcomes for chronic diseases reported significant improvements of mAdherence interventions. This variability in results goes in line with findings of other systematic reviews. Rathbone & Prescott, 2017 found that despite overall improvements in physical health and significant reductions if anxiety, stress, and depression, the effect was considerably reduced over a short period of time (immediately post-test to 6 month follow-up).
Dr Rosa Suñol
Dr Rosa Suñol leads the first EU tender on patient empowerment and has been involved in several EU projects on the areas of patient empowerment and self-management since then. She now leads the COMPAR-EU project with the aim of contributing significantly to reducing the gap between evidence on self-management and its implementation across Europe.
Given this lack of clarity on the effectiveness, new research is emerging focusing in particular on identifying the reasons for this variability. For example, a recent RCT (Ma, 2018) on the use of mobile health applications in chronic diseases found a variability in the use of apps (measured by the number of apps and the updating of those apps). Ma found that several factors influence the use, highlighting that Emergency hospitalization and significant change in personal health condition increase the likelihood of updating apps. On the other hand, factors such as being parent or older age were associated with lower use, when controlling for other socioeconomic effects.
Therefore, it seems that if we want to take advantage of the potential benefits and advantages of apps for self-management, we need to tailor those apps to the circumstances of the people using them. And there is still much to learn on the specific circumstances in which the self-management apps work best and how to sustain it overtime. COMPAR-EU aims to contribute in this area by performing sub-group analysis on the effectiveness of app-based self-management interventions to help identify precisely those areas of success, contributing to expand them across Europe.