Academic Journal
Predictors of Retention and Sustained Engagement With a 12-Month Asthma Self-Management App in Underserved Adults.
| Τίτλος: | Predictors of Retention and Sustained Engagement With a 12-Month Asthma Self-Management App in Underserved Adults. |
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| Συγγραφείς: | Zhang S; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York., Ahsan AM; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York., Agarwal R; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York., Han KH; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York., Green S; Mr. Green and Dr. Jariwala are affiliated with the Department of Allergy/Immunology, Montefiore Medical Center, Bronx, New York., Feldman JM; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York.; Prof. Feldman and Dr. Reznik are affiliated with the Department of Pediatrics, Children's Hospital at Montefiore Einstein, Bronx, New York.; Prof. Feldman is affiliated with the Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York., Reznik M; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York.; Prof. Feldman and Dr. Reznik are affiliated with the Department of Pediatrics, Children's Hospital at Montefiore Einstein, Bronx, New York., Su Z; Dr. Su and Dr. Zheng are affiliated with the Department of Informatics, University of California, Irvine, Irvine, California., Zheng K; Dr. Su and Dr. Zheng are affiliated with the Department of Informatics, University of California, Irvine, Irvine, California., Jariwala SP; Ms. Zhang, Mr. Ahsan, Mr. Agarwal, Ms. Han, Dr. Reznik, and Dr. Jariwala are affiliated with the Albert Einstein College of Medicine, Bronx, New York.; Mr. Green and Dr. Jariwala are affiliated with the Department of Allergy/Immunology, Montefiore Medical Center, Bronx, New York. |
| Πηγή: | Respiratory care [Respir Care] 2026 Oct; Vol. 71 (10), pp. 1131-1142. Date of Electronic Publication: 2026 May 11. |
| Τύπος έκδοσης: | Journal Article; Multicenter Study; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy Country of Publication: United States NLM ID: 7510357 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1943-3654 (Electronic) Linking ISSN: 00201324 NLM ISO Abbreviation: Respir Care Subsets: MEDLINE |
| Imprint Name(s): | Publication: <1983-> : Dallas, TX : Daedalus Enterprises for the American Association for Respiratory Therapy Original Publication: Philadelphia : Lippincott, c1971- |
| Ιατρικοί όροι (MeSH): | Asthma*/therapy , Mobile Applications*/statistics & numerical data , Patient Dropouts*/statistics & numerical data , Self-Management*/methods , Vulnerable Populations*/statistics & numerical data, Adult ; Female ; Humans ; Male ; Middle Aged ; Adherence Interventions ; Digital Health ; Health Literacy ; Proportional Hazards Models |
| Περίληψη: | Background: Long-term retention and engagement with digital asthma self-management tools remain challenging in underserved adults. We examined predictors of study dropout and sustained engagement with ASTHMAXcel PRO, an asthma self-management mobile health app, over 12 months in an underserved adult population. Methods: In this randomized controlled trial, adults with asthma who were on daily controller medications were recruited from 3 Bronx primary care clinics and randomized 1:1 to intervention (ASTHMAXcel PRO plus standard care) or control (standard care alone). Baseline questionnaires collected demographic, clinical (eg, asthma control, exacerbation history, and comorbidity), and health literacy data. Attrition was analyzed using Cox proportional hazards models. Engagement metrics in the intervention arm (logins, chapters read, and subject-reported outcomes) were evaluated with negative binomial mixed models, adjusting sequentially for sociodemographic and clinical covariates. Results: Among 99 participants (77% female; 97% non-White), 39 (39%) dropped out before the fourth study visit. Study dropout was associated with some college or technical education versus high school or less (hazard ratio [HR] 2.11, 95% CI 1.01-4.42, P = .048), assignment to the intervention versus control group (HR 2.11, 95% CI 1.05-4.24, P = .036), and the presence of at least 1 comorbidity (HR 2.14, 95% CI 1.12-4.09, P = .02). Engagement declined over time but was strongly predicted by higher early app use (logins incidence rate ratio [IRR] 40.95; chapters read IRR 7.23; subject-reported outcomes IRR 15.35; all P < .001). Higher educational attainment was also associated with greater sustained engagement across multiple metrics. Conclusions: In this urban underserved cohort, comorbidities and some college/technical education predicted dropout, whereas greater early app use and higher education predicted sustained engagement. These findings highlight the importance of early identification of participants at risk of dropout to enable targeted retention strategies that support sustained self-management behaviors critical to asthma outcomes. |
| Competing Interests: | Author Disclosure StatementThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: comorbidities; digital health; health literacy; mobile health (mHealth); patient engagement; self-management; study attrition; underserved populations |
| Entry Date(s): | Date Created: 20260511 Date Completed: 20261007 Latest Revision: 20261008 |
| Update Code: | 20261009 |
| DOI: | 10.1177/19433654261444702 |
| PMID: | 42109255 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1943-3654 |
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| DOI: | 10.1177/19433654261444702 |