Principal Results
depression
DISEASE, CHRONIC DISEASES
While both the mHealth and mHealth+I groups had access to the app following the completion of the intervention, more participants in the mHealth+I group (n=28) demonstrated sustained usage of the mHealth app until the end of the sixth month, and the difference was statistically significant. Perhaps the personalized support received by participants in the mHealth+I group triggered the notion that even in the absence of support, they could still monitor their health status and know how to report it to health care professionals during medical appointments. Yet, it should be highlighted that more than half of the participants in both groups stopped using the app after the intervention, with only 37.8% (n=28) of the mHealth+I group using the app at the 6-month follow-up despite the added aspect of proactive calls.The finding affirms that sustained use of mHealth apps in self-managing chronic diseases is generally low among older persons [About outcomes, statistically significant findings were observed on self-efficacy and depression levels in the mHealth(S) group from T1 to T3. Interestingly for the mHealth+I(S) group, the effect was only significant at T2, with a reduction in self-efficacy and an increase in depression scores from T2 to T3. Put together, these results indicate that a greater sustained effect from the intervention was seen in the mHealth(S) group than in the mHealth+I(S) group. In addition to sustained use of the mHealth app, this finding may be related to the fact that the mHealth(S) group did not receive the formal support received by those in the mHealth+I(S) group. Although the telephone calls offered an opportunity to proactively follow up, the biweekly care planning offered the opportunity of tailoring the services to the unique needs of the participants. The formal support ended after the completion of the intervention, although the participants were encouraged to continue using the app, making them equal to the mHealth group. However, they might have needed some time to become accustomed to using the app without any active follow-up calls, something that the mHealth group was already used to.Despite the improved outcomes on self-efficacy and depression in the mHealth(S) group, their total health service usage scores generally decreased from T1 to T2 and increased from T2 to T3. From T1 to T2, participants in the mHealth and mHealth+I groups were actively followed up by a nurse via telephone calls if abnormalities were detected in the health status–tracking system. The calls only targeted participants in the mHealth and mHealth+I groups, allowing them to be compared to the control group. As highlighted across existing studies, it may be helpful for technology-driven automations to complement, rather than entirely replace in-person communication [The finding regarding the reduction of depression levels from T1 to T2 and increase from T2 to T3 is particularly noteworthy among participants in the mHealth+I(S) group. Although of limited duration, the nurse-initiated telephone calls may have created a social environment that promoted interaction between the participants and the nurse. Withdrawal of this form of social support from T2 to T3 may have extinguished the notion of interaction and contributed to the increase in depression. The potential need for sustained contact with nurses can be challenging considering the ongoing shortage of nurses across the globe. The use of robotics has been reported in patient monitoring and medication administration [The control and intervention groups had comparable levels of health service usage, although the latter groups demonstrated a marginally lower level of usage. Perhaps the participants experienced similar disease trajectories, leading to the observed levels of health service usage.