Patient engagement with an asthma app to improve inhaler adherence

InspirerMundi app aims to transform adherence into a positive experience through gamification and social support, while allowing objective monitoring of inhaler adherence. We explored patients’ engagement with this app. Adolescents and adults with persistent asthma, followed in 24 Portuguese hospital outpatient clinics, were invited by their physicians to use the InspirerMundi app daily for 4 months and register medication and symptoms. To stimulate engagement, the app includes a gamification component (point and badge system with a storyline of a warrior evolving to an Inspirer-advanced player that can motivate warriors to improve adherence). During the study period, patients received 3 phone interviews for additional data collection and 6 text messages to promote app engagement. Usage rate (days with app uses/total days) during weeks that followed a contact (phone/message) were compared to weeks with no contacts. A total of 77 patients (27±13y) were recruited and 72 used the app a median[P25-P75] of 48[24-114] days (usage rate 60[32-83]%).Total use period was >30 days for 2/3 of patients and >90 days for 1/3. Sixty-four patients registered ≥1 medication; 66 patients answered a median of 14[4-35] symptom questionnaires; 63 received ≥1 badge; and 9 achieved Inspirers level. Text messages did not seem to influence usage rate (p=.386), while phone calls seemed to have a negative effect (p=.003). 16 (22%) users continued to use the app after the end of the study. The usage rate of InspirerMundi app was higher than usage reported for other health apps. These results might be related to the app engagement features and to the recommendation of use by a physician. Additional contacts do not seem to improve app usage rate.