1171 — The Power of Healthcare Team Encouragement on Veterans’ Use of Mobile Health Apps

Lead/Presenter: Stephanie Shimada,  COIN - Bedford/Boston
All Authors: Shimada SL (Center for Healthcare Organization and Implementation Research, Bedford), , Zocchi MS (Center for Healthcare Organization and Implementation Research, Bedford), Am L (Center for Healthcare Organization and Implementation Research, Bedford), Robinson SA (Center for Healthcare Organization and Implementation Research, Bedford), Etingen B (Center of Innovation for Complex Chronic Healthcare, Chicago), Smith BM (Center of Innovation for Complex Chronic Healthcare, Chicago), Bixler FR (Center of Innovation for Complex Chronic Healthcare, Chicago), Wilson GM (Center of Innovation for Complex Chronic Healthcare, Chicago), Amante DJ (UMass Chan Medical School), & Hogan TP (Center for Healthcare Organization and Implementation Research, Bedford)

Objectives:
The number of mobile health applications (apps) available to patients has increased exponentially. Veterans additionally have the choice of an array of VA-developed mobile health apps. We set out to understand Veterans’ adoption of VA and non-VA health apps and predictors of their use.

Methods:
We analyzed survey data collected in 2021 from a national sample of Veterans as part of a longitudinal quality improvement initiative. To be eligible for inclusion, Veterans had to be active users of VA services, have a mobile phone number, and be users of existing VA connected care technologies including the secure messaging feature of the My HealtheVet patient portal. Survey questions asked about Veteran demographics, current technology use, use of VA and non-VA mobile health apps, and interactions with VA healthcare team members regarding apps. We used chi-square and multiple logistic regression to identify factors associated with use of mobile health apps.

Results:
Of the 1,358 Veterans invited to complete the survey, 858 responded (63.2% response rate). Most respondents were age 65+ (71.8%), male (87.5%), White (88.2%), received most of their care at the VA (72.0%), and rated their physical health as good (43.2%)/fair (25.1%) and their mental health as very good (28.9%)/good (27%). Virtually all owned or had easy access to a computer (93.4%), smartphone (89.6%), and/or or tablet (52.8%). Relatively few reported not having used any health apps (21.7%). VA-app users (74.9%) most frequently reported using health communication apps that support 2-way communication or transactions such as RxRefill (83.1%), VA Video Connect (51.8%), and VA Online Scheduling (49.0%). The 20% of Veterans using non-VA apps were most likely to report use of simple monitoring apps that track health parameters like weight, diet, sleep, activity, blood pressure/glucose readings, or wearable data (63.6%) followed by apps to access non-VA patient portals 29.1%). App users were significantly more likely than non-users to agree that their healthcare team members encouraged app use, were aware of their app use, spoke to them about the data, and saw value in the data shared via the apps (all Ps < 0.000). However, only a fraction of app users agreed that their healthcare team encouraged health app use (28.9%), saw value in app data (29.4%), or used it to inform their care (24.6%). After adjusting for health, access to technology, and sociodemographic variables, the odds of overall app use were significantly higher (OR = 3.16, 95%CI[1.79,5.57]) among Veterans who agreed (vs. disagreed or felt neutral) that their healthcare team members had encouraged them to use apps to manage their health.

Implications:
Veterans are adopting a wide variety of VA apps and favor VA apps for health communication and non-VA apps for simple monitoring. Healthcare team encouragement to use mobile health apps is highly impactful; yet even tech-savvy Veterans report relatively low levels of discussion with their healthcare team about apps or the benefits of app data to inform care.

Impacts:
Ensuring that healthcare team members understand the value of data collected from mobile health apps and can communicate the expected benefits to patients should support increased adoption.