Predictors of Retention and Sustained Engagement With a 12-Month Asthma Self-Management App in Underserved Adults.
Serena Zhang, Atiq M Ahsan, Rishab Agarwal et al.
✦ AI-curated · Sources linked
In 30 seconds
This randomized controlled trial examined predictors of dropout and sustained use of ASTHMAXcel PRO over 12 months among adults with asthma receiving daily controller medication at three Bronx primary care clinics. Of 99 participants, 39 (39%) left the study before the fourth visit. Dropout was associated with intervention assignment, some college or technical education, and at least one comorbidity. In the intervention group, engagement declined over time, while higher early app use strongly predicted later engagement across logins, chapters read, and reported outcomes; higher education was also associated with sustained engagement.
Key findings
- Thirty-nine of 99 participants (39%) dropped out before the fourth study visit.
- Dropout was associated with intervention assignment (HR 2.11, 95% CI 1.05-4.24, P = .036) and at least one comorbidity (HR 2.14, 95% CI 1.12-4.09, P = .02).
- Higher early app use predicted later engagement: logins IRR 40.95, chapters read IRR 7.23, and subject-reported outcomes IRR 15.35; all P < .001.
- Engagement declined over time, while higher educational attainment was associated with greater sustained engagement across multiple metrics.
Why it matters
Digital self-management tools may support asthma care, but their potential depends on participants remaining involved and using them. These findings identify early app use as a marker of later engagement and highlight that dropout and sustained use may vary with participant characteristics. Understanding these patterns can inform evaluation of digital interventions in underserved populations.
What to keep in mind
The study involved 99 adults recruited from three Bronx clinics, and engagement analyses applied to the intervention arm; findings may not generalize to other populations or settings.