Effect of a mobile health application with nurse support on quality of life among community-dwelling older adults in Hong Kong : a randomized clinical trial

Abstract

Importance: Mobile health (mHealth) smartphone apps are becoming increasingly popular among older adults, although the reactive care approach of these apps has limited their usability. Objective: To evaluate the effects of an interactive mHealth program supported by a health-social partnership team on quality of life (QOL) among community-dwelling older adults in Hong Kong. Design, setting, and participants: This was a 3-group, randomized clinical trial conducted in 5 community centers in Hong Kong from December 1, 2020, to April 30, 2022, with a last follow-up date of January 31, 2022. Participants included older adults aged at least 60 years who were living within the service area, used a smartphone, and had at least 1 of the following problems: chronic pain, hypertension, or diabetes. Data were analyzed from May 1 to 10, 2022. Interventions: Participants were randomly assigned to the mHealth with interactivity (mHealth+l) group, mHealth group, or control group. Participants in the mHealth+l group received the mHealth app and nurse case management supported by a health-social partnership team. The mHealth group received the mHealth app only. The control group received no mHealth app or health-social care services. Main outcomes and measures: The primary outcome was the change in QOL from baseline to 3 months after completion of the intervention. Results: Among 221 participants (mean [SD] age 76.6 [8.0] years; 185 [83.7%] women), 76 were randomized to the control group, 71 were randomized to the mHealth group, and 74 were randomized to the mHealth+l group. The most common chronic diseases or problems were hypertension (147 participants [66.5%]). pain (144 participants [65.2%]). cataracts (72 participants [32.6%]), and diabetes (61 participants [27.6%]). At 3 months after the intervention and compared with the intervention group, there were no statistically significant differences in either the physical component summary (mHealth+l: beta = -1.01 [95% CI, -4.13 to 2.11]; P = .53; mHealth: beta = 0.22 [95% CI, -3.07 to 3.50]; P = .90) or the mental component summary (mHealth+1: beta = -0.87 [95% CI, -4.42 to 2.69]; P = .63; mHealth: beta = 1.73 [95% CI, -1.89 to 5.34]; P = .35) QOL scores. Only secondary outcomes, including self-efficacy (beta = -2.31 [95% CI, -4.26 to -0.36]; P = .02), systolic blood pressure (beta = -2.30 [95% CI, -5.00 to -0.13]; P = .04). pain levels (beta = 1.18 [95% CI, 0.52 to 2.00]; P = .02), and health services utilization (beta= 0.98 [95% CI, 0.32 to 2.09]; P = .048) improved in the mHealth+l group compared with the control group. Conclusions and relevance: This randomized clinical trial found no difference in the primary outcome between the mHealth+l group and the control group confirming that there were no incremental benefits to adding interactivity in mHealth programs for older adults with chronic diseases.