Preferences for Mobile App Features to Support People Living With Chronic Heart Diseases: Discrete Choice Study

Using digital health technologies to aid individuals in managing chronic diseases offers a promising solution to overcome health service barriers such as access and affordability. However, their effectiveness depends on adoption and sustained use, influenced by user preferences.

This study quantifies the preferences of individuals with chronic heart disease (CHD) for features of a mobile health app to self-navigate their disease condition.

We conducted an unlabeled web-based choice survey among adults older than 18 years with CHD living in Australia, recruited via a web-based survey platform. Four app attributes-ease of navigation, monitoring of blood pressure and heart rhythm, health education, and symptom diary maintenance-were systematically chosen through a multistage process. This process involved a literature review, stakeholder interviews, and expert panel discussions. Participants chose a preferred mobile app out of 3 alternatives: app A, app B, or neither. A D-optimal design was developed using Ngene software, informed by Bayesian priors derived from pilot survey data. Latent class model analysis was conducted using Nlogit software (Econometric Software, Inc). We also estimated attribute importance and anticipated adoption rates for 3 app versions.

Our sample included 302 participants with a mean age of 50.5 (SD 18.2) years. Latent class model identified 2 classes. Older respondents with education beyond high school, prior experience with mobile health apps, and a positive perception of app usefulness were more likely to be in class 1 (257/303, 85%) than in class 2 (45/303, 15%). Class 1 membership preferred adopting a mobile app (app A: β coefficient 0.74, 95% uncertainty interval (UI) 0.41-1.06; app B: β coefficient 0.53, 95% UI 0.22-0.85). Participants favored apps providing postmonitoring recommendations (β coefficient 1.45, 95% UI 1.26-1.64), tailored health education (β coefficient 0.50, 95% UI 0.36-0.64), and unrestricted symptom diary entry (β coefficient 0.58, 95% UI 0.41-0.76). Class 2 showed no preference for app adoption (app A: β coefficient -1.18, 95% UI -2.36 to 0.006; app B: β coefficient -0.78, 95% UI -1.99 to 0.42) or any specific attribute levels. Vital sign monitoring was the most influential attribute among the 4. Scenario analysis revealed an 84% probability of app adoption with basic features, rising to 92% when app features aligned with respondents' preferences.

The study's findings suggest that designing preference-informed mobile health apps could significantly enhance adoption rates and engagement among individuals with CHD, potentially leading to improved clinical outcomes. Adoption rates were notably higher when app attributes included easy navigation, vital sign monitoring, feedback provision, personalized health education, and flexible data entry for symptom diary maintenance. Future research to explore factors influencing app adoption among different groups of patients is warranted.