User Perceptions of a Multilevel mHealth Intervention to Boost Adherence to Hydroxyurea in Sickle Cell Disease

Adherence to hydroxyurea has been low historically. The InCharge Health app demonstrates increased adherence with hydroxyurea, but engagement has not been fully investigated. This study investigated the association between InCharge Health app perceptions and app engagement among adolescents and young adults with sickle cell disease (SCD).

We obtained user perceptions of InCharge with the Mobile App Rating Scale (MARS) among participants of the "Integration of mHealth into Sickle Cell Disease Care to Increase Hydroxyurea Utilization" study. Days of app use were correlated with reported patient-reported outcomes of interest, ease of use, the utility of features, and importance of features.

Of 293 enrolled participants, 284 remained active in the study, and 206 (72.5%) completed the 24-week MARS survey. App Interest was positively correlated with app use (p = 0.01) and self-reported days of app use (p = 0.0008). Perceived ease of use trended toward significance with greater app use (p = 0.06). Most individuals (72.0%, 144/200) agreed the app helped them remember to take hydroxyurea, with trends toward higher days of app use (p = 0.07). Those who used the app more agreed they would continue to use it after the study (p = 0.04). Most individuals (54.3%) reported that reminders to take their hydroxyurea were the most important app feature.

In this study, positive perceptions toward the application features influenced app use and intention to continue using the application. Determining features that drive application utilization can have a positive impact when an app, such as the InCharge app, is demonstrated to improve adherence with proven therapy.