Content-specific engagement with a mobile asthma education application: a real-world analysis of ASTHMAXcel PRO

Mobile health interventions offer scalable strategies for improving asthma education and self-management, yet little is known about how patients engage with specific educational content. Understanding content-level engagement is essential for designing effective, personalized digital interventions. This study examines demographic and clinical predictors of content-specific engagement with the ASTHMAXcel PRO app using real-world data.

We analyzed chapter-level engagement data from 109 real-world ASTHMAXcel PRO users. Negative binomial, quasi-Poisson, and logistic regression models assessed associations between user characteristics and engagement across (1) total chapters completed, (2) four NAEPP-aligned thematic content categories, and (3) individual chapters, adjusting for age, gender, primary language, education, comorbidities, asthma control, and self-management readiness.

Mean age was 40 ± 16 years, 74% were female, 92% were primarily English-speaking, and 67% had poor asthma control. Engagement was variable and right-skewed. Older age and poorer asthma control were consistently associated with higher total chapter completion, whereas non-English primary language was associated with lower engagement. Thematically, older adults and individuals with poorer asthma control engaged more with understanding asthma and asthma medications/devices content; older adults also engaged more with monitoring and environmental modules. At the chapter level, self-management readiness was associated only with engagement in "Understanding Asthma", while older adults and patients with comorbidities more frequently accessed action-oriented modules like "Peak Flow Monitoring" and "Asthma Action Plan".

Engagement with ASTHMAXcel PRO varies by content type and user characteristics. These findings support tailoring digital asthma education through adaptive, personalized content, and improved linguistic accessibility to enhance relevance, retention, and long-term self-management.