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3. Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App : Analysis of Real-World, Medium-Term Feasibility Studies

Author

Jacome, Cristina, Almeida, Rute, Pereira, Ana Margarida, Amaral, Rita, Vieira-Marques, Pedro, Mendes, Sandra, Alves-Correia, Magna, Ferreira, Jose Alberto, Lopes, Ines, Gomes, Joana, Araujo, Luis, Couto, Mariana, Chaves Loureiro, Claudia, Santos, Lilia Maia, Arrobas, Ana, Valerio, Margarida, Todo Bom, Ana, Azevedo, Joao, Teixeira, Maria Fernanda, Ferreira-Magalhaes, Manuel, Pinto, Paula Leiria, Pinto, Nicole, Neves, Ana Castro, Morete, Ana, Bom, Filipa Todo, Costa, Alberto, Silva, Diana, Vasconcelos, Maria Joao, Falcao, Helena, Marques, Maria Luis, Mendes, Ana, Cardoso, Joao, Cidrais Rodrigues, Jose Carlos, Oliveira, Georgeta, Carvalho, Joana, Lozoya, Carlos, Santos, Natacha, Menezes, Fernando, Gomes, Ricardo, Camara, Rita, Alves, Rodrigo Rodrigues, Moreira, Ana Sofia, Abreu, Carmo, Silva, Rui, Bordalo, Diana, Alves, Carlos, Lopes, Cristina, Taborda-Barata, Luis, Fernandes, Ricardo M. M., Ferreira, Rosario, Chaves-Loureiro, Carla, Calix, Maria Jose, Alves, Adelaide, Fonseca, Joao Almeida, Jacome, Cristina, Almeida, Rute, Pereira, Ana Margarida, Amaral, Rita, Vieira-Marques, Pedro, Mendes, Sandra, Alves-Correia, Magna, Ferreira, Jose Alberto, Lopes, Ines, Gomes, Joana, Araujo, Luis, Couto, Mariana, Chaves Loureiro, Claudia, Santos, Lilia Maia, Arrobas, Ana, Valerio, Margarida, Todo Bom, Ana, Azevedo, Joao, Teixeira, Maria Fernanda, Ferreira-Magalhaes, Manuel, Pinto, Paula Leiria, Pinto, Nicole, Neves, Ana Castro, Morete, Ana, Bom, Filipa Todo, Costa, Alberto, Silva, Diana, Vasconcelos, Maria Joao, Falcao, Helena, Marques, Maria Luis, Mendes, Ana, Cardoso, Joao, Cidrais Rodrigues, Jose Carlos, Oliveira, Georgeta, Carvalho, Joana, Lozoya, Carlos, Santos, Natacha, Menezes, Fernando, Gomes, Ricardo, Camara, Rita, Alves, Rodrigo Rodrigues, Moreira, Ana Sofia, Abreu, Carmo, Silva, Rui, Bordalo, Diana, Alves, Carlos, Lopes, Cristina, Taborda-Barata, Luis, Fernandes, Ricardo M. M., Ferreira, Rosario, Chaves-Loureiro, Carla, Calix, Maria Jose, Alves, Adelaide, and Fonseca, Joao Almeida

Abstract

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently

Published
2021
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4. Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma : Secondary Analysis of Observational Studies

Author

Neves, Ana Luisa, Jacome, Cristina, Taveira-Gomes, Tiago, Pereira, Ana Margarida, Almeida, Rute, Amaral, Rita, Alves-Correia, Magna, Mendes, Sandra, Chaves-Loureiro, Claudia, Valerio, Margarida, Lopes, Cristina, Carvalho, Joana, Mendes, Ana, Ribeiro, Carmelita, Prates, Sara, Ferreira, Jose Alberto, Teixeira, Maria Fernanda, Branco, Joana, Santalha, Marta, Vasconcelos, Maria Joao, Lozoya, Carlos, Santos, Natacha, Cardia, Francisca, Moreira, Ana Sofia, Taborda-Barata, Luis, Pinto, Claudia Sofia, Ferreira, Rosario, Silva, Pedro Morais, Ferreira, Tania Monteiro, Camara, Raquel, Lobo, Rui, Bordalo, Diana, Guimaraes, Cristina, Santo, Maria Espirito, de Oliveira, Jose Ferraz, Calix Augusto, Maria Jose, Gomes, Ricardo, Vieira, Ines, da Silva, Sofia, Marques, Maria, Cardoso, Joao, Morete, Ana, Aroso, Margarida, Cruz, Ana Margarida, Nunes, Carlos, Camara, Rita, Rodrigues, Natalina, Abreu, Carmo, Albuquerque, Ana Luisa, Vieira, Claudia, Santos, Carlos, Pascoa, Rosalia, Chaves-Loureiro, Carla, Alves, Adelaide, Neves, Angela, Marques, Jose Varanda, Reis, Bruno, Ferreira-Magalhaes, Manuel, Fonseca, Joao Almeida, Neves, Ana Luisa, Jacome, Cristina, Taveira-Gomes, Tiago, Pereira, Ana Margarida, Almeida, Rute, Amaral, Rita, Alves-Correia, Magna, Mendes, Sandra, Chaves-Loureiro, Claudia, Valerio, Margarida, Lopes, Cristina, Carvalho, Joana, Mendes, Ana, Ribeiro, Carmelita, Prates, Sara, Ferreira, Jose Alberto, Teixeira, Maria Fernanda, Branco, Joana, Santalha, Marta, Vasconcelos, Maria Joao, Lozoya, Carlos, Santos, Natacha, Cardia, Francisca, Moreira, Ana Sofia, Taborda-Barata, Luis, Pinto, Claudia Sofia, Ferreira, Rosario, Silva, Pedro Morais, Ferreira, Tania Monteiro, Camara, Raquel, Lobo, Rui, Bordalo, Diana, Guimaraes, Cristina, Santo, Maria Espirito, de Oliveira, Jose Ferraz, Calix Augusto, Maria Jose, Gomes, Ricardo, Vieira, Ines, da Silva, Sofia, Marques, Maria, Cardoso, Joao, Morete, Ana, Aroso, Margarida, Cruz, Ana Margarida, Nunes, Carlos, Camara, Rita, Rodrigues, Natalina, Abreu, Carmo, Albuquerque, Ana Luisa, Vieira, Claudia, Santos, Carlos, Pascoa, Rosalia, Chaves-Loureiro, Carla, Alves, Adelaide, Neves, Angela, Marques, Jose Varanda, Reis, Bruno, Ferreira-Magalhaes, Manuel, and Fonseca, Joao Almeida

Abstract

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were <= 40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fi

Published
2021
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5. Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study

Author

Jacome, Cristina, Almeida, Rute, Pereira, Ana Margarida, Amaral, Rita, Mendes, Sandra, Alves-Correia, Magna, Vidal, Carmen, Lopez Freire, Sara, Mendez Brea, Paula, Araujo, Luis, Couto, Mariana, Antolin-Amerigo, Dario, de la Hoz Caballer, Belen, Barra Castro, Alicia, Gonzalez-De-Olano, David, Bom, Ana Todo, Azevedo, Joao, Pinto, Paula Leiria, Pinto, Nicole, Neves, Ana Castro, Palhinha, Ana, Bom, Filipa Todo, Costa, Alberto, Loureiro, Claudia Chaves, Santos, Lilia Maia, Arrobas, Ana, Valerio, Margarida, Cardoso, Joao, Emiliano, Madalena, Gerardo, Rita, Rodrigues, Jose Carlos Cidrais, Oliveira, Georgeta, Carvalho, Joana, Mendes, Ana, Lozoya, Carlos, Santos, Natacha, Menezes, Fernando, Gomes, Ricardo, Camara, Rita, Alves, Rodrigo Rodrigues, Moreira, Ana Sofia, Bordalo, Diana, Alves, Carlos, Ferreira, Jose Alberto, Lopes, Cristina, Silva, Diana, Vasconcelos, Maria Joao, Teixeira, Maria Fernanda, Ferreira-Magalhaes, Manuel, Taborda-Barata, Luis, Calix, Maria Jose, Alves, Adelaide, Fonseca, Joao Almeida, Jacome, Cristina, Almeida, Rute, Pereira, Ana Margarida, Amaral, Rita, Mendes, Sandra, Alves-Correia, Magna, Vidal, Carmen, Lopez Freire, Sara, Mendez Brea, Paula, Araujo, Luis, Couto, Mariana, Antolin-Amerigo, Dario, de la Hoz Caballer, Belen, Barra Castro, Alicia, Gonzalez-De-Olano, David, Bom, Ana Todo, Azevedo, Joao, Pinto, Paula Leiria, Pinto, Nicole, Neves, Ana Castro, Palhinha, Ana, Bom, Filipa Todo, Costa, Alberto, Loureiro, Claudia Chaves, Santos, Lilia Maia, Arrobas, Ana, Valerio, Margarida, Cardoso, Joao, Emiliano, Madalena, Gerardo, Rita, Rodrigues, Jose Carlos Cidrais, Oliveira, Georgeta, Carvalho, Joana, Mendes, Ana, Lozoya, Carlos, Santos, Natacha, Menezes, Fernando, Gomes, Ricardo, Camara, Rita, Alves, Rodrigo Rodrigues, Moreira, Ana Sofia, Bordalo, Diana, Alves, Carlos, Ferreira, Jose Alberto, Lopes, Cristina, Silva, Diana, Vasconcelos, Maria Joao, Teixeira, Maria Fernanda, Ferreira-Magalhaes, Manuel, Taborda-Barata, Luis, Calix, Maria Jose, Alves, Adelaide, and Fonseca, Joao Almeida

Abstract

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

Published
2021
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6. Qualidade microbiológica de gelado comestível (sorvete) produzidos em estabelecimentos situados no município de Zé Doca, MA. / Microbiological quality of edible ice cream (ice cream) produced in establishments located in the city of Zé Doca, MA.

Author

Nascimento, Rhamilla Muniz, primary, Camara, Rita de Kassia Santos, additional, Araújo, Jean Aquino de, additional, Cardoso, Raiane Vieira, additional, Rodrigues, Lucelia da Cunha, additional, and Junior, Luciano de Souza Rodrigues, additional

Published
2021
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