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?:abstract
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BACKGROUND: Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. While COVID-19 mobile-health (mHealth) applications have emerged, research examining attitudes towards COVID-19 mHealth use among those with chronic conditions is scarce. OBJECTIVE: To examine attitudes and identify determinants of COVID-19 mHealth use across demographic and health-related characteristics; and evaluate associations of having chronic health conditions with attitudes towards COVID-19 mHealth use (e.g. use of mHealth or web-based methods to track COVID-19 exposures, symptoms, and recommendations). METHODS: We utilized nationally-representative data from the COVID-19 Impact Survey collected from April-June 2020 (n=10,760). Primary exposure was a history of chronic conditions which was defined using self-reported diagnoses of cardiometabolic, respiratory, immune-related, mental health conditions, and overweight/obesity. Primary outcomes were attitudes of COVID-19 mHealth including (1) likelihood of using a mobile-phone app to track COVID-19 symptoms and receive recommendations, (2) likelihood of using a website to track COVID-19 symptoms, location, and receive recommendations, and (3) likelihood of using an app using location to track potential COVID-19 exposure. COVID-19 mHealth use outcome response options were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare likelihood of COVID-19 mHealth use across chronic health conditions, with not too likely/not likely at all as the reference category for each outcome. We evaluated determinants of each form of COVID-19 mHealth intervention using Poisson regression. RESULTS: Among the 10,760 respondents, about half were aged 30-59 years, female, had a household income <$50,000, and had employer-sponsored insurance. Overall, 22% were extremely/very likely to use a mobile-phone app or a website to track their COVID-19 symptoms and receive recommendations. Almost one-quarter were extremely/very likely to use a mobile-phone app to track their location and receive push notifications if they have been exposed to COVID-19. After adjustment for age, race/ethnicity, gender, socioeconomic status, and residence, adults living with mental health conditions were most likely to report being either extremely/very or moderately likely to use each mHealth intervention when compared to those who were not likely. Adults with respiratory-related chronic diseases were extremely/very (cOR:1.16, 95% CI:1.00-1.35) and moderately likely (cOR:1.23, 95% CI:1.04-1.45) to use a mobile-phone app to track their location and send push notifications if they might have been exposed to COVID-19. Across each mHealth intervention, positive determinants of extremely/very likely use included being female, racial/ethnic minority, and having at least one recent COVID-19 related symptom. CONCLUSIONS: Our study demonstrates that attitudes towards COVID-19 mHealth use vary widely by modality (web-based vs. app) and across chronic health conditions. These findings may inform adoption of and long-term engagement with COVID-19 apps, a crucial factor for determining their potential to reduce disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions.
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