Use of mobile health apps in low-income populations: a prospective study of facilitators and barriers

Background: Mobile applications (apps) are increasingly popular in healthcare. For low-income populations, barriers exist, yet limited data are available about the challenges and catalysts for adoption. Methods and Results: We partnered with a primary care center and a community organization and recruited patients to use a health app. A community health worker (CHW) consented participants, downloaded the app and instructed on its use, and provided ongoing technical support. Bi-weekly surveys for three months were sent via email/text to assess participant experiences and perceptions. The majority (81 of 108 [75.0%] English language-preferred and 50 of 52 [96.2%] Spanish language-preferred) of patients approached were enrolled. Common reasons for declining were: did not own a smartphone (13.8%), did not have email (20.7%), and not interested (58.6%). Enrollment challenges included: insufficient storage, unfamiliarity with downloading apps, forgotten passwords to email accounts, and slow/absent WiFi connection - which the CHW and the app company were able to address. Most participants, English and Spanish language-preferred respectively, were interested in monitoring their health through an app (74.4%; 70.4%), connecting devices such as FitBits© and blood pressure cuffs (78.9%; 50.0%), and being the owner of their health records (83.6%; 95.6%). There were concerns about sharing health information with research teams (66.7%; 51.9%), and data being sold (83.0%; 70.4%). However, many (58.6%; 87.2%) reported being likely to share health data with a trusted research team. Compared with before the study, most felt more comfortable using health apps (67.4%; 82.1%) and more likely to participate in research using apps (76.2%; 72.4%). Conclusions: The assistance of a CHW facilitated the enrollment of low-income individuals in a mobile health app by fostering trust and sustained engagement. Participants were interested in having several app features. Despite concerns about data privacy, they demonstrated greater interest in mobile health app use and research participation at study conclusion.