Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Med Internet Res. 2022 Feb 2;24(2):e31565. doi: 10.2196/31565.
SIMPLe is an internet-delivered self-management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment.
The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use.
This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users' data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use.
We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01).
The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management.
SimpLe 是一款用于双相情感障碍（BD）的互联网自我管理移动应用程序，旨在将技术与循证干预措施相结合，并方便获取心理教育内容。SimpLe 应用程序已在现实世界中推出，以便在 BD 治疗范围内在全球范围内使用。
本研究的主要目的如下：根据服务器数据描述应用程序的使用、参与和保留率；确定使用前 6 个月随访期间用户保留的模式；并探讨导致应用程序使用中断的潜在因素。
这是一项观察性生态学研究，我们汇总了 SimpLe 应用程序实际实施中的可用数据。项目网站上开放参与，数据收集来源包括纳入时和 6 个月时进行的临床数据和治疗史的基于网络的问卷、通过持续使用应用程序收集的主观数据以及应用程序服务器捕获的使用模式。使用 2 尾 t 检验或方差分析或其非参数等效项比较常规用户、偶尔用户和非用户的特征和参与度。对常规用户的数据应用生存分析和风险函数，以检查和比较使用和用户保留情况。此外，还基于满意度、感知有用性和停止使用应用程序的原因进行了用户评估分析。
我们纳入了 2016 年至 2018 年间收集数据的 503 名参与者，其中 77.5%（n=390）使用了该应用程序。在应用程序用户中，44.4%（173/390）完成了随访评估，这些参与者的数据用于我们的分析。使用前 6 个月，参与度逐渐下降。在 SimpLe 应用程序使用 1 个月后，常规用户的保留概率为 67.4%（263/390；95%CI 62.7%-72.4%）。年龄（P=.002）、疾病发病时间（P<.001）和双相情感障碍诊断时间（P=.048）与保留时间相关。此外，与发病时间较近（平均 66.49，SD 66.18 天；P<.001）或最近诊断（平均 73.45，SD 66 天；P=.01）或诊断时间较短（平均 97.73，SD 69.15 天；P=.002）的患者相比，发病时间较长的患者使用该应用程序的天数更多。
应用程序的用户保留率在每个月后迅速下降，直到 6 个月时仅保留三分之一的用户。BD 患者的年龄与应用程序参与度之间存在很强的关联。其他变量，如患有焦虑症和服用抗精神病药物的年限，似乎也很相关。了解这些关联有助于确定最适合预测参与趋势、优化应用程序处方和管理的用户特征。
