The COVID-19 pandemic accelerated interest in the use of smartphone apps for remote health monitoring. But while these technologies are proving their value for acute and chronic healthcare and in decentralised clinical trials, there are other research settings where they could bring significant benefits.
One example is population-based health research, which follows large and diverse cohorts of people drawn from across the population over long periods of time to understand the factors involved in health and disease.
Recruitment into these kinds of studies has been falling over recent years and it is increasingly hard to keep a diverse set of participants engaged over months or years, especially if the study requires in-person clinic visits and regular health reporting1.
So far, remote health monitoring apps have only been tested in relatively short-term studies lasting a few weeks or months. We wanted to find out if our Huma remote health monitoring app could support participant recruitment and engagement in a diverse population health research over a much longer time period.
Putting the Huma app to the test in population health research
In a recent study, we teamed up with researchers from the Medical Research Council Epidemiology Unit at the University of Cambridge to investigate the prevalence and symptoms of COVID-19 in a fully remote sub-study of the Fenland longitudinal cohort - a long-term population health research project involving more than 12,000 people recruited from across Cambridgeshire.
2,524 participants from the Fenland study were invited to join the Huma app to take part in this sub-study, making it the largest decentralised digital population health study of its kind to date. Participants were asked to log any symptoms of COVID-19, as well as regularly submitting a range of measurements including resting heart rate, body temperature, activity levels and blood oxygen saturation using their phone or simple digital devices.
We also asked them to fill out monthly questionnaires and take blood spot samples to test for coronavirus antibodies. And we carried out interviews with a number of study participants to discuss their experience of taking part in the study and using the app.
Keeping research participants engaged in the long term
Initial interest in the study was high, with more than 90% of invited participants downloading and registering on the app.2
“To be honest it was spot on. You know, it told you how to download the app, what to do, how to sign in, it told you everything that you needed to know,” said one participant, describing the initial onboarding process.
The Huma app’s user-friendliness also made it easy to gather vital data from participants throughout the study. Nearly three quarters of participants submitted at least one measurement per week - a level of engagement and data gathering that would require a significant logistical effort and cost for a conventional research study.
Importantly, we were also able to maintain these high levels of engagement over time. Participants continued using the app regularly for almost 8 months on average, with only 2.5% of people pulling out of the study along the way. For comparison, a recent meta-analysis showed that digital app-based observational studies for chronic disease have an average dropout rate of 49%.3
We also wanted to explore whether the use of digital technologies might exclude certain groups from taking part, such as older people.
While participants in the app-based sub-study were more likely to be slightly younger on average, older individuals showed higher engagement with the app compared with younger participants once they were using it. Reassuringly, we also found that several indicators of socio-economic status, which are often associated with health inequalities, did not appear to affect engagement levels.
Our commitment to improving digital health technology for all
Here at Huma, we’re committed to building robust clinical and scientific evidence for our technology. But we don’t just keep our data to ourselves - we want to share it with the wider digital health community to improve these technologies and open up participation in health research to as many people as possible. We’ve published our findings from this study in an open access scientific journal.2
Nico O'Kuinghttons, Vice President of Decentralised Clinical Trials at Huma, says, “We are incredibly excited to partner with leading academic institutions such as Cambridge University, bringing more than a decade of experience developing meaningful digital solutions that address both care and research in diverse populations.”
“At Huma, we place a top priority on user-centric design, so it is very rewarding to showcase this level of evidence with such high rates of participant engagement and adherence. We remain focused on our continued investment in delivering a delightful experience to all participants, particularly to diverse populations, as well as our continued efforts demonstrating evidence alongside academic partners.”
User-friendly digital tools like the Huma app have the potential to transform our understanding of human health by making it easier and simpler than ever before for participants to get - and stay - involved in population health studies.
In turn, this research provides vital information about health and disease in the real world, providing insights that can make a big difference to people’s lives. And, ultimately, that’s what we’re all about.
Sources:
- Morton LM, Cahill J, Hartge P. Reporting Participation in Epidemiologic Studies: A Survey of Practice. Am J Epidemiol. 2006;163(3):197-203. doi:10.1093/AJE/KWJ036 PMID: 16339049
- Rennie KL, et al. Engagement With mHealth COVID-19 Digital Biomarker Measurements in a Longitudinal Cohort Study: Mixed Methods Evaluation. J Med Internet Res. 2022 Oct 3. doi: 10.2196/40602 PMID: 36194866
- Meyerowitz-Katz G, et al. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. J Med Internet Res. 2020;22(9):e20283 doi: 10.2196/20283 PMID: 32990635
