Demographics and clinical characteristics
A total of 208 patients were asked whether they would like to participate in the survey, then 204 participants (115 male and 89 female) agreed to do it, from January 2017 to May 2018. The average age of participants in our samples was 68.75 ± 9.54 years (ranged from 52 to 87 years). The number of patients who lived in cities and rural areas are 172 (84.31%) and 32 (15.69%) respectively. The mean education level of participants in our samples was 5.20± 3.14 years(from 1 year to 15 years). In addition, 71.08% of patients could control PD by using less than two types of anti-Parkinson drugs. The mean Morisky Scale score was 5.75±1.45. The demographic details of the patients are given in Table 1.
Table 1 Sociodemographic and Parkinson's disease-related clinical characteristics of surveyed participants.
Variable
|
No.
|
%
|
Age (years)
≤60
61–70
≥71
Gender
Male
Female
Resident location
Urban
Rural
Education level
≤6
7-12
≥13
Occupation (employment)
self-employed
Stable work or retirees
Number of anti-PD drug
≤two drugs
≥three drugs
PD course
≤5
≥6
MDS-UPDRS(Hoehn & Yahr Grade)
≤50(Ⅰ~Ⅱ)
51-100(Ⅲ)
|
46
84
74
115
89
172
32
39
127
38
32
172
145
59
133
71
115
89
|
22.55
41.76
36.27
56.37
43.63
84.31
15.69
19.12
62.25
18.63
15.69
84.31
71.08
28.92
65.20
34.80
56.37
43.63
|
Mobile phone possession and ways of obtaining PD information
Almost all repliers (96.08%, 196/204) had their own cell phones and most patients (65.19%, 133/204) claimed possession of smartphones and access to smartphones among households. According to our survey, 50.00% (102/204) of patients browsed the web, and 20.59% (21/102) of them preferred to use computers while 79.41% (81/102) of them preferred to use smartphones. Respondents claimed that their main sources of PD information were from clinic doctors (100%, 204/204), via a doctor and smartphone (15.20%, 31/204), or other media (7.43%, 16/204) (Fig. 1).
Fig. 1 The methods of obtaining Parkinson's disease information
Willingness and attitudes towards the use of PD self-management APPs
Only 8.82% (18/204) of participants had learned about information of APPs for managing chronic diseases such as diabetes mellitus or hypertension. More than half of the surveyed patients replied that they would use APPs for PD self-management if they were provided for free and were useful and easy to operate, could remind taking medication on time, protect privacy and reduce economical and psychological burden (Table 2). Most importantly, participants had a more positive attitude toward using PD self-management APPs, if easy to operate.
Table 2 The survey results of reaction to the Parkinson disease management apps for related patients
Survey items
|
SA + A
N (%)
|
N
N (%)
|
SDA + DA
N (%)
|
I would use it, if it were free.
|
136
66.67
|
47
23.04
|
21
10.29
|
I would try it out, if it were easy to operate.
|
169
82.84
|
20
9.81
|
15
7.35
|
I would use it, if it allowed doctor to make medication change quicker.
|
145
71.09
|
41
20.09
|
18
8.82
|
I would use it, if it protected my privacy.
|
139
68.14
|
22
10.78
|
43
21.08
|
I thought it would solve the questions related to Parkinson's disease.
|
124
60.78
|
66
32.35
|
14
6.86
|
I thought it would help remind me to follow doctors' directions.
|
150
73.53
|
32
15.69
|
22
10.78
|
I thought it would reduce the psychological burden of Parkinson's disease.
|
160
75.98
|
26
12.75
|
23
11.27
|
I thought it would reduce the frequency of seeking medical advice and the costs.
|
148
72.55
|
37
18.14
|
19
9.31
|
I believed it would be helpful for me to communicate with doctor.
|
151
73.04
|
18
8.82
|
37
18.14
|
I thought it would be useful to manage my Parkinson's disease.
|
141
67.65
|
63
30.88
|
3
1.47
|
SA, strongly agree; A, agree; N, neutral; SDA, strongly disagree; D, disagree; SD, standard deviation.
Participants' interests in contents of smartphone APPs for PD management
Participants' interests in contents of smartphone APPs for PD self-management showed in Fig. 2. The percentages of patients interested in general PD information, interacting with doctor online, medication advice, symptoms recording and, Parkinson's disease education were 60.29%, 77.46%, 54.90%, 65.69% and 80.88%, respectively.
Fig. 2 Participants' interests in contents of smartphone APPs for PD self-management
Characteristics of respondents with positive attitudes to using APPs
To weigh up which characteristic of patients distinguishes potential users better, correlations between every item related to patients and their attitudes towards smartphone APPs were analyzed. We chose the survey item “I would try it out, if it were easy to operate.” to be measured, which is the key point concerning patients' benefits. Sociodemographic and clinical characteristics of participants were analyzed in Table 3. Among these patients, those who were more tend to use APPs were those who were younger, had higher education, had good medication adherence, browsed the web, had longer PD course and had worse conditions of PD(P < 0.001, P = 0.001, P < 0.001, P = 0.041, P < 0.001, P = 0.01). There were no statistically differences between women and men (P = 0.517), resident location (urban and rural, P = 0.795), occupation (self-employer and stable work or retirees, P = 0.478) or drug intake number (no more than 2 and no less than 3 anti-PD drugs, P = 0.162) with respect to whether patients were glad to use it or not.
Table 3 Sociodemographic and clinical characteristics of survey patients who would like to use a Parkinson's disease self-management app, if it were easy to operate.
Variable
|
SA + A
|
N + SD + D
|
P
|
Age (years)
Education level
Morisky Scale score
Gender
Male/Female
Resident location
Urban
Rural
Occupation (employment)
self-employed
Retirees
Number of anti-Parkinson drug
≤two drugs
≥three drugs
Whether browsing a web
Browsing
Not browsing
Parkinson disease course
≤5 years
≥6 years
MDS-UPDRS(H & Y)
≤50(Ⅰ-Ⅱ)
51-100(Ⅲ)
|
67.05±9.24
10.81±3.23
5.91±1.41
97/72
143(84.6%)
26(15.4%)
57(33.7%)
112(66.3%)
123(72.8%)
46(27.2%)
90(53.3%)
79(46.7%)
121(71.6%)
48(28.4%)
87(51.5%)
82(48.5%)
|
76.14±9.76
8.83±3.26
4.94±1.39
18/17
29(82.9%)
6(17.1%)
14(40.0%)
21(60.0%)
22(61.1%)
14(38.9%)
12(34.3%)
23(65.7%)
12(36.4%)
21(63.6%)
26(74.3%)
9(25.7%)
|
<0.001
0.001
<0.001
0.517
0.795
0.478
0.162
0.041
<0.001
0.013
|
|
|
|
|
|
To further investigate the correlation between the characteristics of the above-discussed patients and APP acceptance, we performed a correlation analysis. The results suggest that the willingness to use APPs of patients to management PD is positively related to education level (P < 0.001). However, the age and PD course are negatively correlated with it (P = 0.017, P < 0.001), and MDS-UPDRS is uncorrelated (P = 0.924). Results are shown in Table 4.
Table 4 Correlation analysis between Sociodemographic and clinical characteristics of survey patients and APP acceptance
|
correlation coefficient
|
P
|
Age
|
-2.56
|
< 0.001
|
Education level
|
0.167
|
0.017
|
MDS-UPDRS
|
0.007
|
0.924
|
Parkinson disease course
|
-2.76
|
< 0.001
|