Demographics and clinical characteristics
Between January 2017 and May 2018, a total of 208 patients were asked to participate in the survey. Of these, 204 participants (115 male and 89 female) agreed. The average age of the participants was 68.75 ± 9.54 years, ranging from 52 to 87 years old. The number of patients who lived in cities and rural areas was 172 (84.31%) and 32 (15.69%), respectively. The mean education level of the participants was 5.20 ± 3.14 years (from 1 year to 15 years). In addition, 71.08% of patients took no more than two types of anti-PD drugs. The mean Morisky Scale score was 5.75±1.45. The demographic details of the patients are given in Table 1.
Mobile phone usage and means of obtaining PD information
Almost all respondents (96.08%, 196/204) owned cell phones, and most patients (65.19%, 133/204) owned smartphones or had access to them. According to our survey, 50.00% (102/204) of patients browsed the web; 20.59% (21/102) of these used computers to do so, while 79.41% (81/102) used smartphones. Respondents claimed they obtained PD information from doctors in clinics (100%, 204/204), from smartphones (15.20%, 31/204), and through other media (7.43%, 16/204) (Fig. 1).
Willingness and attitude toward PD self-management apps
Only 8.82% (18/204) of participants had heard of apps for managing chronic diseases such as diabetes mellitus or hypertension. However, more than half of the surveyed patients indicated that they would use apps for PD self-management given the following: the apps are provided for free and are useful and easy to operate; the apps can be used to remind the user to take medication on time; the user’s privacy is protected; and the apps reduce economic and psychological burden (Table 2). Most importantly, the participants had a positive attitude toward using PD self-management apps, provided that the apps are easy to operate.
Participant interest in smartphone app content for PD management
The interest of the participants in various content on smartphone apps for PD self-management is depicted in Fig. 2. The percentage of patients interested in general PD information, interacting with doctors online, medication advice, recording symptoms, and PD education was 60.29%, 77.46%, 54.90%, 65.69%, and 80.88%, respectively.
Characteristics of respondents with positive attitudes to using apps
To better understand the characteristics of potential users, we analyzed the correlation between each item related to patient attitudes toward smartphone apps. In particular, we measured the survey item, “I would try it out, if it were easy to operate.” This item reflects a key point concerning patient benefits. The demographic and clinical characteristics of the participants are shown in Table 3. Among these patients, those who tended to use apps were younger and better educated, they had good medication adherence, they tended to browse the web, and they had a longer PD course with worse PD conditions（P < 0.001, P = 0.001, P < 0.001, P = 0.041, P < 0.001, P = 0.01）. In regard to willingness to use apps, there were no statistically differences between women and men (P = 0.517), resident location (urban or rural, P = 0.795), occupation (self-employed or stable work/retired, P = 0.478), or drug intake number (no more than two or no fewer than three anti-PD drugs, P = 0.162).
To further investigate the correlation between the characteristics of the participants and PD app acceptance, we performed a correlation analysis. The results suggest that the willingness of patients to use apps for PD management is positively related to education level (P < 0.001). However, the age and PD course were negatively correlated with it (P = 0.017, P < 0.001), and MDS-UPDRS was uncorrelated (P = 0.924). The results are shown in Table 4.