Abstract
BACKGROUND: Chronic diseases, such as cardiometabolic and respiratory conditions, are major contributors to global morbidity and mortality. These conditions place a considerable burden on primary care due to rising healthcare costs and increasing patient dependency in daily life. Digital tools, such as mobile health (mHealth), have emerged as promising resources to support chronic disease management in this setting. However, patient adoption of mHealth remains limited, and few studies have specifically examined its use among individuals with multiple chronic conditions. This study aims to examine the overall use and implementation of mHealth technologies among patients with chronic cardiometabolic and/or respiratory diseases receiving care from primary care nursing services. METHODS: A descriptive cross-sectional observational study was conducted from December 2022 to October 2023 in the primary care services of the Denia Health Department, Alicante, Spain. A non-probability purposive-consecutive sampling method was used. Participants were adult patients attending chronic care nursing consultations with one or more of the following diagnoses: hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, dyslipidemia, or obesity. Sociodemographic and clinical variables were assessed, and participants completed an ad hoc questionnaire on mobile phone use, health app usage, and online health information-seeking behaviors. Statistical analysis was performed using RStudio for macOS®. Descriptive statistics, chi-square tests, and t-tests were applied. RESULTS: A total of 523 participants were included (mean age: 71.65 years; SD = 11.91; range: 21-99 years; 50.9% male). Mobile phone and health app usage were significantly higher among men (P = 0.0017) and younger patients, who also demonstrated greater digital proficiency and experience (P < 0.001). Patients with diabetes were the most frequent users of these tools. Those willing to use mHealth for monitoring were also younger and more digitally skilled (P < 0.001). Most participants searched for health information online using search engines (81.8%), and among those who consulted official sources, 69.2% had secondary or higher education. CONCLUSIONS: The use of mHealth technologies in primary care is more common among younger patients, those with higher education levels, and individuals with greater digital skills, suggesting a digital divide. Patients with diabetes were the most frequent users. These findings highlight the importance of promoting digital literacy and designing accessible, user-friendly tools tailored to patients' individual needs. It is also crucial to consider the preference for face-to-face care, particularly among older adults. Effective implementation of digital health solutions requires inclusive strategies that account for technological, socioeconomic, and contextual differences.