Abstract
BACKGROUND: Pediatric to adult health service (AHS) transition is a challenging time for many adolescents and young adults with chronic illness. As the responsibility of illness management shifts from parents to the young person themselves, many young people fail to transition in a timely manner, which has important health consequences. Mobile apps show potential in assisting young people to self-manage their condition during this vulnerable time, but empirical data on app uptake as well as efficacy with respect to transition outcomes and illness control are lacking. OBJECTIVE: This study aimed to evaluate the usage of a mobile app called "TransitionMate" (TMApp) by adolescents and young adults, which was purpose-built to support chronic illness self-management for youth undergoing transition. Secondary aims were to assess AHS attendance and changes in illness control over the first 12 months post transition. Upon demonstration of TMApp feasibility (49/70, ≥70% of participants using TMApp at least once a month), a randomized controlled trial was planned to test app efficacy in relation to transition and illness control outcomes. METHODS: Young people aged 16-19 years who were transitioning out of 2 major pediatric hospitals in Sydney, New South Wales, Australia, were recruited. Just before transition, participants' demographic and clinical details were collected, and TMApp was installed on their mobile devices. Participants were contacted by telephone at 6 and 12 months for information on self-reported usage, app usefulness, and other feedback. Quantitative cohort-level usage data, including the number of times specific app features were accessed, were tracked via mobile analytics. At 12 months, electronic medical records from participants' designated AHS were accessed for data on AHS attendances, measures of illness control, and unplanned hospitalizations. RESULTS: In total, 73 adolescents and young adults (30 male; median age 18, IQR 17-18 y) were recruited, with 1 withdrawing participation in the first month. Participants were primarily from 3 chronic illness subgroups-diabetes mellitus (n=23), inflammatory bowel disease (n=19), and cystic fibrosis (n=9). Of the total, 50% (36/72) of participants reported using TMApp at 1 month post transition. Self-reported usage rates fell to 25% and 11% at 6 and 12 months, respectively. Mobile analytics data broadly corroborated self-reported usage. Furthermore, 8 participants who continued to use TMApp for 12 months gave a median usefulness rating of 8/10. Over two-thirds (48/72, 68%) of participants successfully transitioned to their designated AHS by 12 months. Among the successful transitioners who had illness control data available on electronic medical records, over 80% (24/30) maintained a stable or improved illness status at 12 months. CONCLUSIONS: TMApp was not used regularly enough by our young people to demonstrate feasibility and justify progression to a randomized controlled trial. Despite low app uptake, most participants successfully transitioned, suggesting that TMApp had minimal influence on transition outcomes.