PMID- 33118956 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20210427 IS - 2291-5222 (Electronic) IS - 2291-5222 (Linking) VI - 8 IP - 10 DP - 2020 Oct 29 TI - Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial. PG - e20847 LID - 10.2196/20847 [doi] LID - e20847 AB - BACKGROUND: Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. OBJECTIVE: The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. METHODS: Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. RESULTS: The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (beta at 3 months=-2.184, P=.048) and a greater frequency of items completed (beta at 3 months=-0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. CONCLUSIONS: This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-018-5693-1. CI - (c)Yu Zeng, Yan Guo, Linghua Li, Y Alicia Hong, Yiran Li, Mengting Zhu, Chengbo Zeng, Hanxi Zhang, Weiping Cai, Cong Liu, Shaomin Wu, Peilian Chi, Aliza Monroe-Wise, Yuantao Hao, Rainbow Tin Hung Ho. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 29.10.2020. FAU - Zeng, Yu AU - Zeng Y AUID- ORCID: 0000-0002-2604-9502 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. FAU - Guo, Yan AU - Guo Y AUID- ORCID: 0000-0002-8754-1090 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. AD - Sun Yat-sen Center for Global Health, Guangzhou, China. FAU - Li, Linghua AU - Li L AUID- ORCID: 0000-0001-5711-8681 AD - Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China. FAU - Hong, Y Alicia AU - Hong YA AUID- ORCID: 0000-0002-1481-6495 AD - Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States. FAU - Li, Yiran AU - Li Y AUID- ORCID: 0000-0002-4704-8728 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. FAU - Zhu, Mengting AU - Zhu M AUID- ORCID: 0000-0002-7247-7620 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. FAU - Zeng, Chengbo AU - Zeng C AUID- ORCID: 0000-0002-3512-1115 AD - South Carolina SmartState Center of Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States. AD - Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States. FAU - Zhang, Hanxi AU - Zhang H AUID- ORCID: 0000-0002-2193-9581 AD - National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. FAU - Cai, Weiping AU - Cai W AUID- ORCID: 0000-0002-1287-0623 AD - Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China. FAU - Liu, Cong AU - Liu C AUID- ORCID: 0000-0001-7147-8923 AD - Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China. FAU - Wu, Shaomin AU - Wu S AUID- ORCID: 0000-0002-7954-6502 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. FAU - Chi, Peilian AU - Chi P AUID- ORCID: 0000-0002-1839-1113 AD - Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China. FAU - Monroe-Wise, Aliza AU - Monroe-Wise A AUID- ORCID: 0000-0002-8843-3462 AD - Department of Global Health, University of Washington, Seattle, WA, United States. FAU - Hao, Yuantao AU - Hao Y AUID- ORCID: 0000-0001-8024-5312 AD - Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. AD - Sun Yat-sen Center for Global Health, Guangzhou, China. FAU - Ho, Rainbow Tin Hung AU - Ho RTH AUID- ORCID: 0000-0002-6173-621X AD - Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China. AD - Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China. LA - eng SI - ChiCTR/ChiCTR-IPR-17012606 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20201029 PL - Canada TA - JMIR Mhealth Uhealth JT - JMIR mHealth and uHealth JID - 101624439 SB - IM MH - Depression/epidemiology/therapy MH - Exercise MH - *HIV Infections/complications/epidemiology/therapy MH - Humans MH - Patient Participation MH - *Telemedicine PMC - PMC7661233 OTO - NOTNLM OT - HIV OT - depressive symptoms OT - latent growth curve model OT - mHealth OT - patient engagement COIS- Conflicts of Interest: None declared. EDAT- 2020/10/30 06:00 MHDA- 2021/04/28 06:00 PMCR- 2020/10/29 CRDT- 2020/10/29 12:11 PHST- 2020/07/10 00:00 [received] PHST- 2020/09/22 00:00 [accepted] PHST- 2020/08/30 00:00 [revised] PHST- 2020/10/29 12:11 [entrez] PHST- 2020/10/30 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2020/10/29 00:00 [pmc-release] AID - v8i10e20847 [pii] AID - 10.2196/20847 [doi] PST - epublish SO - JMIR Mhealth Uhealth. 2020 Oct 29;8(10):e20847. doi: 10.2196/20847.