title: Assessment of patient engagement with a mobile application among service members in transition.
abstract: OBJECTIVE
  This article examines engagement with a mobile application ("mCare") for wounded Service Members rehabilitating in their communities. Many had behavioral health problems, Traumatic Brain Injury (TBI), and/or post-traumatic stress disorder (PTS). The article also examines associations between Service Members' background characteristics and their engagement with mCare.
  
  
  METHODS
  This analysis included participants who received mCare (n = 95) in a randomized controlled trial. mCare participants received status questionnaires daily for up to 36 weeks. Participant engagement encompasses exposure to mCare, percentage of questionnaires responded to, and response time. Participants were grouped by health status-that is, presence/absence of behavioral health problems, PTS, and/or TBI. Histograms and regression analyses examined engagement by participants' health status and background characteristics.
  
  
  RESULTS
  Exposure to mCare did not differ by health status. Participants usually responded to ≥60% of the questionnaires weekly, generally in ≤10 h; however, participants with behavioral health problems had several weeks with <50% response and the longest response times. Total questionnaires responded to and response time did not differ statistically by health status. Older age and higher General Well-Being Schedule scores were associated with greater and faster response.
  
  
  CONCLUSIONS
  The sustained response to the questionnaires suggests engagement. Overall level of response surpassed trends reported for American's usage of mobile applications. With a few exceptions, Service Members engaged with mCare irrespective of health status.
  
  
  CONCLUSIONS
  Mobile health has the potential to increase the quantity and quality of patient-provider communications in a community-based, rehabilitation care setting, above that of standard care.
authors.affiliation: mHealth Research Project Manager, The Geneva Foundation, Assigned to the Mobile Health Care Innovation Center (MHIC), Telemedicine and Advanced Technology Research Center (TATRC), United States Army Medical Research and Materiel Command (USAMRMC), Fort Gordon, GA 30905, holly.h.pavliscsak.ctr@mail.mil holly.h.pavliscsak.ctr@mail.mil.
authors.forename: Holly
authors.initials: H
authors.lastname: Pavliscsak
authors.affiliation: Laboratory Lead, Mobile Health Innovation Center, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Gordon, GA, USA, jeanette.r.little.civ@mail.mil.
authors.forename: Jeanette R
authors.initials: JR
authors.lastname: Little
authors.affiliation: Executive Director, Center for Military Medicine Research, University of Pittsburgh, Pittsburgh, PA, USA, rkp19@pitt.edu.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Poropatich
authors.affiliation: Chief Scientist, Advanced Technology and Innovation Laboratory, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, UA, francis.l.mcveigh.civ@mail.mil.
authors.forename: Francis L
authors.initials: FL
authors.lastname: McVeigh
authors.affiliation: Engagement Manager, IMS Health, Government Solutions, Washington, DC, USA, jtong@us.imshealth.com.
authors.forename: James
authors.initials: J
authors.lastname: Tong
authors.affiliation: Former, PI, COL (Ret) Army, currently Director of Integrated Disability Evaluation System, Fort Gordon, GA USA, johnie.s.tillman.civ@mail.mil.
authors.forename: Johnie S
authors.initials: JS
authors.lastname: Tillman
authors.affiliation: Former, Principal Investigator, COL (Ret) Army, currently, Case Management Coordinator, Quality Management and Development, Virginia Department of Behavioral Health and Developmental Services, Richmond, VA, chc.smith@us.army.mil.
authors.forename: Challis H
authors.initials: CH
authors.lastname: Smith
authors.affiliation: Principal Investigator and Senior Scientist, Geneva Research Foundation, Located at Walter Reed National Military Medical Center, Endocrinology Department, Bethesda, MD, USA, sfonda@genevausa.org.
authors.forename: Stephanie Jo
authors.initials: SJ
authors.lastname: Fonda
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D013313:Stress Disorders, Post-Traumatic / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D014481:United States; D014728:Veterans
keywords: case management; mobile health; patient engagement; post-traumatic stress disorder; traumatic brain injury