title: A Mobile App for Chronic Disease Self-Management: Protocol for a Randomized Controlled Trial.
abstract: BACKGROUND
  Health literacy is a critically important skill that helps people become active participants in their health care. Multiple studies in the United States and across the world have documented the association of health literacy with multiple health outcomes. In particular, the elderly and many members of minority groups have been shown to have low levels of health literacy; the same groups are disproportionately affected by chronic illnesses. These twin burdens affect the people most in need of the skills and knowledge required for coping with chronic illnesses. Chronic disease self-management (CDSM) is a logical target for a general health literacy intervention. In an approach that spans across specific diseases, CDSM targets problems and skills needed to cope with issues such as fatigue, pain, stress, depression, sleep disturbance, and treatment adherence. In a previous study, we showed that a computer-delivered tailored information intervention targeting health literacy could improve treatment and adherence and be cost effective, but it is not clear that this same strategy will be effective in persons with low health literacy and multiple chronic conditions.
  
  
  OBJECTIVE
  The purpose of this study is to develop a computer-delivered mobile intervention that will provide individuals with chronic conditions the necessary information to cope with their conditions.
  
  
  METHODS
  In this project, we will complete a qualitative study on the status and needs of individuals with more than one chronic condition. Results of this study will be used to develop a mobile tailored information app that will address self-management challenges in the areas of pain, sleep, fatigue, depression, anger, stress, memory problems, and treatment adherence. The impact of the intervention on patient quality of life, patient-provider relationships, health literacy, and patient activation will be assessed. We will also explore the extent to which health literacy mediates important outcomes, such as health-related quality of life and health service utilization.
  
  
  RESULTS
  We are currently completing the preliminary qualitative and usability studies that will inform the content and design of the intervention. We anticipate that the intervention will be complete in 2017, and the clinical trial of its efficacy will also commence in 2017.
  
  
  CONCLUSIONS
  Results will provide evidence on the usefulness of a mobile tailored information app for improving health literacy, patient activation, health-related quality of life, and self-reported health in patients with multiple chronic conditions.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02922439; https://clinicaltrials.gov/ct2/show/NCT02922439 (Archived by WebCite at http://www.webcitation.org/6pTiqDAyN).
authors.affiliation: Nova Southeastern University, Department of Psychiatry and Behavioral Medicine, Fort Lauderdale, FL, United States.
authors.forename: Raymond L
authors.identifier: http://orcid.org/0000-0001-9433-2820
authors.initials: RL
authors.lastname: Ownby
authors.affiliation: Nova Southeastern University, College of Psychology, Fort Lauderdale, FL, United States.
authors.forename: Amarilis
authors.identifier: http://orcid.org/0000-0003-3173-6718
authors.initials: A
authors.lastname: Acevedo
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
authors.forename: Drenna
authors.identifier: http://orcid.org/0000-0002-4119-7343
authors.initials: D
authors.lastname: Waldrop-Valverde
authors.affiliation: Larkin Health Sciences Institute, Department of Clinical and Administrative Sciences, College of Pharmacy, Miami, FL, United States.
authors.forename: Joshua
authors.identifier: http://orcid.org/0000-0003-4406-2425
authors.initials: J
authors.lastname: Caballero
authors.affiliation: Department of Instructional Design and Technology, Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-3478-7879
authors.initials: M
authors.lastname: Simonson
authors.affiliation: Nova Southeastern University, Department of Psychiatry and Behavioral Medicine, Fort Lauderdale, FL, United States.
authors.forename: Rosemary
authors.identifier: http://orcid.org/0000-0001-7695-6445
authors.initials: R
authors.lastname: Davenport
authors.affiliation: Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States.
authors.forename: Kofi
authors.identifier: http://orcid.org/0000-0002-0862-4649
authors.initials: K
authors.lastname: Kondwani
authors.affiliation: Baylor College of Medicine, Department of Family and Community Medicine--Research Programs, Houston, TX, United States.
authors.forename: Robin J
authors.identifier: http://orcid.org/0000-0001-8235-4096
authors.initials: RJ
authors.lastname: Jacobs
keywords: chronic disease self-management; health disparities; health literacy; health related quality of life; mobile health technology; patient activation