1. RESULTSBACKGROUND
Characteristics of Surveyed Parents
CONCLUSIONS
• With the rise of technology, patients and healthcare providers increasingly integrate mobile
health apps into healthcare.
• Over 200,000 mobile health apps are available.
• Nineteen percent of Black people use their smartphones to look up health information on their
phones compared to 15% of White People. (Pew, 2013)
• Black people more likely to use smartphones for health purposes, but twice as likely to cancel
smartphone service due to financial reasons. (Pew, 2013)
• Race, class, and education levels all are associated with unequal access to healthcare.
• Previous studies have shown that concerns about privacy are elevated among ethnic
minorities. (California Health Care Foundation, 2005)
• Previous studies have shown that concerns about mHealth cost are elevated among those
with lower annual household earnings. (Pew, 2015)
• Health System leaders and policy makers question whether integrating more mobile healthcare
technologies will exacerbate the digital divide and worsen existing health disparities.
OBJECTIVES & HYPOTHESES
• Objective 1: To determine how attitudes regarding mobile health apps vary based on parental
characteristics.
• Hypothesis 1: Black parents will be more likely than White identifying parents to utilize their
smartphones to look up information about their child’s heath.
• Hypothesis 2: Black parents will be less likely to have downloaded a mobile health app to
manage or look for information regarding their child’s health.
• Objective 2: To determine how concerns about cost and the privacy of health information vary
based on parental characteristics.
• Hypothesis 1: Black Parents will be more concerned about the privacy/safety of their child’s
health information when it comes to mobile health apps.
• Hypothesis 2: Parents of a lower socioeconomic background will be more concerned about
cost when it comes to mobile health apps.
METHODS
N (%) 176 (100%)
Race
Black 66 (37%)
White 80 (45%)
Other 20 (11%)
Rather Not Say 10 (6%)
Ethnicity Hispanic 15 (8%)
Education
Level
High School, GED, Technical School or Less 61 (33%)
Some College 44 (25%)
College Graduate and Beyond 71 (40%)
Annual
Household
Income
<$19,999 40 (23%)
$20,000-$49,999 36 (21%)
$50,000- $99,999 35 (20%)
Over $100,000 35 (20%)
Rather not Say 28 (16%)
Age
28 and younger 27 (15%)
29-34 43 (24%)
35+ 106 (60%)
Recruitment
Site
Suburban Primary Care Center 24 (14%)
Urban Primary Care Centers 63 (35%)
Dermatology 34 (19%)
Endocrinology 32 (18%)
Healthy Weight (Obesity Program) 23 (13%)
Participant Characteristics
Univariate Results
• Majority of Parents used their phone
to look up information about their
child’s health
• About 1/3 of Parents reported that
they have downloaded a mobile
health app to track their child’s health
• Majority of parents were quite
concerned about the privacy/security
of their child’s health information.
• None of these results differed
based on race or income
Bivariate & Multivariate Outcomes
Perceptions of mHealth Applications among Parents in a Large Pediatric Health System
Adeiyewunmi Osinubi
Lindsay Berrigan MPH, Emily Sykes, Rachel S. Gruver, MPH, Linda Fleisher, PHD, MPH, Alexander G. Fiks, MD, MSCE
• Recruitment
• Parents of children receiving care at CHOP
were recruited in waiting rooms of CHOP
healthcare facilities.
• Inclusion Criteria: Parents or guardians of
children who are receiving care at CHOP
• Sites:
• 2 Urban primary care centers
• 1 Suburban primary care center
• Healthy Weight Obesity Program
• Endocrinology
• Dermatology
• Survey
• Survey questions were derived from
• The Qualtrics Web Demographics
Survey
• The National Survey of Consumers'
Perspectives of mHealth
• Health Information National Trends
Survey
• 2012 Pew Internet & American Life
Project
• Additional items developed based on
literature review
• Conducted three cognitive interviews to
test the surveys before distribution.
• Primary Outcomes (Parent-Reported)
• Use of mHealth Apps
• Concerns about Cost of Apps
• Concerns about Cost of the Data to use
Apps
• Concerns about Privacy and Security
• Exposures
• Household Income
• Race
• Data Management
• All surveys were double entered and stored
in REDCap, a HIPAA compliant database.
• Analysis
• We used SAS 9.4 (Cary, NC) in order to
analyze the data
• Demographics described
• Conducted Bivariate Analysis to examine
relationship between exposure and primary
outcomes using chi-square tests
• Multivariable Logistic Regression
assessed the independent effect of race
versus income while adjusting for practice
site.
IMPLICATIONS
• In a diverse population of parents of children receiving care at varied CHOP settings, use of smartphones to
access health information was common across all groups.
• Nearly 1/3 have used apps for this purpose.
• Despite the frequent use of smartphones to access health information, privacy concerns were common.
• Contrary to the 2005 California Healthcare Foundation Study, we found that there was no difference between
groups when it came to concerns about privacy. Concerns about security were high across all groups.
• Income, but not race, was a key predictor of cost concerns regarding app use.
ACKNOWLEDGMENTS
• Results suggest that financial supports may be
needed for low-income families, who often belong to
minority groups, to use apps in healthcare.
• For all families, communicating and ensuring the
security of health information entered into apps will
be essential.
• These priorities are important across primary care
and subspecialty settings.
• Those with incomes below $20,000 compared to
those with incomes over $100,000 were more
likely to be concerned about app cost and data
plan costs.
• In models that included race and income, race
was not a significant predictor of concern
regarding cost.
Question Income
Total,
n (%)
<19,999 $20,000-
$99,999
$100,000+ p-value
How Concerned are you
about the smartphone
data cost?
Very Concerned 31
(21%)
14
(35%)
15
(21%)
2 (6%) 0.025
Fairly
Concerned/Concerned
48
(33%)
12
(30%)
25
(35%)
48 (33%)
Not Very/Not at all
Concerned
53
(33 %)
14
(35%)
30(43%) 66 (46%)
How Concerned are you
about the cost of the
app itself?
Very Concerned 32
(23%)
14
(36%)
17
(25%)
1 (3%) 0.008
Fairly Concerned/
Concerned
62
(44%)
17
(44%)
29
(42%)
16 (47%)
Not Very/Not at All
Concerned
48
(34%)
8 (21%) 23
(33%)
17 (50%)
79%
Said that they
used a mobile
device to track
information about
their child’s health
76%
28%
Said that they
were very
concerned about
security of their
child’s health
information
Said that they
have downloaded
a mobile health
app
Question Race
Total,
n(%)
Black
n(%)
All other
races
n(%)
p-
value
How Concerned are you about the
cost of the app itself?
Very Concerned 34 (21%) 21
(33%)
13 (13%) 0.008
Fairly Concerned/Concerned 74 (46%) 26
(41%)
48 (49%)
Not Very/Not at all Concerned 53 (33 %) 16
(25%)
37 (38%)
Multivariate Results Summary
This study was funded by the Chair’s Initiatives of the Department
of Pediatrics at The Children’s Hospital of Philadelphia. We thank
the physicians, patients and families for their contributions to this
clinical research through the Pediatric Research Consortium at
The Children’s Hospital of Philadelphia.
Tele-dermatology App. An example of apps increasingly used in care