Determinants of the Uptake and Frequency of Use of a Web Portal Digital Health Intervention in Patients With Type 2 Diabetes and/or Coronary Heart Disease: Secondary Analysis of a Randomized Controlled Trial.

Only 43.1% of intervention group members used the web portal digital health intervention at least once.

• Of 462 intervention group members, 199 (43.1%) used the web portal at least once.
• The DHI was a web portal provided in an intervention for improving disease-related self-management.
• Eligible participants were adults diagnosed with type 2 diabetes and/or coronary heart disease.
• This was a secondary analysis of intervention group data from a parallel-group randomized controlled trial.

Higher education, openness, and intentions regarding physical activity and healthy nutrition were significantly associated with uptake in simple regression.

• Higher education was significantly associated with uptake (B=0.56, 95% CI 0.18-0.95; P=.004).
• Openness was significantly associated with uptake (B=1.08, 95% CI 0.33-1.83; P=.005).
• Intention regarding physical activity was significantly associated with uptake (B=2.28, 95% CI 1.30-3.26; P<.001).
• Intention regarding healthy nutrition was significantly associated with uptake (B=2.30, 95% CI 1.30-3.31; P<.001).
• Inflation of the α error due to multiple testing was controlled via the approach of Benjamini and Hochberg.

In multiple regression, intentions regarding physical activity and healthy nutrition were positively associated with uptake, while patient activation was negatively associated with uptake.

• The multiple regression model for uptake was highly significant (P<.001).
• Intention regarding physical activity showed a significant positive association with uptake (B=1.86, 95% CI 0.74-2.97; P=.001).
• Intention regarding healthy nutrition showed a significant positive association with uptake (B=2.22, 95% CI 1.00-3.44; P<.001).
• Patient activation showed a significant negative association with uptake (B=-3.20, 95% CI -4.95 to -1.46; P<.001).
• Except for sociodemographic variables, all other variables were standardized to a range from 0 to 1.

No statistically significant determinants of frequency of use were identified in either simple or multiple regression analyses.

• After controlling for inflation of the α error, simple regression for frequency yielded no statistically significant effect.
• The multiple regression model for frequency was not significant (P=.07).
• Frequency was analyzed only for those who used the DHI at least once.
• Frequency of use was analyzed using negative binomial regression with robust SEs.

The determinants of uptake and frequency of use of the digital health intervention differed from each other.

• Factors that were significant predictors of uptake (e.g., intentions regarding physical activity and healthy nutrition, patient activation) were not significant predictors of frequency of use.
• The study concludes that 'factors driving uptake do not necessarily increase the frequency of use.'
• The authors note that 'distinct strategies are required to promote adoption versus sustained engagement.'
• Sociodemographic, psychological, and health-related variables were all examined as potential determinants of both uptake and frequency.

Patient activation was negatively associated with uptake of the digital health intervention.

• Higher patient activation was associated with lower likelihood of using the web portal (B=-3.20, 95% CI -4.95 to -1.46; P<.001) in the multiple regression model.
• This negative association suggests that more activated patients were less likely to initiate use of the DHI.
• Patient activation was among the psychological and health-related variables examined as determinants.
• This finding was identified in the multiple regression model controlling for other variables.