Feasibility of a Digital Therapeutic for Atopic Dermatitis: Analysis of Engagement, Retention and Acceptability (Preprint)

BACKGROUND Patients with Atopic Dermatitis (AD) experience chronic eczema with painful lesions, pruritus, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of AD. Digital therapeutics can help with these, as well as support patients towards a healthier lifestyle to improve their overall QoL. OBJECTIVE Our goal was to test the feasibility of a digital therapeutic intervention tailored for AD through program engagement, retention and acceptability. METHODS Adults with AD were recruited in Iceland for a six-week digital intervention delivered through a smartphone app. Key components of the digital therapeutic were disease and trigger education, medication reminders, patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs), AD symptom PROs, guided meditation, and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth App Usability Questionnaire (MAUQ). RESULTS Twenty-one patients were recruited (17 female, mean age: 31 years), and 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions. The education content, medication reminders, and PROs had high user engagement and retention; all users that were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed AD symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of AD symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program respectively, and all reported improvements over time. User satisfaction was high, with a total score of 6.2/7. CONCLUSIONS We found high overall engagement and retention in a targeted digital therapeutic program among patient with AD, as well as high compliance with missions relating to medication reminders, patient education, and PROs. The collected PROs showed a reduction in symptom number and severity and an improvement in QoL over time. We conclude that a digital therapeutic intervention is feasible and may provide added benefits for AD patients, including the tracking and improvement of AD symptoms.