Inequalities in Uptake and Use of Digital Applications for Home-Monitoring of Neovascular Age-Related Macular Degeneration in an Elderly Visually Impaired Population: The MONARCH Study

Ruth E Hogg, Robin Wickens, Sean O'Connor, Eleanor Gidman, Elizabeth Ward, Tunde Peto, Benjamen J L Burton, Paul Knox, Andrew J Lotery, Sobha Sivaprasad, Michael Donnelly, Chris A Rogers, Barnaby C Reeves

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

PURPOSE: To describe inequalities in the Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home (MONARCH) diagnostic test accuracy study for: recruitment; participants' ability to self-test; and adherence to testing using digital applications during follow-up.

METHODS: Home-monitoring vision tests included two tests implemented as software applications (apps: MyVisionTrack and MultiBit) on an iPod Touch device. Patients were provided with all hardware required to participate (iPod and MIFI device) and trained to use the apps. Regression models estimated associations of age, sex, Index of Multiple Deprivation, strata of time since first diagnosis, and baseline visual acuity at study entry on outcomes of willingness to participate, ability to perform tests, and adherence to weekly testing.

RESULTS: A minority of patients who were approached were willing-in-principle to participate. Increasing age was associated with being unwilling-in-principle to participate. Patients from the most deprived areas had a 47% decrease in odds of being willing compared to those from the middle quintile deprived areas (odds ratio, 0.53; 95% confidence interval = 0.32, 0.88). Increasing age and worse deprivation were not consistently associated either with ability to self-monitor with the index tests, or adherence to weekly testing.

CONCLUSIONS: Associations of increasing age and worse deprivation index were associated with unwillingness-in-principle to participate despite the provision of hardware' highlighting the potential for inequality with interventions of the kind evaluated.

TRANSLATIONAL RELEVANCE: The clear evidence of inequalities in participation should prompt future research on ways to encourage adoption of mobile health technologies by underserved populations.

Original languageEnglish
Article number2
Pages (from-to)2
Number of pages1
JournalTranslational Vision Science & Technology
Volume13
Issue number3
DOIs
Publication statusPublished (in print/issue) - 1 Mar 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors.

Keywords

  • Humans
  • Aged
  • Choroidal Neovascularization
  • Visual Acuity
  • Telemedicine
  • Macular Degeneration/diagnosis
  • home monitoring
  • inequalities
  • digital health
  • inequity
  • Macular Degeneration - diagnosis - epidemiology

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