Key Predictors of Adherence to a Mobile Health App for Managing Chronic Spontaneous Urticaria
Viegas H. Sousa-Pinto B. Vieira R.J. Ramanauskaite A. Witte-Händel E. Gimenez-Arnau A. Guillet C. Salvador Parisi C.A. Katelaris C. Fomina D. Larenas-Linnemann D. Sánchez J. Garcia E. Lima H. Kaidashev I. Nasr I. Canales I.O. Cherrez-Ojeda I. Bousquet J. Bernstein J.A. Peter J. Larco Sousa J.I. Kulthanan K. Weller K. Godse K. Rutkowski K. Lapina L. Bouillet L. Ensina L.F. Gonçalo M. Staevska M. Al-Nesf M.A.Y. Magerl M. Metz M. van Doorn M. Castor M.A. Khoshkhui M. Makris M. Hide M. Abuzakouk M. Al-Ahmad M. Türk M. Teovska Mitrevska N. Conlon N. Nojarov N. Kolkhir P. Li P. Ali R.M. Arnaout R. Asero R. Altrichter S. Thomsen S.F. Ye Y.-M. Brzoza Z. Zhao Z. Zuberbier T. Siebenhaar F. Kocatürk E. Neisinger S.
November 2025John Wiley and Sons Inc
Clinical and Translational Allergy
2025#15Issue 11
Background: Mobile health technologies may improve the management of chronic diseases, such as chronic spontaneous urticaria. However, effectiveness of mHealth tools largely depends on patient adherence, which can be influenced by various demographic, clinical, behavioural, psychosocial factors, and apps characteristics (appealing and simplicity of use). Understanding these adherence patterns is crucial for optimizing mHealth interventions. In this study, we aimed to assess adherence patterns associated to the use of CRUSE, a mHealth app designed for patients with CSU. Methods: We assessed users of the CRUSE app with self-reported CSU or suggested by a physician. For each user, we evaluated the number of days they completed the CRUSE daily monitoring questionnaire (app adherence) within the first 3 months after installation. We constructed univariable and multivariable ordered beta regression models to identify predictors of 3-month adherence to the app. Results: We analysed data from 2085 patients (66,114 days). Median adherence to the CRUSE app was of 22 days (24.4% of 90 days). In multivariable regression models, the variables more strongly associated with increased adherence to CRUSE included age (average increase = 0.16 percent points [pp] per additional year; 95% credible interval [CrI] = 0.08; 0.23 pp), male sex (average difference = 4.24 pp; 95% CrI = 1.77; 6.39 pp), being from a European country (average difference = 2.66 pp; 95% CrI = 0.59; 5.19 pp), and using monoclonal antibodies (average difference = 4.60 pp; 95% CrI = 2.26; 6.65 pp). Conclusions: Our findings suggest that age, male sex, residence in Europe, and the use of monoclonal antibodies are significant factors associated with increased adherence to the CRUSE app. These insights may help identify patient subgroups who would benefit most from mHealth support in managing CSU.
adherence , chronic spontaneous urticaria , mHealth
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MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
Adult and Pediatric Allergy Sections of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina
Department of Medicine, Campbelltown Hospital and Western Sydney University, Sydney, NSW, Australia
Moscow City Research and Practical Center of Allergology and Immunology, Clinical Hospital No 52, Moscow Healthcare Department, Russia Angioedema/Urticaria Center of Reference and Excellence (ACARE, UCARE), Moscow, Russian Federation
Department of Clinical Immunology and Allergology, IM, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
Center of Excellence in Asthma and Allergy Larenas Hospital Médica Sur, Mexico City, Mexico
Group of Clinical and Experimental Allergy, Hospital ‘Alma Mater de Antioquia’, University of Antioquia, Medellín, Colombia
Faculty of Medicine, Universidad de los Andes, Allergy Section, Fundación Santa Fe de Bogotá, UNIMEQ ORL, Bogotá, Colombia
LEADER Research Inc. and Division of Allergy and Clinic Immunology (UCARE), Medicine Department, McMaster University, Hamilton, ON, Canada
Poltava State Medical University, Poltava, Ukraine
Department of Clinical Immunology and Allergy, Royal Hospital, Muscat, Oman
Department of Dermatology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
University Dermatological Center (DermaCDU), Las Condes, Chile
Unit of Dermatology, Rancagua Regional Hospital, Rancagua, Chile
Universidad Espíritu Santo, Respiralab Research Center, Guayaquil, Ecuador
Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
ACARE Centre, Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town Lung Institute, Cape Town, South Africa
Department of Allergy, UCARE, Clinica San Felipe, Lima, Peru
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Dermatology, Dr D Y Patil Medical College and Hospital, Navi Mumbai, India
Urticaria Clinic, St Johns Institute of Dermatology, Guys and St Thomas Hospital, London, United Kingdom
Allergic Diseases Diagnosis and Treatment Center, Riga Stradins University, Pauls Stradins Clinical University Hospital, Riga, Latvia
French National Reference Center for Angioedema (CREAK), Internal Medicine Department, Grenoble University Hospital, La Tronche, France
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil
Dermatology, Faculty of Medicine, University of Coimbra and University Hospital, Coimbra Local Health Unit, Coimbra, Portugal
Medical University of Sofia, Sofia, Bulgaria
Allergy and Immunology Section, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
Department of Dermatology, UCARE, Erasmus MC, Rotterdam, Netherlands
Department of Pediatrics, University of the Philippines Manila-Philippine General Hospital, Manila, Philippines
Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Department of Dermatology, Hiroshima University, Hiroshima, Japan
Allergy & Immunology Department, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
Division of Allergy and Clinical Immunology, Erciyes University School of Medicine, Kayseri, Turkey
ReMedika General Hospital, Skopje, North Macedonia
School of Medicine, Trinity College Dublin, St Jamess Hospital Dublin, Dublin, Ireland
University of Hong Kong, Hong Kong
Department of Dermatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
Ambulatorio di Allergologia, Clinica San Carlo, Milan, Italy
Department of Dermatology and Venerology, UCARE, Kepler University Hospital, Linz, Austria
Faculty of Medicine, Center for Medical Research, Johannes Kepler University, Linz, Austria
Department of Biomedical Sciences, Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
Division of Allergology, Department of Internal Diseases, Institute of Medical Sciences, University of Opole, Opole, Poland
Department of Dermatology and Venerology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Diseases, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China
Department of Dermatology, Bahçeşehir University School of Medicine, Istanbul, Turkey
MEDCIDS—Department of Community Medicine
CINTESIS@RISE
Institute of Allergology
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
Department of Dermatology
Department of Dermatology
Adult and Pediatric Allergy Sections of the Italian Hospital of Buenos Aires
Department of Medicine
Moscow City Research and Practical Center of Allergology and Immunology
Department of Clinical Immunology and Allergology
Department of Pulmonology
Center of Excellence in Asthma and Allergy Larenas Hospital Médica Sur
Group of Clinical and Experimental Allergy
Faculty of Medicine
LEADER Research Inc. and Division of Allergy and Clinic Immunology (UCARE)
Poltava State Medical University
Department of Clinical Immunology and Allergy
Department of Dermatology
University Dermatological Center (DermaCDU)
Unit of Dermatology
Universidad Espíritu Santo
Division of Rheumatology
ACARE Centre
Department of Allergy
Department of Dermatology
Department of Dermatology
Urticaria Clinic
Allergic Diseases Diagnosis and Treatment Center
French National Reference Center for Angioedema (CREAK)
Division of Allergy
Dermatology
Medical University of Sofia
Allergy and Immunology Section
Department of Dermatology
Department of Pediatrics
Allergy Research Center
Allergy Unit
Department of Dermatology
Allergy & Immunology Department
Faculty of Medicine
Division of Allergy and Clinical Immunology
ReMedika General Hospital
School of Medicine
University of Hong Kong
Department of Dermatology
Ambulatorio di Allergologia
Department of Dermatology and Venerology
Faculty of Medicine
Department of Biomedical Sciences
Department of Allergy and Clinical Immunology
Division of Allergology
Department of Dermatology and Venerology
Department of Dermatology
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