mHealth Journal Club

Article Name: Web versus App – compliance of patients in a telehealth diabetes management programme using two different technologies
Gunter Schreier, Harald Eckmann, Dieter Hayn, Karl Kriener, Peter Kastner, and Nigel Lovell
Journal Published:
Journal of Telemedicine and Telecare
Date Published:
December 3, 2012


Schreier G, Eckmann H, Hayn D, Kreiner K, et al. Web versus App – compliance of patients in a telehealth diabetes management programme using two different technologies. J Telemed Telecare. 2012;18(8):476-80.


The authors introduce that there are presently two different ways patients can interact with a telehealth system: (1) e-health via web-based methods, (2) mhealth via app-based methods. The Austrian Social Insurance Institution for Railways and Mining Industry called for a telediabetes project aiming to:

  1. Achieve sustainable lifestyle modifications
  2. Individualized therapy
  3. Increasing adherence
  4. Increasing safety


Determine the dropout rate between two cohorts using either an e-health or mhealth supported intervention.


  • Patients were enrolled at a rehabilitation facility for 1-3 weeks and educated on health and conditions along with standard of care.
  • Intervention
    • Patients received glucose meters, BP measuring device, and body weight scales. Measurements depended on what type of diabetes they had (type 1 vs type 2), and they were then given the choice of joining the mhealth or e-health group to report measurements. They were asked to record their data for as long as they wished.
      • mhealth patients received a Near Field Communication (NFC) enabled mobile phone with pre-installed DM app and RFID cards for personal identification. The devices given had the ability to collect and transmit data by touching the NFC device with the measuring tool.
      • e-health patients utilized a web-based browser to submit their health data via internet-connected devices
  • Analysis was conducted by categorizing users based on what group they were in. However, a number used both mechanics to report data, and were split into the group they primarily reported via. Compliance was then compared by defining a ‘dropout’ if the date of the last data submission was earlier than 20 days prior to the day the when the analysis was conducted.


  • 403 patients enrolled (341 male, 62 female)
    • Average age 57
    • Average length of time using the system was 347 days
    • 291 patients used the app
    • 112 patients used web-based submission
  • During first 350 days, no significant difference existed between either groups submission
  • After 350 days, patients using the app remained significantly more active than those submitting via web-based browsers (p = 0.027).
  • No difference noted between sex or disease state.

Study Conclusion:

Authors concluded that the results demonstrated a higher compliance rate for patients using NFC enabled mobile phones vs those that had to use a web-based browser. The type of technology used may impact adherence to use, and further research is needed to determine user-centered design on long-term compliance.

Commentary & Implication to mHealth:

This was an interesting study that seemed to demonstrate a higher adherence rate to reporting personal data via a mobile device through an app.

However, several shortcomings need to be evaluated:

  • What devices were used? Would this play a significant role in the ergonomics or decision of patients in using one product over another? Also, what was the app used?
  • The determination of dropout period seems a little odd and had no set date per the paper, and may have biased one way or another the impact of determining compliance.

The use of NFC technology and its integration was a very nice step, and really opens up the question of integration of mobile devices and measuring equipment in a cloud based format. This study was conducted in Europe, who have different oversight compared to the US FDA, and will be interesting to see what may develop here in the US in the future. It may be worthwhile to evaluate a similar study here in the US with a modified methods that refines certain parameters.




Journal of Telemedicine and Telecare