BACKGROUND: Apps can potentially support asthma self-management, however attracting downloads and encouraging on-going adherence is challenging.OBJECTIVES: We observed the impact of different recruitment strategies and app features on adoption and continued use.METHODS: Practice nurses in five practices in Lothian/Oxford approached adults with active asthma to try out a prototype app. We also advertised the app via social media (Asthma UK; AUK Centre for Applied Research). We observed patients'

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... download and retention rates and sent pre- and post-trial questionnaires. We sampled 15 patients for interviews before and after using our app for one month to explore motivations, triggers and barriers to adoption and usage. Interviews were transcribed and analysed thematically with reference to the Fogg behaviour model.RESULTS: Social media attracted 87 users, but only 15 (17%) used the app for 30 days. Practices recruited 24 patients, 13 (54%) continued for 30 days. Successful adoption was dependent on ease of downloading and sufficient motivation. Some patients needed technological assistance with downloading the app and starting to use the features. Adherence was dependent on motivation derived from a sense that the healthcare professional and/or researcher was interested in the results, and that using an app to support their self-management could improve their asthma control.CONCLUSION: Social media attracted more downloads in a short time. However, most patients stopped using the app within a month. Practices recruited fewer patients, but patents adhered longer to the app. Dual promotion strategies (social media with practice support) may be the optimal approach to encourage adoption and adherence to telehealth.