Principal findings
The majority of the participants in this study had smartphones and access to the Internet on their mobile phones. Almost half of the participants occasionally used mobile phone calls and mobile Internet to receive asthma-related information. A significant number of the patients had never used mobile phone apps or E-mails to receive asthma-related information. The patients had made their greatest use of mobile phone functionalities through the Internet search, followed by social media, for the purpose of receiving information about asthma warning symptoms and allergenic and irritating substances, medicinal therapy and how to use therapy aids. The participants were most willing to use social media to receive information, communicate with other patients and be reminded of their doctor's appointments, and warned about their lack of asthma control.
The present findings showed that a significant number of the patients had Internet access on their mobile phones, which agrees with the results of other studies on the access of patients with asthma (2017) [
31], pregnant women (2014) [
32] and African–American families (2014) [
33] to the Internet. In contrast, a Pew Research Center report found that Internet access rates among African–Americans were relatively low [
34]. Due to recent technological advances, there has been a significant increase in the use of mobile technologies and Internet access. So that areas with low Internet access are also increasing [
35]. Therefore, the availability of these tools provides new mechanisms for providing self-care for chronic diseases such as asthma. In addition, the majority of the participants in the present study were willing to use their mobile phones to receive asthma care services. Similarly, Fonseca et al. [
36], reported in a study that a large majority of patients were willing and ready to use communication technologies such as cell phones and the web to help them manage their asthma. In another study, the most important reason for patients' desire to use mobile phone technologies was to save time and engaging patients in their disease management [
37]. But in general, to successfully introduce new technologies to patients, their concerns must be addressed and patients must be confident about the benefits of using such technologies.
The results showed that less than half of the participants occasionally used mobile phone calls and the Internet to receive asthma-related information. Similarly, Van de Belt et al. (2013) [
38] argued that less than half of Dutch people conducted online search for health-related information occasionally before visiting their doctors and after consulting with the doctor. Also, in a study by Calderón et al. (2017) [
31], less than half of patients with asthma used the Internet to seek information about asthma. Despite the potential benefits of searching for health information on the Internet, many patients have raised concerns about the negative effects of this searched health information on the Internet. Therefore, the low quality of information available on the Internet can be stated as one of the reasons for patients' low use of Internet health information seeking, which can lead to patients being misinformed, lead to distress, and increase the tendency towards self-diagnosis or self-treatment [
39].
The results of one study showed that 77.3% of patients with asthma used E-mails at least once a week, and E-mail was the only platform through which most of them were interested in receiving information and communicating with physicians [
40]. However, in the present study, patients' non-use of E-mail communication may be due to their lack of knowledge about using this feature to communicate, lack of an E-mail account, delay in receiving a response, and a lack of sufficient time for physicians to respond. The results of the study conducted by Singh et al. (in New York 2014) [
41] concur with the present study findings in terms of the degree of mobile app usage. They reported that although the majority of adolescents or their caregivers were willing to use mobile health apps, only 26% of them had health-related apps installed, and their feedback revealed that the lack of knowledge, poor finances, and privacy concerns were barriers for downloading or using medical apps. Therefore, it seems necessary for physicians to carefully review the information content of the mobile app, before introducing it to their patients.
In the present study, the participants had their greatest use of mobile phone functionalities through the Internet search, followed by social media, to receive asthma-related information, which agrees with the results of other studies [
32,
38,
42,
43]. A systematic review study reported that most pregnant women used the Internet as a source of information [
44], while in a recent study, patients with asthma preferred SMS over the Internet search and social media, and their reasons for this preference were the low costs and reliability of SMS [
31]. In another study, Chisolm et al. [
45] analyzed the potential reasons for asthma and diabetes patients' use or lack of use of the Internet, and proposed the lack of time, interest, access and medical necessity as the reasons for not using the Internet, and argued that the reasons for using the Internet were its usefulness, ease of use, medical necessity, and up-to-date nature. In that study, health literacy and demographic factors were significantly linked to the Internet use. Considering that the Internet and social media technologies, in particular, are an important source of health information and the use of online social groups is also increasing, therefore, patients can use these technologies to share experiences and offer support to their peers.
In the present study, the patients were most willing to use social media for the purpose of receiving information, communicating with other patients, being reminded of doctor's appointments, and being warned about their lack of asthma control. Similarly, Ramirez et al. [
46] reported that more than 70% of the patients in primary care clinics in Los Angeles were willing to use social media to communicate with other patients with similar problems. Calderón et al. [
31] argued that young participants were inclined to use WhatsApp to receive information and be in direct contact with their doctor about asthma. Previous studies have shown how social media, such as Facebook and Twitter, have been effective in improving the outcomes of patients with chronic diseases such as human immunodeficiency virus (HIV), breast cancer and chronic tobacco use [
47‐
49]. These studies demonstrated that social media encourage patients to share health information with others, to teach them about diseases and their treatment, and also to communicate with other patients with similar symptoms who are receiving similar therapies. Nevertheless, privacy concerns are often proposed as the barriers to use social media [
50]. Like many emerging technologies, access to information must be controlled to address privacy concerns and safeguards must be put in place to reduce the risk of privacy breaches.