Abstract
BackgroundThe public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools.ObjectiveThis review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults.MethodsWe conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF).ResultsOf the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E).ConclusionsAcross a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.
Highlights
BackgroundDigital behavior change interventions, such as smartphone apps, can be effective and cost-effective tools to change a range of health-related behaviors [1,2]
Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior
Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps
Summary
BackgroundDigital behavior change interventions, such as smartphone apps, can be effective and cost-effective tools to change a range of health-related behaviors [1,2]. There have been promising studies of apps, including (1) delivering health prevention messages for men who have sex with men [3], (2) self-managing diabetes [4] and cardiovascular diseases [5], (3) weight management [6,7,8], (4) alcohol reduction [9,10,11], (5) mental health interventions [12], and (6) managing long-term conditions [13]. The public health implications are substantial because of their potential to have a low incremental cost and broad reach Despite their promise, effect sizes reported in evaluations of app-based interventions are often small. There is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools
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