Szinay, D; Jones, A; Chadborn, T; Brown, J; Naughton, F; (2020) Influences on uptake of and engagement with health and wellbeing smartphone apps: a systematic review. Journal of Medical Internet Research , 22 (5) , Article e17572. 10.2196/17572.

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Abstract

Background: The public health impact of health and wellbeing digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently dependent largely on popularity indicators (e.g. 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 wellbeing apps to inform new approaches that promote the effective use of such tools. / Objective: To synthesise what is known about influences on the uptake of and engagement with health and wellbeing smartphone apps amongst adults. / Methods: A systematic review of quantitative, qualitative and mixed-methods studies. Studies conducted on adults were included if they focused on health and wellbeing smartphone apps reporting on uptake and engagement behaviour. Studies identified through a systematic search in MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, Cochrane library databases, DBLP and ACM Digital library were screened, with a proportion screened independently by two authors. Data synthesis and interpretation was 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 COM-B behaviour change model and the Theoretical Domains Framework. / Results: Out of 7640 identified studies, 42 were included in the review. Under ‘Capability’, the main factors identified were app literacy skills, user knowledge, including app awareness, available user guidance, health information, statistical information on progress, well-designed reminders, features to reduce cognitive load, and self-monitoring features. Availability at low cost, positive tone and personalisation were identified as physical ‘Opportunity’ factors, while recommendations for health and wellbeing apps, embedded health professional support together with social networking possibilities were social ‘Opportunity’ factors. Finally, ‘Motivation’ factors included positive feedback, available rewards, goal setting and the perceived utility of the app. / Conclusions: Across a wide range of populations and behaviours, twenty-six diverse factors relating to capability, opportunity and motivation appear to influence the uptake of and engagement with health and wellbeing smartphone apps. Further investigation of these factors, including where there are contradictory findings, and clearer reporting is required to advance the field. Clinical Trial: Protocol registration: PROSPERO 2019: CRD42019120312; Available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120312

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