Szinay, D; Perski, O; Jones, A; Chadborn, T; Brown, J; Naughton, F; (2021) Perceptions of factors influencing engagement with health and wellbeing apps: a qualitative study using the COM-B model and Theoretical Domains Framework as an analytical framework. JMIR mHealth and uHealth 10.2196/29098. (In press).

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Abstract

Background: Digital health media, such as health and wellbeing smartphone apps, could offer an accessible and cost-effective way to deliver health and wellbeing interventions. A key component of the effectiveness of these apps is user engagement. However, engagement with health and wellbeing apps is typically sub-optimal. Previous studies have identified multiple factors that influence engagement, however, most of these studies were conducted on specific populations or focused on apps targeting a particular behaviour. Understanding factors that influence engagement with a wide range of health and wellbeing apps can help inform the design and development of more engaging apps. Objective: The aim of this study was to explore users’ experiences of and reasons for engaging and not engaging with a wide range of health and wellbeing apps. Methods: A sample of adults in the UK (N=17) interested in using a health or wellbeing app took part in a semi-structured interview to explore experiences of engaging and reasons for not engaging with these apps. Participants were recruited via social media platforms. Data were analysed with the framework approach, informed by the Capability, Opportunity, Motivation – Behaviour (COM-B) model and the Theoretical Domains Framework, two widely used frameworks that incorporate a comprehensive set of behavioural influences. Results: Factors appearing to influence the capability of participants to engage with health and wellbeing apps included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help to establish a routine, features that allow retaining the app for a potential precipitating event in the future (‘safety netting’) and features that offer a first step in the behaviour change process (‘stepping stone’). Tailoring, peer support and embedded professional support were identified as important factors that appeared to enhance users’ opportunity for engagement with health and wellbeing apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence and commitment were judged to be motivation factors affecting engagement with health and wellbeing apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for enhancing the engagement of health and wellbeing apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load and support self-monitoring (capability), provide embedded social support (opportunity), and goal setting with action planning (motivation). We provide recommendations for policy makers, industry, health care providers and app developers on how to increase engagement. Clinical Trial: Not applicable.

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