Understanding Engagement: Factors associated with access and use of a healthy lifestyles app among adolescents

Abstract

Background: Mobile apps have significant potential to change health behaviours and address service gaps. However, uptake and adherence to these interventions is often poor. Identifying factors associated with engagement is a critical issue for the digital health field. 

Aims: This study aimed to identify key factors associated with adolescents’ engagement with a healthy lifestyles mobile app (The Health4Life app).

Methods: Participants were intervention participants in a large school-based trial who were provided with access to the Health4Life app as a part of this trial. A series of regressions were performed to ascertain the effects of variables that might impact students’ opportunities to access the app (e.g. teacher actions) and individual student variables, on app access and app use (number of days using the app).

Results: Of 2489 students, 407 (16.4%) accessed the app. A number of significant predictors of app access, but not app use, were identified. Of note, assigning students to download the app as homework was associated with increased likelihood of app access and psychological distress, socio-economic status and health risk behaviours were not significant predictors app access. 

Conclusion: These findings are important as they indicate that clinical factors (e.g. psychological distress and health behaviours) and socieo-economic status may not be significant barriers to adolescents engaging with digital health interventions. However, these results do highlight the need for more research to identify what type of factors are strongly associated with digital engagement, particularly ongoing use and engagement with these interventions.