Egilsson Erlendur, Bjarnason Ragnar, Njardvik Urdur
Department of Psychology, University of Iceland, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
JMIR Form Res. 2021 Feb 17;5(2):e21432. doi: 10.2196/21432.
The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed.
The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention's usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health.
A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects.
The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (R=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group.
This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants' self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates.
大多数青少年都拥有智能手机，尽管其中只有8%的人使用健康应用程序。针对焦虑和抑郁等心理健康问题的青少年移动健康（mHealth）干预措施的损耗率是一个存在高度差异的问题。针对青少年群体的mHealth干预措施的损耗情况通常以两点式呈现，即从干预开始到治疗结束，缺乏关于使用情况和损耗时间的更具时间特异性的信息。自我效能感可能为降低损耗率提供一条途径，不过需要更好地理解心理健康因素与特定时间损耗率之间的关系。
本研究的目的是获取mHealth干预中青少年的特定时间损耗率，并描述该干预措施在青少年自我效能水平、情绪和身体健康方面的使用情况及可行性。
对41名青少年进行了一项单中心随机对照公立学校试点试验。在基线和6周后评估结果指标，同时在整个干预期持续评估应用程序内的活动和损耗率。主要结果是基于应用程序内健康行为使用的时间和类型的损耗情况，以及mHealth应用程序的可行性。次要结果指标是自我效能水平、抑郁和焦虑症状，以及标准化体重指数和睡眠情况。通过Bonferroni校正调整α水平后进行组均值方差分析，以评估主要结果效应。
从干预开始到6周随访的损耗率为35%。损耗从干预的第三周开始，且与每日应用程序使用时间有关（R = 0.43，P <.001）。从干预的第一周（平均55.25，标准差10.96）到下一周（平均13.63，标准差2.94），每周平均完成的应用程序内健康锻炼次数显著减少。然而，在第2周和干预最后一周之间使用量增加了22%（平均16.69，标准差8.37）。可用性测量显示得分令人满意（平均78.09，标准差9.82），且无性别差异（P = 0.85）。干预组自我报告的每日身体活动增加了19.61%，而对照组则下降了26.21%。与对照组下降3.03%相比，干预组的自我效能水平提高了8.23%。
这项试点研究证明了mHealth干预在青少年参与者中的可行性和可用性。有迹象表明对身心健康有有益影响，值得进一步研究。关注特定时间的损耗测量以及每日使用时间和提高参与者自我效能水平的方法，似乎是针对青少年群体的mHealth干预研究的一个有前景的途径，其目的是最终降低损耗率。
