Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Ann Behav Med. 2021 Nov 18;55(12):1220-1230. doi: 10.1093/abm/kaab008.
Despite the promise of mobile health (mHealth), engagement is often too low for durable health behavior change, and little is known regarding why certain individuals abandon mHealth tools.
Guided by a mHealth engagement framework, we evaluated contextual predictors of objective engagement with an app for adolescents and young adults (AYA) who survived cancer.
One hundred and ten AYA survivors (M age = 20.5, 43% female, 30% racial/ethnic minority) were randomized to receive a disease self-management app that delivered 1-2 tailored messages/day for 16 weeks, and contained a survivorship care plan (SCP). Demographic, disease, psychosocial, and setting characteristics were examined as predictors of three objective engagement outcomes: (a) % of active app days, (b) % of messages read, and (c) viewed SCP in the app versus not. A subsample (n = 10) completed qualitative interviews to further assess engagement barriers.
Self-reported uninterrupted app access (β = -0.56, p < .001), iPhone (vs. Android) ownership (β = 0.30, p < .001), and receiving the intervention in the summer (β = -0.20, p = .01) predicted more active days. Lower depressed mood (β = -0.30, p = .047) and uninterrupted app access (β = -0.50, p < .001) predicted more messages read. Qualitatively, technical glitches and competing priorities were described as engagement barriers, whereas certain types of messages (e.g., health goal messages) were perceived as engaging. Among participants who had uninterrupted app access (n = 76), higher baseline motivation to change, better health perceptions, using the app during the summer, and iPhone ownership predicted higher engagement.
Findings demonstrate the importance of comprehensively assessing and planning for multi-level ecological determinants of mHealth engagement in future trials.
CLINICALTRIALS.GOV IDENTIFIER: NCT03363711.
尽管移动医疗（mHealth）前景广阔，但参与度往往难以持久，难以实现健康行为的改变，而且人们对于为什么某些人会放弃 mHealth 工具知之甚少。
本研究以 mHealth 参与框架为指导，评估了青少年和年轻成人（AYA）癌症幸存者对应用程序客观参与的情境预测因素。
110 名 AYA 幸存者（M 年龄=20.5 岁，43%为女性，30%为少数族裔）被随机分为两组，分别接受疾病自我管理应用程序，该应用程序每天发送 1-2 条个性化消息，持续 16 周，并包含生存护理计划（SCP）。评估人口统计学、疾病、心理社会和环境特征作为三个客观参与结果的预测因素：（a）活跃应用天数的百分比，（b）阅读消息的百分比，以及（c）在应用程序中查看 SCP 与未查看的百分比。一个子样本（n=10）完成了定性访谈，以进一步评估参与障碍。
自我报告的无中断应用程序访问（β=-0.56，p<.001）、拥有 iPhone（vs. Android）（β=0.30，p<.001）和在夏季接受干预（β=-0.20，p=0.01）预测了更多的活跃天数。较低的抑郁情绪（β=-0.30，p=0.047）和无中断的应用程序访问（β=-0.50，p<.001）预测了更多的消息阅读。定性研究表明，技术故障和竞争优先级被描述为参与障碍，而某些类型的消息（例如，健康目标消息）则被认为具有吸引力。在有持续应用程序访问的参与者中（n=76），较高的基线改变动机、较好的健康感知、夏季使用应用程序和拥有 iPhone 预测了更高的参与度。
研究结果表明，在未来的试验中，全面评估和规划 mHealth 参与的多层次生态决定因素非常重要。
临床试验.gov 标识符：NCT03363711。
