BACKGROUND
Following the need for prevention of non-communicable diseases, mobile health (mHealth) apps are increasingly used for promoting lifestyle behavior changes. While mHealth apps have the potential to reach all population segments, providing accessible and personalized services, their effectiveness is often limited by low participant engagement and high attrition rates.
OBJECTIVE
This paper concerns a large-scale, open access mHealth app, based in the Netherlands, focusing on improving the lifestyle behaviors of its participants. This study examines whether periodic email prompts increase participant engagement with the mHealth app, and how this effect evolves over time. Points gained from activities in the app are used as an objective measure of participant engagement with the program. The activities considered are physical workouts tracked through the mHealth app, and interactions with the virtual coach.
METHODS
The data analyzed covers 22,797 unique participants over a period of 78 weeks. A Hidden Markov model (HMM) is employed for disentangling the over-time effects of periodic email prompts on participant engagement with the mHealth app. The HMM accounts for transitions between latent activity states, which generate the observed measure of points received in a week.
RESULTS
The HMM indicates that, on average, 70% (15,958/22,797) of the participants are in the inactivity state – gaining zero points in total per week, 18% (4,103/22,797) of the participants are in the average activity state – gaining 27 points per week, and 12% (2,736/22,797) of the participants are in the high activity state – gaining 182 points per week. Receiving and opening a generic email is associated with a 3 percentage points increase in the likelihood of becoming active in that week, compared to the weeks when no email is received. Examining detailed email categories reveals that participants are more likely to increase their activity level following emails that are in line with the program goal, such as health campaigns, while being resistant to emails that deviate from the program’s goal, such as special deals.
CONCLUSIONS
Participant engagement with a behavior change mHealth app can be positively influenced by email prompts, albeit to a limited extent. Given the relatively low costs associated with emails and the high population-reach that mHealth apps can achieve, such instruments can be a cost-effective means of increasing participant engagement in the stride towards improving program effectiveness.
CLINICALTRIAL