Background Physical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research.
BACKGROUND Physical inactivity is a global issue that impacts the health and productivity of a large number of people. With the advancement of mobile and wearable technologies, many applications and devices have been developed to facilitate self-health management and promote a healthy lifestyle. However, little research has examined the effectiveness of these mobile health applications (mHealth apps) to motivate exercise adherence. OBJECTIVE The purpose of this study is to improve the design of mHealth apps for exercise self-management by tailoring the message content and use tactics. Specifically, we 1) investigate whether sending motivational messages can improve adherence to exercise plans; 2) consider whether the motivational effect is impacted by personality; 3) test the impact of message type (logical vs. emotional) and repetition; 4) investigate the interaction effect between message type, repetition, and personality type; and 5) explore the possibility of involving a behavior experiment in the design process and learning new design principles from the results. METHODS We proposed an enhanced action design research process by incorporating a behavior experiment into the process. Based on problem framing and theoretical premises, we used Apple’s ResearchKit to develop the initial artifact (i.e. the mHealth app). The app was available for anyone to download from the Apple store. We also recruited participants through a gym, where many members were participating in weight loss programs. We then conducted a field behavior experiment, targeting the users who had used the app for at least 2 months. All user inputs and usage patterns were recorded in the online database for analysis, through which we understood how users interact with the app, and we were thus able to verify, correct, and enhance the design principles of the mHealth app. RESULTS There were 160 users who downloaded the app during the 2-month period; after excluding users who stopped using the application in the middle of the process, 89 participants remained. The results of the experimental study suggest that people with a feeling personality type are more likely to adhere to self-defined exercise plans than people with a thinking personality type. Emotional messages are more effective in motivating exercise adherence than logical messages. With repeated reminders, the adherence rates of people with a thinking personality type are significantly improved. CONCLUSIONS This study contributes to the research area of mHealth apps. The principles learned from this study can be applied to make mHealth apps more effective. By incorporating a behavior experiment into the action design research process, we demonstrate the benefit of combining design science and behavior experiments. The application design can be considered a foundation to develop more advanced applications for specific diseases, such as diabetes and asthma for future research.
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