Do Daily Fluctuations in Psychological and App-Related Variables Predict Engagement With an Alcohol Reduction App? A Series of N-Of-1 Studies

Perski, Olga; Naughton, Felix; Garnett, Claire; Blandford, Ann; Beard, Emma; West, Robert; Michie, Susan

doi:10.2196/14098

Cited by 19 publications

(13 citation statements)

References 55 publications

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“…Some factors might influence both uptake and engagement; for example, our research suggests that the perceived utility of an app is one of the main factors for uptake. However, a previous study found that perceived utility was a predictor of engagement with an alcohol reduction app [ 43 ]. Therefore, where possible, uptake and engagement should be considered together as 2 linked constructs.…”

Section: Discussionmentioning

confidence: 99%

Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study

Szinay¹,

Perski²,

Jones³

et al. 2021

JMIR Mhealth Uhealth

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Background Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people’s experiences of them. Objective The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. Methods A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. Results Searching for health and well-being apps on the internet was described as a minefield . App uptake appeared to be influenced by participants’ capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual’s needs. Conclusions The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations.

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Section: Discussionmentioning

confidence: 99%

Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study

Szinay¹,

Perski²,

Jones³

et al. 2021

JMIR Mhealth Uhealth

Self Cite

View full text Add to dashboard Cite

show abstract

“…Previous research has found that notifications are important components that influence engagement with behavior change apps [ 60 - 62 ]. This includes an ecological momentary assessment study with Drink Less , which found that establishing a daily routine is important for maintaining engagement and that the daily push notification supports such routines [ 63 ]. This study also found that time-varying, endogenous factors of motivation and perceived usefulness of the app were the most consistent predictors of engagement.…”

Section: Discussionmentioning

confidence: 99%

Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study

Bell¹,

Garnett²,

Qian³

et al. 2020

J Med Internet Res

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Background Behavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich. Objective This study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom. Methods We explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the sample if they were from the United Kingdom; were 18 years or older; were interested in reducing their alcohol consumption; had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking; and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots. Results The daily 11 AM notification is strongly associated with a change in engagement in the following hour; reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download; identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users); and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings. Conclusions Visualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of individuals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT.

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“…The study will determine whether sending a notification at 8 pm increases engagement in the subsequent hour with Drink Less and whether the impact of the notification changes over time. Previous research has found that the perceived usefulness of the app is a predictor of both the amount and frequency of engagement with Drink Less [ 20 ]. Building on these findings, secondary analyses will systematically explore if messages which aim to increase the perceived usefulness of the app by encouraging users to try out various modules are more effective at increasing engagement than the standard request to record drinking and mood diary entries.…”

Section: Discussionmentioning

confidence: 99%

“…The behavioral aspect of engagement can be objectively measured through app use data. The effectiveness of a behavior change app can be moderated by a user’s engagement with the intervention’s active ingredients, and engagement fluctuates within and across users over time [ 20 , 21 ]. A push notification is a message that pops up on the phone, and may also vibrate, make a sound, or lock the screen to gain the user’s attention.…”

Section: Introductionmentioning

confidence: 99%

“…An Ecological Momentary Assessment study with Drink Less users found that establishing a daily routine is important for maintaining engagement and that the daily notification supports such routines [ 20 ]. This study also found that perceived usefulness of the app (the belief that using the app will help the user to achieve their goal(s) and an indicator of users’ reflective motivation to engage) was associated with increased engagement for some users.…”

Section: Introductionmentioning

confidence: 99%

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Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial

Bell¹,

Garnett²,

Qian³

et al. 2020

JMIR Res Protoc

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Background Drink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to “Please complete your mood and drinking diaries.” Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user’s perceived usefulness of the app. Objective The primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. Methods This is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of “Did the user open the app in the hour from 8 pm to 9 pm?”. The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. Results Approval was granted by the University College of London’s Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. Conclusions Understanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. International Registered Report Identifier (IRRID) DERR1-10.2196/18690

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Do Daily Fluctuations in Psychological and App-Related Variables Predict Engagement With an Alcohol Reduction App? A Series of N-Of-1 Studies

Cited by 19 publications

References 55 publications

Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study

Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study

Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study

Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial

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