Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration (Preprint)

Abstract

Background: New mobile health (mHealth) apps are emerging, and are providing the foundation to radically transform the practice and reach of medical research and care. For the purpose of this study we collaborated with Quit Genius (QG), a cognitive behavioral therapy (CBT) based mHealth app that helps users quit smoking, to explore the effective design of a digital mHealth app; one that delivers important benefits to its users and helps them change their behaviors for a healthier lifestyle. Objective: The specific aims of this study were to (1) explore the key app elements that deliver significant benefits to users, (2) explore the effectiveness of these app elements to help users quit smoking, and (3) identify and describe any potential drivers and hindrances arising from the app design elements. Methods: We developed an online survey and sent an email invitation to 4,144 individuals, who had previously or were at the time using the QG mHealth app, to encourage participation in the study. We matched the online survey data with objective app usage data of the study participants. Results: A dataset of 190 completed responses was used. At the time of the survey, respondents had completed an average of 60% of the CBT program in the QG mHealth app. 36% of the respondents noted to have quit smoking successfully after using the QG app. As for those remaining smokers after using the app, the number of cigarettes smoked per day was significantly reduced by 59.6%. The app's ability to enhance users' psychological well-being and psychologically empower them in their daily lives was identified as being key in helping users quit smoking. Specifically, the results show that users whose well-being was enhanced through the app were 1.72 times more likely to quit smoking successfully. Moreover, a one-unit increase on a 7-point Likert scale in the app's ability to empower smokers in their daily lives led to a reduction of cigarettes smoked per day of 53%. The app's inspiration to users, however, was negatively associated with quitting success and the reduction in cigarette smoked per day. Conclusions: The findings offer important insights for the design of digital mHealth apps. Specifically, we find that perceived psychological empowerment and enhanced well-being from the mobile solution may be a more impactful way to support the effectiveness of mobile cognitive behavioral therapy for smoking cessation than eliciting inspiration.