JMIR Publications

ABSTRACT

Background:

Interest in mHealth, or the use of mobile computing and communication technologies in health care, public health and personal wellness, has increased significantly over the last decade. Initial research suggests that mHealth devices can enhance end-user engagement, especially when used in conjunction with relevant brief message content.

Objective:

The objective of this research was to explore a ‘stages of engagement’ framework for mHealth devices and develop a person-centered method to generate relevant brief message content to promote sustained user engagement. This paper used the O’Brien and Toms’ (2008) framework as a departure point, where engagement is defined as the uptake or use of an mHealth device. The framework is a linear process of stages, including ‘point of engagement’, ‘period of engagement’, ‘disengagement’ and ‘re-engagement’, with each stage characterized by attributes that relate to a person’s technology experience. While extant literature identified stages of engagement for health-related technology, few papers specifically explore mHealth engagement or seek to deepen the understanding of engagement stages and attributes. Additionally, little research has determined a method for creating brief message content specifically for mHealth at each stage in this engagement journey. This research brings together these two areas addressing this gap by answering the question; ‘How can knowledge about users’ mHealth device engagement stages inform the development of brief message content intended to promote sustained user engagement?’

Methods:

Interviews and observations from 19 participants who used mHealth technologies (apps, devices or wellness websites) in a solo capacity were recruited for Sample Group 1. Sample Group 2 used interviews and observations from 25 participants engaged with mHealth technologies in a group capacity through the Global Corporate Challenge (GCC). These samples were investigated at three time points in both research contexts. The results underwent theme and content analysis for the engagement stages’ framework and attributes.

Results:

In addition to the four stages identified by O’Brien and Toms (2008) two additional stages of engagement, self-management and limited engagement, were identified. ‘Self-management’ refers to a stage where users had completely disengaged from their technology, however, were still engaged with their health activity. ‘Limited engagement’ refers to when group mHealth users had minimal interaction with their mHealth technology but continued to engage in a group fitness activity. The results revealed that mHealth engagement stages were non-linear and that each stage was characterized by a combination of 49 attributes that could be organized into eight themes. Themes documented the total user experience and included usability, technology features, technology aesthetics, use motivations, health awareness, goal setting, social support and interruptions, situated at the intersection of health, business studies and information systems literature. Lastly, different themes were found to have more relevance at different engagement stages. Knowing which set of themes and attributes are relevant at any engagement stage allows technology developers and healthcare professionals to generate relevant brief message content informed by a person-centered approach.

Conclusions:

This research extends an existing engagement stages framework and identified attributes and themes relevant to mHealth technology users’ total user experience incorporating concepts derived from health, business studies and information systems literature. Additionally, we also offer a practical a five-step process based on a person-centered approach, to develop mHealth technology brief message content for sustained engagement.