JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) interventions may help adolescents in adopting a healthy lifestyle. However, attrition in these interventions is high. Overall, there is a lack of research on non-usage attrition in adolescents, in particular on the role of socioeconomic status (SES).

Objective:

This study focused on the role of SES in three research questions: (1) when do adolescents stop using an mHealth intervention (RQ1), (2) which reasons do they report for non-usage attrition (RQ2) and (3) which intervention components (i.e. self-regulation component, narrative and chatbot) prevent adolescents from non-usage attrition (RQ3).

Methods:

A total of 186 Flemish adolescents (12-15 years) participated in a 12-week mHealth intervention. Log data were monitored to measure 1) non-usage attrition and 2) usage duration in the three intervention components. An online questionnaire was administered to assess reasons for attrition. Survival analysis was used to estimate the time to attrition (RQ1). Descriptive statistics were performed to map the reasons for attrition and Fisher’s exact tests were used to determine if these attrition reasons differed depending on educational track (RQ2). Mixed effects cox proportional hazard regression models with clusters (i.e. classes) as a random factor were used to identify whether the usage duration of the three components during the first week could predict attrition (RQ3).

Results:

After 12 weeks, 95.7% of participants had stopped using the app. Thirty percent only opened the app on the installation day and 44.1% stopped using the app in the first week. Attrition at any given time during the intervention period was significantly higher for adolescents from the non-academic educational track compared to the academic track. The other SES-indicators (family affluence and perceived financial situation) did not explain attrition. Most common reasons for non-usage attrition were the perception that the app did not lead to behavior change, not liking the app, thinking they already had a sufficiently healthy lifestyle, using other apps and not being motivated by their environment. There were no statistically significant differences between the attrition reasons depending on educational track. More time spent in the self-regulation and narrative component during the first week was associated with lower attrition, whereas chatbot use duration during the first week was not associated with attrition rates. The effect of usage duration in the three components during the first week on attrition was not significantly different according to SES.

Conclusions:

Non-usage attrition was high, especially for adolescents of the non-academic educational track. The reported reasons for attrition were diverse, with no statistical differences according to educational level. Duration usage of the self-regulation and narrative component during the first week may prevent attrition for both educational tracks. Clinical Trial: The study is registered as a clinical trial (Clinicaltrials.gov NCT04719858).