JMIR Publications

ABSTRACT

Background:

Despite most adolescents having access to smartphones, few of them seem to use mobile health (mHealth) applications for health improvement, highlighting the apparent lack of interest in mHealth applications among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates, where attrition is often measured at two time points. Research on these interventions among adolescents have frequently lacked detailed time related attrition data alongside analysis of attrition reasons through usage.

Objective:

The objective was to obtain daily attrition rates among adolescents in an mHealth intervention and gain a deeper understanding of attrition patterns and reasons along and motivational support, such as altruistic rewards, through analysis of application usage data.

Methods:

A randomized controlled trial was conducted with 304 adolescent participants (m:f ratio 152:152) from 13 to 15 years of age. Based on three participating schools, participants were randomly assigned to control, treatment-as-usual (TAU) and intervention groups where measures were obtained at baseline, continuously throughout the 42 days trial period and end of trial while control group only partook baseline and study-end measures. Primary measures were attrition based on time from launch as well as type, frequency and time of in-app health behaviour usage. Outcome differences were obtained through comparison tests while regression models and survival analysis were used for attrition measures. The mHealth application is called SidekickHealth and is a social health game with three main categories; nutrition, mental- and physical health.

Results:

Attrition significantly differed between research groups; intervention group (44.4%) and treatment-as-usual (TAU) group (94.3%); x2(1)= 61.220, P.01. Mean days of usage were 6.286 in TAU group and 24.975 days in intervention group. Male participants in the intervention group were active significantly longer (29.155 days) compared to female participants (20.433 days). Participants in the intervention group completed a significantly larger number of health exercises in all trial weeks and a significant decrease in usage was observed in the TAU group (12.347, SD 13.803) from 1st to 2nd (t105=9.208, P.001) but not in the intervention group. Results showed a significant mean increase (M=22.904, SD=71.721) in health exercises in the intervention group from 5th to 6th week of the trial; t105=3.446, P.001. Such significant increase in usage was not evident in the TAU group. Research group was significantly related to time of attrition (hazard ratio 0.308, 95% CI .222-.420) as well as number of mental health exercises (P.001) and nutrition exercises (P.001) in both research groups.

Conclusions:

Differences in attrition rates and usage between groups of adolescents were obtained. Motivational support seems to be a significant factor in lowering attrition in adolescent mHealth interventions. Results point to sensitivity periods in completion of diverse health tasks and emphasis on time-specific attrition along with time, type and frequency of health behaviour are likely fruitful avenues for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive.