JMIR Publications

ABSTRACT

Background:

Physical inactivity and poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases including diabetes. Mobile Health applications (mHealth apps) can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity (PWO), and electronic health (eHealth) literacy skills have the potential to impact mHealth app use.

Objective:

The purpose of this study was to explore the associations between the two dimensions -access and application - of eHealth literacy skills and mHealth app use among U.S. adults (≥18 years) with obesity (body mass index, BMI ≥ 30 kg/m2)

Methods:

Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1,079 respondents met the inclusion criteria of adults with obesity and owner of a smartphone. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and t-tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios of using mHealth apps with corresponding 95% confidence intervals were reported across multiple sociodemographic variables. An Ising model weighted network visualization was produced. A receiver operating characteristic curve was calculated and the area under the curve was reported with corresponding Delong 95% confidence interval.

Results:

A majority of respondents were female (59.59%) or non-Hispanic white (58.83%). Individuals in households earning less than $50,000 comprised 41.39% of the sample. All sociodemographic variables were found to be univariately significant at the 5% level except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a Doctor/Doctor's office, respectively. Several sociodemographic variables were found significant, such as education where adjusted odds ratios comparing sub-groups to the lowest educational attainment were substantial (ORs≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees.

Conclusions:

This work provides an initial understanding of mHealth app use and eHealth literacy skills among PWO, identifying PWO subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for PWO (as well as other groups) and their use of mHealth apps.