JMIR Publications

ABSTRACT

Background:

With one in three adults globally living with chronic conditions and the rise in smartphone ownership, mobile health apps have become a prominent tool for managing lifestyle-related health behaviors and mental health. However, high rates of app abandonment pose challenges to their effectiveness.

Objective:

This study aimed to explore the real-world abandonment of health apps used for managing physical activity, diet, alcohol, smoking, and mental health, examining the duration of app use before abandonment and identifying the reasons behind this phenomenon.

Methods:

A scoping review was designed, based on the PRISMA-ScR guidelines and SPIDER framework. Four online databases were searched (Medline, Scopus, Embase and PsycINFO) to identify quantitative and qualitative studies with outcome measures related to app abandonment in adults in free-living conditions, including reasons for abandonment and duration of use, for mobile health apps related to WHO modifiable health behaviors and mental health. The included studies’ risk of bias was appraised based on the STROBE and COREQ checklists. To enable data synthesis across different methodologies, categories were formed to describe app domains, demographic data, and outcome measures. Results were presented in two sections, quantitatively in a scatterplot to understand when users abandon apps and qualitatively through inductive thematic analysis to identify the reasons behind app abandonment.

Results:

A total of 18 eligible studies were identified, published between 2014 and 2022, predominantly from the US, Canada, the UK and Germany. These studies involved a total sample size of 525,824 participants. Findings revealed a curvilinear pattern of app abandonment, with sharper abandonment soon after acquisition, followed by a slowing rate of abandonment over time. Taken together, a median of 70% of users discontinued use within the first 100 days. The abandonment rate appeared to vary by app domain, with apps focusing on alcohol and smoking exhibiting faster abandonment, and physical activity and mental health exhibiting longer usage durations. Twenty-two unique reasons for abandonment emerged, categorized into six themes: technical and functional issues, privacy concerns, poor user experience, content and features, time and financial costs, and evolving user needs and goals.

Conclusions:

The study highlights the need for improved user experience, with a particular focus on onboarding processes, personalization, and potential for healthcare integration in app development. It underscores the importance of designing apps to cater to specific health behaviors and the necessity for strategic investment in app development. The findings also emphasize the need for longitudinal studies and a consistent definition of app abandonment to optimize the health benefits of these digital tools.