A systematic review of factors affecting adherence to mHealth apps

Mobile health (mHealth) apps have the potential to support patients and health care systems in mitigating the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, a substantial proportion of users do not adhere to them as intended for one reason or another, and may consequently not receive effective treatment.

A team of researchers from ETH Zurich, the University of St. Gallen, Zurich University, National University of Singapore and Prof. Elgar Fleisch, Dr Jacqueline Louise Mair, Dr Alicia Salamanca-Sanabria and Asst Prof. Tobias Kowatsch, set out to investigate the factors influence or deter adherence. The study would address fundamental concerns in mHealth apps: preventing intervention dropouts and increasing the effectiveness of digital health interventions.

After a comprehensive literature search, the team identified four key intervention-related factors that supported on adherence across all health domains: personalising the content of mHealth apps to the individual needs of the user, the use of individualised push notifications as reminders, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Other features that drove adherence included social and gamification features, and patient-related factors, like user characteristics or recruitment channels.

This study contributes scientific evidence on factors that positively or negatively influence adherence to mHealth apps, and is the first to quantitatively compare adherence relative to the intended use of various health domains. Research on factors influencing adherence to mHealth apps is still limited, however. Thus, the study calls on developers to clearly outline and justify the mHealth app’s intended use, report objective data on actual use relative to the intended use, and, ideally, provide long-term use and retention data.