Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

Citizens’ Juries: When Older Adults Deliberate on the Benefits and Risks of Smart Health and Smart Homes

open access articleBackground: Technology-enabled healthcare or smart health has provided a wealth of products and services to enable older people to monitor and manage their own health conditions at home, thereby maintaining independence, whilst also reducing healthcare costs. However, despite the growing ubiquity of smart health, innovations are often technically driven, and the older user does not often have input into design. The purpose of the current study was to facilitate a debate about the positive and negative perceptions and attitudes towards digital health technologies. Methods: We conducted citizens’ juries to enable a deliberative inquiry into the benefits and risks of smart health technologies and systems. Transcriptions of group discussions were interpreted from a perspective of life-worlds versus systems-worlds. Results: Twenty-three participants of diverse demographics contributed to the debate. Views of older people were felt to be frequently ignored by organisations implementing systems and technologies. Participants demonstrated diverse levels of digital literacy and a range of concerns about misuse of technology. Conclusion: Our interpretation contrasted the life-world of experiences, hopes, and fears with the systems-world of surveillance, e ciencies, and risks. This interpretation o ers new perspectives on involving older people in co-design and governance of smart health and smart homes

The integration of independent national HIV surveillance datasets and application of statistical methods to enhance their public health utility

The aims of this thesis were two-fold. Firstly, to develop a robust method to create a fully integrated, national surveillance dataset for human immunodeficiency virus (HIV) infections by linking records from three independent, national HIV case reporting systems. Secondly, to apply statistical techniques, more commonly used in cohort study research, to the integrated dataset to yield more of the potential from the constituent information and increase the public health utility of the data. This demonstrated that an integrated dataset can reduce missing information in each surveillance system and improve information use by combining different data that was previously available only in separate databases. Using the integrated dataset, I achieved the following: accounted for missing information; described the frequency of CD4 count measurements and associated factors; determined characteristics associated with late diagnosis and consequent mortality; estimated the national incidence of acquired immunodeficiency syndrome (AIDS) and death and the influencing factors; assessed information about the date of starting therapy for each individual; and assessed factors associated with immune defence recovery after the start of treatment. These analyses will be/have been integrated into national surveillance processes as appropriate and used to publish academic papers. Lessons have been learnt for surveillance methodology with regards sharing information and ensuring that data are representative of the whole population. The large size, wide coverage and prospective nature of the integrated dataset mean that national (and local) policy decisions can be based on information that reflects the national picture rather than unrepresentative and time-bound studies. The dataset also has the power to unpick differences within small population groups. For example, evidence about late diagnoses and mortality has been used to promote the need for earlier HIV diagnosis and is updated annually and used to target local needs and to monitor improvements

Perceptions of factors influencing engagement with health and wellbeing apps: a qualitative study using the COM-B model and Theoretical Domains Framework

Objectives. User engagement with health and wellbeing apps is typically poor. Understanding factors that influence engagement can inform the design of more engaging apps. This study explored users’ experiences of and reasons for engaging and not engaging with health and wellbeing apps. / Methods. UK-based adults (N=17) interested in using a health or wellbeing app took part in a semi-structured interview to explore experiences of engaging with these apps. Data were analysed with the framework approach, informed by the Capability, Opportunity, Motivation – Behaviour (COM-B) model and the Theoretical Domains Framework, two widely used frameworks that incorporate a comprehensive set of behavioural influences. / Results. Factors to influence capability included accessible information (e.g. user guidance, statistical and health information), reduced cognitive load, well-designed reminders, self-monitoring features, features that help to establish a routine, features that offer safety netting and stepping-stone app characteristics. Tailoring, peer support and embedded professional support were identified as important factors that enhance users’ opportunities for engagement. Feedback, rewards, encouragement, goal setting, action planning, self-confidence and commitment were judged to be motivation factors that affect engagement. / Conclusion. Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and wellbeing apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load and support self-monitoring (capability), provide embedded social support (opportunity), and goal setting with action planning (motivation)

A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes

Purpose: Older people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training. Design/methodology/approach: Two trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings. Findings: Trainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present. Research limitations/implications: The authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk. Originality/value: This is the first study of learning needs for GP trainees to provide integrated care for older care home residents

Improving community support for older people’s needs through commissioning third sector services: a qualitative study

Aim: This exploratory study of commissioning third sector services for older people aimed to explore whether service data was fed back to commissioners and whether this could improve intelligence about the population and hence inform future commissioning decisions. Background: Third sector services are provided through charities and non-profit community organisations, and services that assess and advise people for self-management or provide wellbeing support in the community have developed over recent years. Third sector services have an opportunity to reach vulnerable populations and to provide intelligence about them. Some third sector services are state funded (commissioned) in the United Kingdom (UK). While evidence is available about the commissioning of statutory health and social care, as well as private providers, there is limited evidence about how third sector health services are funded. Methods: Participants were recruited from commissioner organisations and third sector organisations, both with an interest in supporting the independence, self-management and wellbeing of older people. Organisations were recruited from five purposively selected sites within one region of England (East Midlands). Semi-structured interviews explored the relationships between commissioners and providers and the nature of funding arrangements, including co-production. Interviews also explored collection of data within the service and how data was fed back to commissioners. Focus groups were held with older people with the potential to benefit from wellbeing services.Results: Commissioning arrangements were varied, sometimes complex, and often involved co-production with the third sector. Commissioners valued third sector organisations for their engagement with the local community, value for money, outreach services and ability to provide information about the community. Assessing the needs and outcomes of individuals was integral to delivery of support and advice to older people. Diverse approaches were used to assess an individual’s needs and outcomes, although there were concerns that some assessment questionnaires may be too complex for this vulnerable group. Assessment and outcomes data were also used to monitor the service contract and there was potential for the data to be summarised to inform commissioning strategies, but commissioners did not report using assessment data in this way. While the policy context encouraged partnerships with third sector organisations and their involvement in decision-making, the relationship with third sector organisations was not valued within contract arrangements, and may have been made more difficult by the tendering process and the lack of analysis of service data.Conclusion: This exploratory study has demonstrated a diversity of commissioning arrangements for third sector services across one region of England. Most commissioners invited co-production; that is, the commissioners sought input from the third sector while specifying details of the service. Service data, including assessments of needs and outcomes, were reported to commissioners, however commissioners did not appear to use this to full advantage to inform future commissioning decisions. This may indicate a need to improve measurement of needs and outcomes in order to improve the credibility of commissioning process

Loss to Follow-Up Among Adults Attending Human Immunodeficiency Virus Services in England, Wales, and Northern Ireland

AIM: To assess the extent to which human immunodeficiency virus (HIV)-diagnosed adults attending HIV-services in England, Wales, and Northern Ireland are lost to follow-up or attend services intermittently. METHODS: A cohort of HIV-diagnosed adults was created by linking records across the 1998 to 2007 national annual Survey of Prevalent HIV Infections Diagnosed. The records were also linked to the national HIV and acquired immune deficiency syndrome New Diagnoses Database (n = 61,495) and to Office for National Statistics death records. Patterns of HIV-service attendance were analyzed. RESULTS: On average, 90% of adults attending HIV-services in any one year attended the following year. Nearly 5% of adults attending services in any one year were lost to follow-up, a further 4% subsequently attended services intermittently, whereas less than 2% died. Cumulatively, 19% of adults seen for HIV care between 1998 and 2006 were lost to follow-up by the end of 2007. Factors associated with loss to follow-up included being the following: female; aged 15 to 34 years; black-African or "other" ethnicity; not on antiretroviral therapy; recently diagnosed; and infected outside the United Kingdom. CONCLUSIONS: Although the majority of HIV-diagnosed adults in England, Wales, and Northern Ireland attended HIV-services regularly, cumulatively nearly 1 in 5 adults were lost to follow-up between 1998 and 2007. Innovative strategies focusing on those most likely to drop out of regular care should be developed to maintain regular service engagement and to ensure optimal care