Electronic Thesis and Dissertation Repository

Thesis Format

Alternative Format

Degree

Master of Science

Program

Kinesiology

Supervisor

Mitchell, Marc

2nd Supervisor

NA

3rd Supervisor

NA

Abstract

BACKGROUND: Mobile health application (mHealth app) effectiveness may be limited by low engagement. Increasing understanding of factors influencing engagement may help. mHealth app subscription and renewal are two metrics of interest to commercial app publishers. PURPOSE: To identify homogenous user subgroups (i.e., behavioural phenotypes) within a paid mHealth app context and examine associations with subscription and renewal. METHODS: A 6-month latent class analysis (LCA) study was conducted with new users of the WayBetter app, a subscription-based mHealth app with financial incentives. Users completing a 7-day free trial between November 2, 2023 and January 3, 2024 were included. LCA produced phenotypes using (1) purpose-built survey responses (e.g., socio-demographics, previous health behaviours, personality traits), (2) device-assessed health data (e.g., daily step count), and (3) 7-day trial period engagement data (e.g., number of app opens). Odds ratios (OR; pRESULTS: The total sample included 934 users (2[SD]=42.00 [9.65] years; % women= 91.10%). Based on key LCA fit indices (e.g., Vuong-Lo-Mendell-Rubin likelihood test=467.16, p=0.032), and theoretical interpretability, five distinct phenotypes were formed: (1) Highly Engaged Subscribers, (2) Subscribers with Multimorbidity, (3) Healthy Subscribers, (4) Non-subscribers with Multimorbidity, and (5) Healthy Non-Subscribers. Phenotypes 1, 2, and 3 had greater odds of subscribing (OR= 21.31, [8.56,53.06]; OR=7.11, [4.04,12.50]; OR=8.28, [4.26,16.08], respectively) than phenotype 4 (OR=0.82, [0.48,1.41]), compared to phenotype 5, the reference. As well, the odds phenotypes 1, 2, 3 and 4 renewed were OR=1.06, [0.62,1.81]; OR=0.900, [0.54,1.49]; OR=0.99, [1.0,1.8], OR=0.5, [0.3,0.7], respectively (compared to the reference class phenotype 5). CONCLUSION: Behavioural phenotypes likely or not to subscribe were identified using data collected during the 7-day free trial period. These may be targeted with future intervention.

Summary for Lay Audience

Mobile health applications (mHealth apps) used to promote healthy behaviours (e.g., physical activity, healthier eating, mindfulness) are increasing in popularity. However, for these apps to be effective, users must remain engaged long enough for sustained, health promoting lifestyle behaviour changes to occur. In partnership with WayBetter Inc., creators of a lifestyle modification mHealth app leveraging deposit contract-based financial incentives, this study aimed to identify subgroups of app users likely to subscribe ($69.99 USD for six months) and renew ($69.99 USD). New WayBetter app users were invited to complete a survey to collect socio-demographic, psychological, and past health behaviour information. Baseline daily step count and body weight, along with early engagement metrics (i.e., app opens) were also collected during a 7-day free trial period. Data were used to group individuals with similar characteristics, including app engagement patterns, together. Five distinct user subgroups were formed from a total of 934 included app users. Two of these were at-risk of low engagement and not subscribing after the 7-day free trial. Study findings may be used to inform future interventions targeting at-risk users, ultimately boosting app engagement and sustained, health promoting lifestyle behaviours.

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