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Assessing user engagement of an mHealth intervention: development and implementation of the growing healthy app engagement index

Taki, Sarah, Lymer, Sharyn, Russell, Catherine, Campbell, Karen, Laws, Rachel, Ong, Kok-Leong, Elliott, Rosalind and Denney-Wilson, Elizabeth 2017, Assessing user engagement of an mHealth intervention: development and implementation of the growing healthy app engagement index, JMIR mHealth uHealth, vol. 5, no. 6, doi: 10.2196/mhealth.7236.

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Title Assessing user engagement of an mHealth intervention: development and implementation of the growing healthy app engagement index
Author(s) Taki, Sarah
Lymer, Sharyn
Russell, CatherineORCID iD for Russell, Catherine orcid.org/0000-0002-0848-2724
Campbell, KarenORCID iD for Campbell, Karen orcid.org/0000-0002-4499-3396
Laws, RachelORCID iD for Laws, Rachel orcid.org/0000-0003-4328-1116
Ong, Kok-Leong
Elliott, Rosalind
Denney-Wilson, Elizabeth
Journal name JMIR mHealth uHealth
Volume number 5
Issue number 6
Article ID e89
Total pages 14
Publisher JMIR Publications
Place of publication Toronto, Ont.
Publication date 2017-06
ISSN 2291-5222
Keyword(s) children
infant development
infant obesity
infants
mHealth
practitioners
primary healthcare
social medium
Summary Background: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics.

Objective: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement.

Methods: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth.
Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models.

Results:
The overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including “app only” users or “both” app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005).

Conclusions: The EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions.
Language eng
DOI 10.2196/mhealth.7236
Field of Research 111799 Public Health and Health Services not elsewhere classified
Socio Economic Objective 920499 Public Health (excl. Specific Population Health) not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, Sarah Taki, Sharyn Lymer, Catherine Georgina Russell, Karen Campbell, Rachel Laws, Kok-Leong Ong, Rosalind Elliott, Elizabeth Denney-Wilson
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30097751

Document type: Journal Article
Collections: School of Exercise and Nutrition Sciences
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.