Theoretical Factors Associated with Real-time Use of an mHealth App Designed for HIV Self-management Open Access

Abstract

Background: Despite the ubiquity of mobile health (mHealth) apps, mobile phone users infrequently integrate them into their daily lives. Few empirical studies shed light on theoretical factors contributing to this lack of sustained interest.

Purpose: Guided by the modified Unified Theory of Acceptance and Use of Technology (UTAUT2), this secondary analysis of data from the Music for Health Project (MFHP) evaluated theoretical factors associated with the acceptance and adoption of a smartphone intervention app (iApp). The MFHP is an NIH/NINR-funded randomized control trial designed to test the efficacy of the iApp on antiretroviral therapy adherence and symptom/side effect selfmanagement among rurally dwelling HIV-infected individuals.

Methods: The results of UTAUT2, smartphone experience (SPexp), and electronic health (eHealth) literacy surveys were compared with iApp usage among 34 MFHP participants in the first 100 days of the study. The SPexp survey was administered at baseline and measured how frequently common smartphone tasks were performed in the past three months. The other surveys were administered at baseline and three months. These measured UTAUT2 constructs (behavioral intention, effort expectancy, hedonic motivation, and performance expectancy) and eHealth literacy (confidence finding/using Internet-based health information). Usage metrics included frequency of iApp openings and duration of time spent in the app.

Findings: At baseline and three months, most scored at or near the highest attainable in all surveys. UTAUT2 subscales, eHealth literacy, and SPexp were positively intercorrelated with each other (all p ≤ .05) but not with frequency or duration of iApp usage. Younger participants scored the highest in the UTAUT2 survey, indicating the most intent to adopt mHealth apps and reporting stronger beliefs that mHealth apps could be easy to use, enjoyable, and helpful to maintain health (all p < .025). Forty-one percent did not open the iApp - these were typically newly diagnosed with HIV less than six months prior to entering the MFHP (p < .025). Among those who opened the app, frequency and duration of use peaked in the first four weeks, then declined to almost zero over the next eleven weeks.

Discussion: Findings suggest that MFHP participants' intention to adopt mHealth does not necessarily translate into initial or sustained action. Moreover, a "one-app-fits-all" approach might not be the most effective way to improve disease self-management equally among all HIV-positive patients. Newly diagnosed individuals may require a different mHealth approach to foster engagement-in-care and facilitate effective self-management behavior

Table of Contents

CHAPTER ONE: INTRODUCTION 1

Statement of the Problem2

Purpose of the Study5

Theoretical Framework8

CHAPER TWO: LITERATURE REVIEW12

UTAUT2 Overview12

Behavioral Outcomes 18

Behavioral Intention18

Technology Usage21

Behavioral Intention Antecedents24

Performance Expectancy24

Effort Expectancy26

Hedonic Motivation28

Moderating Influences29

eHealth Literacy29

Technology Experience32

Conclusion34

CHAPTER THREE: METHODS36

Overview36

Music for Health Project36

Setting38

Study Sample39

Procedure40

Recruitment40

Screening, Baseline, and Follow-up41

Research Instruments42

Data Management47

Data Analysis48

CHAPTER FOUR: RESULTS53

Baseline Survey Reliability53

Sample Characteristics55

Participant Demographics56

Survey and Metric Results60

RQ 1: Association of BI Antecedents with BI 72

RQ 2 and 3: Association of BI with Frequency/Duration of iApp Access73

RQ 4: Moderating Effects of eHealth Literacy and Smartphone Experience79

CHAPTER FIVE: DISCUSSION82

Sample Characteristics83

iApp Utilization85

UTAUT2 and iApp Use90

Moderating Factors in the UTAUT2 Framework92

Study Strengths95

Study Limitations96

Future Directions98

Implications99

References101

Appendixes120

Appendix A. Venkatesh Permission to Use UTAUT2 120

Appendix B. Norman Permission to Use eHEALS 121

Appendix C. Venkatesh Permission to Modify UTAUT2 122

Appendix D. UTAUT2 Survey123

Appendix E. eHealth Literacy Scale (eHEALS) 124

Appendix F. Smartphone Experience Questionnaire (SPexp) 125

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Psychology, Behavioral Health Sciences, Nursing
Keyword	Digital health Behavioral health Health information technology Technology acceptance theory mHealth
Committee Chair / Thesis Advisor	Holstad, Marcia McDonnell, Emory University
Committee Members	Himelhoch, Seth, University of Maryland Higgins, Melinda K, Emory University Waldrop-Valverde, Drenna , Emory University

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