Theoretical Factors Associated with Real-time Use of an mHealth App Designed for HIV Self-management 公开
Baumann, Maya (2017)
Published
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
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