Freek Van Baelen

Background: The last decade has seen a considerable increase in the number of mobile health (mHealth) apps in everyday life. These mHealth apps have the potential to significantly improve the well-being of chronically ill patients. However, behavioral engagement with mHealth apps remains low. Objective: The aim of this study was to describe the behavioral engagement of chronically ill patients with mHealth apps by investigating (1) how it is affected by social factors (ie, physician recommendation) and app-related factors (ie, app integration) and (2) how it affects patient well-being. This study also considers the moderating effect of attachment to traditional health care and the mobile app experience among patients. Methods: We carried out a scenario-based survey study of chronically ill patients (N=521). A Bayesian structural equation modeling with mediation and moderation analysis was conducted in MPlus. Results: Both physician recommendations for mHealth app use and app integration have positive effects on the behavioral engagement of chronically ill patients with mHealth apps. Higher behavioral engagement positively affects the hedonic well-being (extent of pleasure) and the eudaemonic well-being (extent of self-efficacy) of chronically ill patients. Mobile app experience, however, positively moderates the relationship between app integration and behavioral engagement, whereas patient attachment to traditional care does not moderate the relationship between physician recommendation and behavioral engagement. Taken together, the proportion of variance explained (R²) equals 21% for behavioral engagement and 52.8% and 62.2% for hedonic and eudaemonic well-being, respectively, thereby providing support for the strong influence of app integration and physician recommendation via the mediation of the patients’ behavioral engagement on both patients’ hedonic and eudaemonic well-being. Conclusions: Physician recommendation and app integration enable behavioral engagement and promote well-being among chronically ill patients. It is thus important to take social and app-related factors into consideration during and after the development of mHealth apps.

BACKGROUND Last decade has shown a considerable increase in the amount of mobile health applications (mHealth apps) in everyday life. These mHealth apps have the potential to significantly improve well-being for chronically ill patients. However, behavioral engagement with mHealth apps remains low. OBJECTIVE The aim of this study is to provide insight into the behavioral engagement of adults with chronic conditions with mHealth apps by investigating (1) how it is affected by human-related factors (here, physician motivation) and app-related factors (here, app integration) and (2) how it affects their well-being. Supplementary, this study considers the moderating effect of preference for traditional visits to the physician (habit) and experience in app use (app experience) by the patients. METHODS A scenario based experiment among patients with a chronic condition (n= 521) was carried out. A Bayesian SEM model with mediation and moderation analysis was conducted in MPlus. RESULTS Both physician motivation for mHealth app use and mHealth app integration have a positive effect on the behavioral engagement of chronically ill patients towards mHealth apps. Higher behavioral engagement positively influences the hedonic and eudaimonic well-being of chronically ill patients. App experience positively moderates the relationship between app integration and behavioral engagement. A patients’ habit with receiving traditional care does not moderate the relationship between physician motivation and behavioral engagement. CONCLUSIONS The human and design factor play a key role in behavioral engagement and well-being among patients with a chronic condition. During and after the development of a mHealth app, app integration and physician motivation should be a point of attention.