Mobile Health App User Behavior Stage And Engagement

This post reviews the findings of a recent study that analyzes the behavioral stage of mHealth app users and implications for ongoing engagement.

Director of Lifestyle Medicine at Optimal Heart Center | Chief Science Officer at Nudge

I was visiting with a friend the other day and as the conversation drifted into areas unknown he asked me if I had ever considered origami.  

At first this seemed a rather odd question to be asked, but after considering the friend across the table, it made perfect sense. “No”, I replied in a monotone voice. “Origami is not something I have considered, nor do I ever plan to do.”

Surprisingly, later that weekend I was cleaning out my closet and came upon the brand new, highly acclaimed 35mm camera I purchased. Thinking back to my friends question about considering origami, it dawned on me that this was one of those things I did consider that ended up a flop.

You see, I wanted to take perfect photographs but never was able to muster the requisite action steps to learn the settings and functions of this expensive paper weight.

When it comes to the use of mHealth apps we often see similar scenarios to my origami and camera experience.

In fact, the gap between an individual’s decision to try out an mHealth app and the point at which they actually use it, is where we most often see individuals drop out and become lost.

However, it is at this point that the power of effective engagement can leverage mHealth technology to the benefit of both member and Health Professional.

mHealth App Engagement

The Konstanz Life Study looked at the adoption process of nutrition and fitness apps. Sorting through the sociodemographic status, behavioral characteristics, and decision-making styles of people throughout adoption process, they were able to identify the stages where the gap becomes too wide to cross.

Consider a new perspective on mHealth apps…it is not just about retaining users. Obviously, discovering new ways to keep participants engaged in apps and implementing individualized plans are very important aspects to remember. However, they are not the only important pieces to the puzzle.

Let’s take a deeper look at the process of joining an mHealth app:

According to the Konstanz Life Study, there are 5 basic stages in the process of adopting an mHealth app.

(1) “Unengaged”

  • Those who have never thought about using mHealth apps.

(2) “Decided to Act”

  • Those who intend to use mHealth apps in the future.

(3) “Decided Not to Act”

  • Those who have decided not to us mHealth apps in the future.

(4) “Acting”

  • Those who are currently using mHealth apps.

(5) “Disengaged”

  • Those who once used mHealth apps but have chosen not to anymore.

From the 30,000 foot view, the study found a large percentage of the population has never even considered using an mHealth app (52% regarding Nutrition Apps and 29% regarding Fitness Apps).

Moreover, less than 10% of those aware of mHealth app opportunities actually make the decision to act.

And finally, only 8% identified as using Nutrition Apps while 26% noted using Fitness Apps.

mHealth App Users By Behavior Stage

behavior stage mhealth app engagement table

The suggestions made by the authors support the idea that use of a mHealth app technology must be implemented on an individual basis and that they are much more likely to used if the individual is ready.

As we work to apply the findings we must consider the tenets of Health Engagement Science.

This study highlights the importance of creating an mHealth app experience to bridge the gap between “Deciding to Act” and truly “Acting.”  From the behavior change perspective, it is at this critical point that engagement with a qualified Health Coach has a significant impact on the success of integrating this tool into the process.

If you're ready to discuss how to most effectively fit remote coaching and mHealth apps into your engagement strategy schedule an introductory call with our team today.


Laura M König, BSc, MSc; Gudrun Sproesser, PhD; Harald T Schupp, PhD; Britta Renner, PhD. Describing the Process of Adopting Nutrition and Fitness Apps: Behavior Stage Model Approach. University of Konstanz, Konstanz, Germany JMIR Mhealth Uhealth 2018 | vol. 6 | iss. 3 | e55 | p.1