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Review
. 2022 Apr 26;24(4):e35120.
doi: 10.2196/35120.

Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review

Saki Amagai  1 , Sarah Pila  1 , Aaron J Kaat  1 , Cindy J Nowinski  1 , Richard C Gershon  1
Affiliations
Review

Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review

Saki Amagai et al. J Med Internet Res. .

Abstract

Background: Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps.

Objective: This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention.

Methods: We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention.

Results: Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained.

Conclusions: Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.

Keywords: engagement; mHealth; mobile phone; retention.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study selection flowchart.
See this image and copyright information in PMC

References

    1. Mobile fact sheet. Pew Research Center. 2019. [2022-04-07]. https://www.pewresearch.org/internet/fact-sheet/mobile/
    1. Grand View Research. 2021. [2022-04-07]. https://www.marketresearch.com/Grand-View-Research-v4060/mHealth-Size-Sh...
    1. Almalki M, Giannicchi A. Health apps for combating COVID-19: descriptive review and taxonomy. JMIR Mhealth Uhealth. 2021 Mar 02;9(3):e24322. doi: 10.2196/24322. https://mhealth.jmir.org/2021/3/e24322/ v9i3e24322 - DOI - PMC - PubMed
    1. Chan YF, Bot BM, Zweig M, Tignor N, Ma W, Suver C, Cedeno R, Scott ER, Gregory Hershman S, Schadt EE, Wang P. The asthma mobile health study, smartphone data collected using ResearchKit. Sci Data. 2018 May 22;5:180096. doi: 10.1038/sdata.2018.96. doi: 10.1038/sdata.2018.96.sdata201896 - DOI - DOI - PMC - PubMed
    1. Chan YF, Wang P, Rogers L, Tignor N, Zweig M, Hershman SG, Genes N, Scott ER, Krock E, Badgeley M, Edgar R, Violante S, Wright R, Powell CA, Dudley JT, Schadt EE. The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit. Nat Biotechnol. 2017 Apr;35(4):354–62. doi: 10.1038/nbt.3826. http://europepmc.org/abstract/MED/28288104 nbt.3826 - DOI - PMC - PubMed