Examining an Integrative Cognitive Model of Predicting Health App Use: Longitudinal Observational Study

Specifying the determinants of using health apps has been an important research topic for health scholars as health apps have proliferated during the past decade. Socioeconomic status (SES) has been revealed as a significant determinant of using health apps, but the cognitive mechanisms underlying the relationship between SES and health app use are unknown.

This study aims to examine the cognitive mechanisms underlying the relationships between SES and use of health apps, applying the integrative model of behavioral prediction (IM). The model hypothesizes the indirect influences of SES on intentions to use health apps, which in turn predict actual use of health apps. The relationships between SES and intentions to use health apps were assumed to be mediated by proximal variables (attitudes, perceived behavioral control [PBC], injunctive norms, and descriptive norms).

We conducted path analyses using data from a two-wave opt-in panel survey of Korean adults who knew about health apps. The number of respondents was 605 at baseline and 440 at follow-up. We compared our model with two alternative theoretical models based on modified IM to further clarify the roles of determinants of health app use.

Attitudes (β=.220, P<.001), PBC (β=.461, P<.001), and injunctive norms (β=.186, P<.001) were positively associated with intentions to use health apps, which, in turn, were positively related to actual use of health apps (β=.106, P=.03). Income was positively associated with intentions to use health apps, and this relationship was mediated by attitudes (B=0.012, 95% CI 0.001-0.023) and PBC (B=0.026, 95% CI 0.004-0.048). Education was positively associated with descriptive norms (β=.078, P=.03), but descriptive norms were not significantly related to intentions to use health apps. We also found that PBC interacted with attitudes (B=0.043, SE 0.022, P=.046) and jointly influenced intentions to use health apps, whereas the results did not support direct influences of education, income, and PBC on health app use.

We found that PBC over using health apps may be the most important factor in predicting health app use. This suggests the necessity of designing and promoting health apps in a user-friendly way. Our findings also imply that socioeconomic inequalities in using health apps may be reduced by increasing positive attitudes toward, and boosting PBC over, health app use among individuals with low income.