Parental and Demographic Predictors of Engagement in an mHealth Intervention: Observational Study From the Let's Grow...

Parents are integral in shaping early childhood health behaviors, and mobile health (mHealth) interventions offer an accessible method of supporting them in this role. Optimizing participant engagement is key to mHealth effectiveness and impact; however, research examining personal predictors of engagement remains underexplored.

We aimed to describe participant engagement with a novel parental mHealth intervention (Let's Grow) during the first 25 weeks of use and investigate whether engagement levels varied by family demographics and parental cognitions and behaviors relevant to the intervention.

We used data from parents in the intervention group of the Let's Grow trial. The intervention targeted toddlers' movement behaviors, and the program (a purpose-designed progressive web app) was delivered via self-paced modules. The content was built around 3 main components (behavior change activities, information provision, and social support). Engagement data (web app analytics) collected across the first 25 weeks of the intervention were summarized as study-specific metrics (time using the app, proportion of accessed features and pages, clicks in the main parts of the app) and overall engagement measures (composite engagement index [EI], individual subindexes [click depth, loyalty, recency, and diversity]). The baseline measures included family demographics (main carer, child and family characteristics, and postcode) and parental cognitions and behaviors relevant to the intervention (coping, concern, and information seeking). Linear regression was used to assess associations between baseline and engagement measures.

All parents allocated to the intervention group (n=682) were included. Most parents (609/682, 89.3%) logged in and used at least 1 app feature; those who never used the app were excluded from subsequent analyses. App access declined from 90.6% (552/609) in the first week to 31.2% (190/609) at 25 weeks. For users active during weeks 12 to 25, EI remained consistent and was nearly identical to the average EI (28%, range 3%-50%). More work hours, parents living together, having siblings in the family, and living in a regional or remote area were each associated with lower engagement on 10 out of 12 indicators (β=-31.37 to -0.01; all P≤.046). Higher education level was associated with higher engagement on 9 indicators (β=0.77-18.59; all P≤.02). Of the parental characteristics, only higher coping was positively associated with engagement (β=1.25; P=.003).

Our findings indicate that time and sociodemographic factors might be the most relevant predictors of engagement and highlight the characteristics of parents who may benefit from more active strategies to support their engagement with digital interventions. The uptake and continued engagement with this app exceeded what is generally reported for apps, but it is unknown whether this is sufficient for behavior change. Individual and composite engagement measures yielded similar results, indicating that simpler, more feasible metrics can be useful for reporting engagement in digital interventions.

RR2-10.1136/bmjopen-2021-057521.