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Adolescents' Engagement With an mHealth Multiple Health Behavior Change Intervention (LIFE4YOUth): Mixed Methods and

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Summary

Mobile health interventions struggle with engagement. This study found that Swedish high school students with multiple risk behaviors were not engaged by LIFE4YOUth if they perceived little need for behavior change, highlighting a key challenge for mHealth interventions.

Keywords:
adolescentshealth behaviorsmHealthmixed methodsqualitative comparative analysisuser engagement

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Area of Science:

  • Adolescent health
  • Behavioral science
  • Digital health interventions

Background:

  • Mobile-based behavior change interventions often suffer from low user engagement.
  • Adolescents, particularly those with multiple risk behaviors, present unique challenges for intervention design.
  • Understanding factors contributing to low engagement is crucial for improving mHealth effectiveness.

Purpose of the Study:

  • To explore factors influencing engagement with the mobile-based LIFE4YOUth intervention among Swedish high school students.
  • To specifically investigate reasons for low engagement in a multi-behavior change program.
  • To identify psychosocial and behavioral characteristics associated with low engagement.

Main Methods:

  • A sequential explanatory mixed-methods design integrating quantitative usage data and qualitative focus groups/interviews.
  • Analysis of usage data from 377 high school students to identify engagement patterns.
  • Inductive content analysis of qualitative data (n=20) and qualitative comparative analysis (QCA) to determine configurations of low engagement.

Main Results:

  • A majority (67%) of participants exhibited low engagement with the LIFE4YOUth intervention.
  • Key factors influencing engagement included perceived importance of behavior change, user experience, and environment.
  • Three distinct profiles of low engagement were identified: unmotivated high-needers, motivated low-needers, and dissatisfied needers.

Conclusions:

  • The LIFE4YOUth intervention failed to engage high school students content with their current lifestyle and undervaluing behavior change.
  • Positive user experiences, such as feeling confirmed and encouraged, may drive engagement in students with mixed behaviors.
  • Future mHealth interventions should consider tailoring the number of targeted behaviors to enhance adolescent engagement and outcomes.