Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps
Open accessAbstract
Objective To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps.Methods A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics.Results Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (p<0.01).Conclusion Apps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions.Practice implications Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content.
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Technology cannot compensate for content that is not engaging, easy to consume and appropriate for the audience.
“It is also important to note that while technology is a very useful tool it cannot compensate for content that is not engaging, easy to consume and appropriate for the audience (73, 111).”
From Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners. (2023) · cites this paper as [111]
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Fitzpatrick, P. J. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1264780 · Cited by 416 · see citing works
- Authors
- Paige, S. R., Alber, J. M., Stellefson, M. L., & Krieger, J. L.
- Affiliations
- University of Florida Health (US)
- California Polytechnic State University (US)
- East Carolina University (US)
- Corresponding author
- Paige, Samantha R.
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 101
- Issue
- 5
- Pages
- 951-955
- ISSN
- 0738-3991 (ISSN-L)
- PMC
- PMC5911212
- OpenAlex
- W2767852500
- Cited by
- 25
- References
- 27
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 3 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 2
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 351 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Patient Education and Counseling (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (F31HL132463)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- smoking cessation apps, transtheoretical model, change processes, patient engagement, app usability, plain language, interactivity, mobile health apps
- MeSH terms
- Biobehavioral Sciences, Humans, Motivation, Patient Participation, Smoking Cessation, Telemedicine, Health Literacy, Mobile Applications
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