Effect of self-monitoring on long-term patient engagement with mobile health applications

PLoS One. 2018 Jul 26;13(7):e0201166. doi: 10.1371/journal.pone.0201166. eCollection 2018.


Despite the growing adoption of the mobile health (mHealth) applications (apps), few studies address concerns with low retention rates. This study aimed to investigate how the usage patterns of mHealth app functions affect user retention. We collected individual usage logs for 1,439 users of single tethered personal health record app, which spanned an 18-months period from August 2011 to January 2013. The user logs contained timestamps whenever an individual uses each function, which enables us to identify the usage patterns based on the intensity of using a particular function in the app. We then estimated how these patterns were related to 1) the app usage over time (using the random effect model) and 2) the probability of stopping the use of the application (using the Cox proportional hazard model). The analyses suggested that the users utilize the app most at the time of the adoption and gradually reduce their usage over time. The average duration of use after starting the app was 25.62 weeks (SD: 18.41). The degree of the usage reduction, however, decreases as the self-monitoring function is more frequently used (coefficient = 0.002, P = 0.013); none of the other functions has this effect. Moreover, engaging with the self-monitoring function frequently (coefficient = -0.18, P = 0.003) and regularly (coefficient = 0.10, P = 0.001) significantly also reduces the probability of abandoning the application. Specifically, the estimated survival rate indicates that, after 40 weeks since the adoption, the probability of the regular users of self-monitoring to stay in use was about 80% while that of non-user was about 60%. This study provides the empirical evidence that sustained use of mHealth app is closely linked to the regular usage on self-monitoring function. The implications can be extended to the education of users and physicians to produce better outcomes as well as application development for effective user interfaces.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Mobile Applications*
  • Patient Dropouts
  • Patient Generated Health Data*
  • Patient Participation*
  • Telemedicine*
  • Time Factors

Grant support

This work was supported by a grant from the Institute for Information & communications Technology Promotion (IITP) project, Korea government (MSIT) (No. 2017M3A9B6061832) (YRP); and by the MSIT (Ministry of Science and ICT), Korea, under the ITRC (Information Technology Research Center) support program (IITP-2017-01629) supervised by the IITP (Institute for Information & communications Technology Promotion), by a grant from Kyung Hee University in 2016 (KHU-20161377) (SYS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.