The aim of this study was to understand the factors associated with continued use of a behaviour change health app. We looked at the effect of age, gender, motivation, perceived self-efficacy, and expected use - documentary ('how much water do I drink?'), diagnostic ('has my water drinking an effect on fatigue?'), behaviour change oriented ('I want to drink more water'), reward-oriented (comparison to others, badges, etcetera), and 'fetishized' (interest in gadgets for their novelty value) - and feedback properties - feedback valence, cooperative feedback, and competitive feedback - on app retention rates. Due to the number of users who abandoned the app, we lacked the statistical power to gauge the impact of the app on behaviour change.

1. Lessons from a failed attempt at
increasing sustained use of a mobile app
providing feedback on water drinking
.
Sander Hermsen
Hogeschool Utrecht
Jeana Frost
VU University Amsterdam

2. 1.
Drinking enough water (m: >2900ml per
day, f: >2200ml) is associated with a range
of health benefits
- weight loss
- blood pressure regulation
- increased energy expenditure
Unfortunately, most people do not
achieve this daily recommendation
The background

3. 2.
Smartphones and other devices can deliver
tailored feedback to support behaviour
change
- increases motivation
- gives higher priority to behaviour
- encourages self-monitoring
Unfortunately, smartphone apps have
limited adoption and high churn / attrition
rates
The background

4. The research questions
1+1= ?
Does a smartphone app help people
increase their water drinking?
Who uses app longer? Looked at:
- age, gender
- motivation, perceived self-efficacy
- expected use
Can we increase sustained use of the app
by manipulating:
- feedback valence
- competition / co-operation?

5. The app

6. The research
538 participants downloaded
existing water-consumption tracker app
from iOS app store
Questionnaire:
- age, gender,
- motivation, perceived self-efficacy
- appropriateness of five goals:
documentary, diagnostic, behaviour
change-oriented, reward-oriented, and
‘fetishized'

7. The research
538 participants downloaded
existing water-consumption tracker app
from iOS app store
Participants recorded water-drinking
behaviour during 68 days
Participants were randomly assigned
to one of five conditions:
1) app-as-is,
2) app with negative feedback,
3) app with positive feedback,
4) app with competitive feedback
5) app with cooperative feedback

8. The failure
Of the 538 participants,
23.8% (128 participants) downloaded the
app, but never used it
23.6% (127 participants) only used the app
once
Only 129 users (24%) made it past the first
week
None of the participants made it to the end
of the 68-day trial period
Condition did not affect sustained use

9. The research questions
1+1= ?
Does a smartphone app help people
increase their water drinking?
Who uses app longer? Looked at:
- age, gender
- motivation, perceived self-
efficacy
- expected use
Can we increase sustained use of the
app by manipulating:
- feedback valence
- competition / co-operation?

10. All downloaders had high motivation (µ = 5.38, SD = 1.36 on a
seven-point scale),
but it required
- very high motivation (B=.25, SE=.08, p<.01, Exp(B)=1.28, 95%
CI 1.09<Exp(B)< 1.51)
- the goal to change drinking behaviour (B=.61, SE=.30, p<.05,
Exp(B)=1.83, 95% CI 1.02<Exp(B)< 3.25)
to actually start using the app
The results

11. Once in use,
- gender (women more than men, B=-3.63, SE=1.77, p<.05, 95% CI
-7.41<B<-.15)
- having the concurrent 'documentary' goal (B=4.59, SE=1.56, p<.01,
95% CI 1.52<B<7.67) besides the behaviour change goal
had a positive effect on sustained use
(but not the experimental manipulation:
feedback valence,
competition vs cooperation)
The results

12. The conclusion
User churn / attrition is very high
To start using: very high motivation, good fit goals + app
To keep on using: gender, even better fit goals + app
'lived informatics', the idea that people will actively select those
resources that best support the behavioural change they seek,
rather than 'persuasive technology', the idea that technology is
capable of driving behavioural change itself

13. Thank you
Questions?
sander.hermsen@hu.nl
@sanderhermsen