The promise of public health app portals (versus commercial app stores) in promoting the adoption of digital behaviour change aids

By Dr Olga Perski & Dorothy Szinay

To estimate the likely public health impact of digital behaviour change aids, we need to consider both their effectiveness and how far they are adopted within the target population. Although digital aids for smoking cessation, alcohol reduction, physical activity and dietary improvement have small, positive effects on behaviour (in comparison with no or minimal support), they have the potential to reach a much larger number of people than conventional, face-to-face treatment. For example, digital aids are easy to access for those who live too remotely to access available face-to-face support or who feel anxious about the prospect of talking to a healthcare professional about their health. Previous studies have described the characteristics of users (e.g. smokers, drinkers) who sign up to take part in controlled trials of digital aids or who self-select to download a particular app for smoking cessation or alcohol reduction. However, we currently know little about the reach of digital aids in the general population, which makes it difficult to judge whether they are in fact delivering on their promise of wide reach.

Observed adoption rates in the general population of smokers and drinkers in England

In a recent study published in Drug and Alcohol Dependence, we assessed adoption rates and characteristics of those adopting digital aids for smoking cessation and alcohol reduction in a nationally representative sample in England. A total of 3,655 smokers and 2,998 high-risk drinkers (defined as a score of >4 on the Alcohol Use Disorders Identification Test-Consumption; AUDIT-C) who had made a past-year quit/reduction attempt were surveyed as part of the Smoking and Alcohol Toolkit Studies between 2015 and 2018. They were asked if they had used a digital aid (e.g. website, smartphone app) in a recent quit/reduction attempt. In weighted analyses (used to match the sample to the proportions of the English population on age, social grade, etc.), we found that 2.7% of smokers and 3.6% of high-risk drinkers had used a digital aid in a recent quit/reduction attempt. Hence, our findings suggest that digital aids for smoking cessation and alcohol reduction are not yet reaching a large proportion of the target population in England. Another key finding was that none of the smoking or sociodemographic variables assessed were significantly associated with the uptake of digital aids in smokers. In high-risk drinkers, however, those who were highly motivated to reduce their drinking and had a higher AUDIT score had greater odds of adoption. This means that we may specifically need to focus promotion efforts on those with lower motivation to change going forwards.

Why are adoption rates so low?

These low adoption rates could be due to the lack of public or healthcare professional awareness of, or confidence in using/recommending the use of, digital aids. It should, however, be noted that public-facing campaigns in England (e.g. Stoptober, Dry January, One You) have promoted the use of smartphone apps for smoking cessation and alcohol reduction for several years. As the Smoking and Alcohol Toolkit Studies don’t currently include measures of awareness of available aids, we weren’t able to assess if the low adoption rates are indeed attributable to low awareness. Recently, regulatory frameworks for digital aids have been developed in the UK, with related resources (e.g. the NHS Apps Library) specifically designed to help healthcare professionals and patients navigate the host of available apps. It’s hence possible that increased awareness of and confidence to use/recommend evidence-based apps via curated, public health app portals among healthcare professionals and patients may help to speed up the adoption process.

The potential for public health app portals

As part of her PhD project, funded by Public Health England, Dorothy is in the process of developing and evaluating a web-based intervention, delivered via a public health app portal, to increase the adoption of health and wellbeing apps in England. Her ongoing qualitative research aims to explore potential users’ views on available public health app portals (e.g. One You Apps), with a view to identifying areas for improvement. Early findings suggest that the majority of participants weren’t aware of existing portals, although a few had heard of some of the apps listed through social media. All participants recognised the benefit of the portals and expressed their trust in and respect towards the National Health Service/Public Health England. However, the manner in which the apps are currently presented on the portals did not meet users’ expectations and led them to continue their searches in commercial app stores. Participants thought that the apps are not as clearly presented on current health portals (as compared with commercial app stores), and a few users did not manage to find an app for their key behaviour of interest. It should be noted that, at the time of the interviews, no smoking cessation app was listed on the NHS Apps Library, and only one was listed on the One You Apps portal. The next step is to use these findings to inform the development of an intervention to promote the adoption of health and wellbeing apps, delivered by a real or sham public health app portal.

Questions

• What is the role of national health organisations (e.g. the National Health Service, Public Health England) in promoting evidence-based digital behaviour change aids?
• What is the best strategy for redirecting people interested in digital behaviour change aids from commercial app stores to public health app portals?

Bios

Dr Olga Perski is a Research Associate in the UCL Tobacco and Alcohol Research Group. Her research focuses on the development and evaluation of digital aids for smoking cessation and alcohol reduction.

Dorothy Szinay is a PhD candidate at the University of East Anglia. Her research focuses on the development and evaluation of web-based interventions to increase the uptake of and engagement with health and wellbeing smartphone apps.