Secondary analysis shows health literacy and intentions drive uptake of digital health interventions, suggesting targeted approaches for diverse patients.
BACKGROUND Digital health interventions (DHIs) can only be effective if they are actually used. Accordingly, appropriate application and/or targeted design of DHIs requires knowledge regarding the determinants of two key aspects of their usage, namely initial “uptake” of the intervention (i.e., use of the DHI at least once), and “frequency” (i.e., how often the DHI is used over time). OBJECTIVE The objective is to investigate the determinants of uptake and frequency in the usage of a specific DHI. METHODS The investigated DHI is part of a complex intervention for improving self-management in persons with type 2 diabetes mellitus and/or coronary heart disease. It consists of a web portal designed to promote physical activity and healthy nutrition among this group. The study presented here is a secondary analysis of data from a randomised controlled trial of this complex intervention (2019-2024). The data was gathered from the 465 members of the intervention group. The variables investigated as possible determinants of DHI use are age, gender, education, the Big Five, loneliness, depression, anxiety, health literacy, patient activation, intention regarding physical activity, and intention regarding healthy nutrition. The relationship with uptake is analysed using logistic regression; the relationship with frequency using Poisson regression with robust standard errors – both for each variable separately (simple regression analysis), and for all variables together (multiple regression analysis). RESULTS For uptake, the simple regression analyses reveal significant positive associations with: higher education (p<.01); openness (p<.01); health literacy (p<.05); and intentions regarding physical activity (p<.001) and healthy nutrition (p<.001). In the multiple regression analysis, only the two intentions remain significant (p<.01 and p<.001), while patient activation (p<.001) emerges as a significant negative predictor. For frequency, the simple regression analyses reveal positive associations with: age (p<.01) and conscientiousness (p<.05); and a negative association with depression (p<.05). In the multiple regression analysis, only age (p<.05) and conscientiousness (p<.05) remain significant, while extraversion (p<.05) and loneliness (p<.05) emerge as significant negative predictors. CONCLUSIONS Individuals who intend to adopt a healthy lifestyle and perceive a need for support are most likely to use the DHI at least once. However, not all addressed individuals use the DHI with equal frequency. Extraverted, less conscientious and lonely people might require different interventions, which should be taken into account when designing complex interventions. CLINICALTRIAL The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-021-05636-4
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