Why health apps fail: the role of smartphone proficiency in mHealth resistance

Background Mobile health apps offer significant potential for health promotion, yet initial adoption remains limited. While prior research has identified app-specific barriers, the perceived usefulness (PU) and psychological resistance toward health apps compared to everyday commercial apps, as well as the foundational role of users’ smartphone proficiency, remain understudied. Objective This study aimed to compare users’ perceptions of health apps with those of other app categories and to examine whether smartphone proficiency or health-related status was consistently associated with PU and psychological resistance. Methods A cross-sectional internet survey was conducted among 717 adults in Japan. We compared the PU of health apps with news, video streaming, social media, and gaming apps. Furthermore, we compared psychological resistance toward a physician-recommended health app with a discount-incentivized shopping app. Ordinal logistic regression was used to identify independent predictors of PU and resistance. Results Health apps were perceived as moderately useful (mean PU = 6.2), similar to social media (adjusted p = 0.345) but inferior to news apps (adjusted p < 0.001). Psychological resistance toward a physician-recommended health app (mean = 2.69) was virtually no different to resistance toward a discount-incentivized shopping app (mean = 2.66, p = 0.521). Practical barriers, such as device storage (43.1% vs. 48.3%) and privacy concerns (42.3% vs. 46.0%), were the primary barriers for both, rather than a lack of perceived necessity (23.2% vs. 31.2%). Health-related indicators showed only limited associations with app acceptance. In contrast, higher smartphone proficiency independently predicted both increased PU [adjusted odds ratio (aOR) = 4.69, 95% CI: 1.90–11.52, p < 0.01] and diminished psychological resistance (aOR = 0.12, 95% CI: 0.05–0.31, p < 0.001). Conclusion Health apps face practical adoption barriers similar to those of everyday commercial apps. Initial acceptance appears to be more consistently shaped by foundational digital proficiency than by health-related status. To support equitable digital health interventions, public health strategies should prioritize strengthening basic digital competencies in the population.