Introduction: Adolescents report cost, opening hours, difficulty getting to services, and feeling embarrassed, as significant barriers to accessing health care. eHealth has significant potential to overcome these barriers, improve mental health and change health behaviours. However, engagement with eHealth is often low and high levels of attrition are common. Strategies to increase engagement exist but have not been well-reported or systematically tested. The Triple E project aims to address these gaps by systematically testing the impact of key engagement strategies on engagement with a healthy lifestyles and mood tracking app among adolescents. It also aims to identify predictors of use, and intentions to use, health apps.
Methods: A 2x2x2x2 factorial experimental design will be employed. All participants will receive access the Health4Life app and a combination of four engagement strategies (reminder text messages, access to a health coach, gamification content and parent resources). 336 dyads of adolescents and a parent/guardian will be recruited. The primary outcome will be engagement with the Health4Life app, as measured by an Engagement Index including sub-indices of: click depth, loyalty, volume of contributions, recency, and subjective feedback. An extended ‘Unified Theory of Acceptance and Use of Technology’ model will be used to examine if variables including performance and effort expectancy, social influence, hedonic motivations, trust, health consciousness, mobile self-efficacy and/or participant characteristics can predict adolescents’ use and intentions to use health apps.
Results/Conclusions: It is anticipated the Triple E Project will make a significant and important contribution to the field of adolescent eHealth research, providing guidance on how best to engage adolescents with digital health and mental health solutions. Recruitment is due to begin August 2023, and preliminary baseline data will be presented. We will also provide examples of comprehensive measures of engagement others could incorporate into their evaluation of physical and mental health apps.