Caregiver inclusion influence on adolescent acceptance and engagement of an mHealth app, a randomized controlled trial.

Abstract

Background: Adolescent obesity has become a major health concern. As adolescent obesity rates continue to rise, mobile health applications (mHealth apps) may play a unique role in reversing these trends by promoting positive health behavior change. The inclusion of adult caregivers in mHealth lifestyle interventions has been shown to be effective in young children, yet this aspect has not been well studied or described in adolescent populations. The aim of our study was to (I) determine whether adolescents find it acceptable to include caregivers in their mHealth lifestyle interventions; (II) evaluate whether caregiver engagement in mHealth lifestyle interventions is positively correlated with adolescent CommitFit mHealth app engagement based on their logging; and (III) explore whether including caregivers in adolescent mHealth lifestyle interventions increases the adolescent's self-perceived motivation to improve their health behavior.

Methods: In this 4-month parallel randomized controlled trial (RCT), 30 dyads of caregivers (n=30) and their adolescents (n=30) were randomized into three study arms: CommitFit, CommitFit$, and waitlist control. Both intervention arms were given access to the novel CommitFit app which uses gamification and behavior economics to promote positive health behavior. The CommitFit app allows users to earn points and compete on a leaderboard by setting and logging health behavior goals. The CommitFit$ group also received money per point that was earned in the app. Dyads were encouraged to form a family team and compete on a team leaderboard. At baseline, 90 days, and 120 days, study participants completed surveys to assess their motivations to use the CommitFit app. Participant use of the app was tracked over time with the use of analytic software developed by the research team.

Results: All participants that were randomized were analyzed. Adolescents responded favorably to caregiver inclusion with an overall score of 71.9 out of 100. Caregiver app engagement was shown to be positively correlated with adolescent app engagement (r=0.65, P=0.002). However, caregiver inclusion had a marginal impact on adolescent motivation to achieve goals with a score of 51.8 out of 100. Additionally, adolescents at baseline did not consider caregivers to be a strong motivator for health behavior change with a score of 0.62 out of 3.00, although a significant difference at 120 days was shown between the CommitFit study arm and the control group (1.10/3.00 vs. 0.20/3.00) (P=0.01).

Conclusions: Adolescents may be willing to use mHealth apps that partners with their caregivers. Additionally, increased parental involvement in adolescent mHealth lifestyle interventions may increase adolescent motivation and use of the mHealth app, and has the potential to increase the effectiveness of the mHealth intervention. However, adolescents do not perceive caregiver inclusion to be an important motivator for health behavior change.

Trial registration: ClinicalTrials.gov registration #NCT06985251.