title: A Comparison of Mobile and Fixed Device Access on User Engagement Associated With Women, Infants, and Children (WIC) Online Nutrition Education.
abstract: BACKGROUND
  Online health education has expanded its reach due to cost-effective implementation and demonstrated effectiveness. However, a limitation exists with the evaluation of online health education implementations and how the impact of the system is attenuated by the extent to which a user engages with it. Moreover, the current online health education research does not consider how this engagement has been affected by the transition from fixed to mobile user access over the last decade.
  
  
  OBJECTIVE
  This paper focuses on comparing the impact mobile versus fixed devices have on user engagement key performance indicators (KPI) associated with the wichealth website (.org), an Internet-based parent-child feeding intervention offered to clients associated with the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  
  
  METHODS
  Data were collected from 612,201 nutrition education lessons completed by 305,735 unique WIC participants in 21 states over a 1-year period. Data consisted of system-collected measures, profile items, and items from an exit survey administered at the conclusion of each lesson. User engagement was defined based on 3 KPIs associated with usage of the wichealth website: number of link views, link view time, and progression in stage of readiness to change. Independent samples t tests were used to compare KPIs between fixed only and mobile only device users and paired samples t tests were used to compare KPIs within users who completed at least one lesson each on both a fixed and mobile device. A logistic regression was performed to estimate the odds of KPI performance thresholds in the independent samples study group given access device type while controlling for confounding of user characteristics associated with these KPIs.
  
  
  RESULTS
  Analysis of 8 user characteristics (lessons completed, race, ethnicity, language, state of residence, pregnancy status, beginning stage of change, and preferred nutrition education method) were significantly (P<.001) related to various KPI differences between mobile and fixed device access. Non-mobile users were significantly (P<.001) more likely to engage based on all 3 KPIs, even after logistic regression control for the potential confounding related to the strongly associated user characteristics identified.
  
  
  CONCLUSIONS
  The findings of this study support the idea that online health education developers need to seriously consider access device when creating programs. Online health education developers need to take extra effort to truly understand access patterns of populations being served, and whether or not access device will influence user engagement performance indicators.
authors.affiliation: Western Michigan University, Department of Human Performance and Health Education, Kalamazoo, MI, United States.
authors.forename: John J
authors.identifier: http://orcid.org/0000-0002-3559-8773
authors.initials: JJ
authors.lastname: Brusk
authors.affiliation: Western Michigan University, Department of Human Performance and Health Education, Kalamazoo, MI, United States.
authors.forename: Robert J
authors.identifier: http://orcid.org/0000-0003-3374-4551
authors.initials: RJ
authors.lastname: Bensley
keywords: Internet; eHealth; mHealth; mobile phone