title: Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey.
abstract: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions.
  
  
  
  The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors.
  
  
  
  A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied.
  
  
  
  It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor's advice.
  
  
  
  Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user's motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions.
authors.affiliation: Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Clemens
authors.identifier: 0000-0003-1821-0340
authors.initials: C
authors.lastname: Ernsting
authors.affiliation: Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom.
authors.forename: Stephan U
authors.identifier: 0000-0001-9832-2777
authors.initials: SU
authors.lastname: Dombrowski
authors.affiliation: Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Monika
authors.identifier: 0000-0002-0207-4068
authors.initials: M
authors.lastname: Oedekoven
authors.affiliation: Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Julie L
authors.identifier: 0000-0002-8991-9966
authors.initials: JL
authors.lastname: O Sullivan
authors.affiliation: Pfizer Deutschland GmbH, Berlin, Germany.
authors.forename: Melanie
authors.identifier: 0000-0002-9854-1184
authors.initials: M
authors.lastname: Kanzler
authors.affiliation: Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Adelheid
authors.identifier: 0000-0003-4088-4675
authors.initials: A
authors.lastname: Kuhlmey
authors.affiliation: Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Paul
authors.identifier: 0000-0001-7492-7210
authors.initials: P
authors.lastname: Gellert
mesh_terms: D000368:Aged; D019468:Disease Management; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008875:Middle Aged; D063731:Mobile Applications; D011788:Quality of Life; D000068997:Smartphone; D011795:Surveys and Questionnaires
keywords: chronic disease; eHealth; health literacy; health promotion; mHealth; mobile apps; quality of life; smartphone; telemedicine