Understanding health information literacy of mHealth app users from digital wellbeing perspective: Evidence from regression analysis and fsQCA

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Highlights

  • Digital wellbeing framework is used to identify what factors improve mHealth app users’ health information literacy (HIL).

  • Regression analysis with fuzzy-set qualitative comparative analysis (fsQCA) were combined to validate related factors.

  • Person-specific, device-specific, and context-specific factors had independent effects on users’ HIL.

  • Person-specific, device-specific, and context-specific factors had synergistic effects on users’ HIL.

Abstract

While past research suggests mHealth apps help cultivate users’ health information literacy (HIL), factors contributing to their HIL development have not been systematically studied. Applying digital wellbeing framework, an empirical investigation using a large-scale survey dataset was conducted. From regression analysis and fuzzy-set qualitative comparative analysis (fsQCA), two findings were yielded. First, six influential factors, including person-specific factors (i.e., gender, annual family income, Internet experience), device-specific factors (i.e., screen sizes of mobile phones), and context-specific factors (i.e., use frequency and perceived quality of mHealth apps), were identified. Second, gender, annual family income, internet experience, screen size of mobile phones, use frequency and perceived quality of mHealth apps had synergistic effects on HIL. By introducing fsQCA to library and information science community, the study not only extends literature by teasing out the combinations of different categories of factors contributing to HIL but informs health professionals and mHealth app developers.

Introduction

Health information literacy (HIL) refers to the extent to which users are able to obtain, use, and understand the information needed to make informed health decisions (Medical Library Association, 2003). Users in the current digital era have relied on mobile devices to stay connected and obtain health information from verified or unverified sources. Against this backdrop, HIL has become increasingly important because it determines one’s “abilities to discern good versus bad health information from various information sources […]” (Xie et al., 2020, p. 1421). As a result, users with high HIL can efficiently identify useful and credible health resources to make choices of a healthy lifestyle and self-manage health status (Fu, Chen, & Zheng, 2021). Conversely, users with low HIL might be vulnerable to health-related misinformation and disinformation (Yin & Zhang, 2020). Therefore, it is crucial to improve users’ HIL.

In recent years, mobile health applications (hereafter referred to as mHealth apps) are recognized as an emerging healthcare service driven by mobile digital technologies. The apps can facilitate medical knowledge sharing, personal health data recording, and healthcare consultations across the spatiotemporal boundary (Cho, Park, & Lee, 2014; Dehling, Gao, Schneider, & Sunyaev, 2015; Krebs & Duncan, 2015). Given such advantages, mHealth apps have become an important tool for mobile phone users to implement daily health self-management, especially for young adults—typically seen as “digital-savvy”—who depend heavily on mobile phones to keep digitally connected (Fu, Chen, & Deng, 2021). The use of mHealth apps can help them raise HIL through multiple approaches, including healthcare knowledge education, improved autonomous self-regulation and perceived competence (Ghose, Guo, Li, & Dang, 2021; Li, Chen, & Bi, 2021). Using mHealth apps on mobile phones may facilitate an active lifestyle and behavior modification. It is not surprising that the global market for mHealth apps is expected to increase at an average rate of 36.5% from 2016 to 2022, reaching a value of 22.31 billion USD by 2022 (Ghose, Guo, Li, & Dang, 2021). In China, the domestic market of mHealth apps has reached a value of about 3 billion USD in 2020 (CNNIC, 2021).

Section snippets

Problem statement

Despite the helpfulness of mHealth apps, users may suffer from many adverse impacts resulting from mobile phone usage, ranging from addiction, anxiety, to technostress (e.g., Dehling et al., 2015; Fu, Chen, & Zheng, 2021; Tarafdar, Cooper, & Stich, 2019). Such phenomena represent the “dark side” of digital technologies, indicating that the relationship between the use of mHealth apps on mobile phones and users’ HIL development could be complex. Such a complex relationship implies that mHealth

Theoretical foundation: Digital wellbeing framework

The theoretical foundation of this study is based on the digital wellbeing framework (Abeele, in press). Digital wellbeing is an important concept in research on mobile technologies and wellbeing (Przybylski & Weinstein, 2017), as it “can inform users, health practitioners, designers, and developers in the industry as well as policymakers about people’s struggles with ubiquitous connectivity, and what can be done to help people foster healthier mobile media habits” (Abeele, in press, p. 2). In

Measures and instrument design

Self-report scales were used to measure the person-specific, device-specific, and context-specific factors of mHealth apps users and their HIL. First, in terms of person-specific factors, this study measured gender, education level, annual family income, and internet experience. Gender included male and female; Education level was assessed as follows: “Year 1,” “Year 2,” “Year 3,” “Year 4,” and “Postgraduate.” Annual family income was assessed as follows: “no more than 20,000 RMB,” “20,000 – no

Sample characteristics

Table 1 shows the demographic breakdown of the sample. Roughly fifty-five percent (55.1%) of the respondents were males, and 44.9% were females. The majority of respondents ranged in education level from Year 1 to Year 4 as undergraduate students (69.89%). The annual family income of most respondents (23.7%) was between 50,000-100,000, whereas only 487 (8.99%) respondents’ annual family income was more than 200,000. Finally, 4,276 respondents (78.9%) had more than three years of internet

Discussion

This study determined important factors that improve the HIL of mHealth apps users from the digital wellbeing perspective. The key findings are two-fold. First, based on the hierarchical OLS regression model, six influential factors of HIL were identified, including person-specific factors (i.e., gender, annual family income, and Internet experience), device-specific factors (i.e., screen sizes of mobile phones), and context-specific factors (i.e., use frequency of mHealth apps and perceived

Implications for literature

This study contributes to related literature in three ways. First, by drawing upon the digital wellbeing framework, this study advances the understanding of how person-specific, device-specific, and context-specific factors can contribute to users’ high HIL. The cultivation of mHealth apps users’ HIL is complex and may be affected by multiple factors simultaneously. Past research has not systematically studied how the three categories of factors affect mHealth app users’ HIL, while this study

Conclusion

Adopting mHealth apps has been recognized as an effective approach to improving users’ health information literacy (HIL). Drawing upon the digital wellbeing framework, this study identified what factors can raise mHealth app users’ HIL. Through an empirical investigation of college students in a public university, this study found that users’ gender, annual family income, internet experience, use frequency of mHealth apps, perceived quality of mHealth apps, and screen size of mobile phones had

Funding statement

The study is funded by The Fundamental Research Funds of Humanities and Social Science Research for the Central Universities of China (Project No. SKYC2021023) and 2021 Shuang Chuang Doctoral Program in Jiangsu Province.

Shaoxiong Fu is an associate professor and head of Department of Information Management Science at College of Information Management of Nanjing Agricultural University, Nanjing, China. He holds a PhD in information science from Wuhan University. He also worked as a visiting scholar at Department of Digitalization of Copenhagen Business School (Denmark). His current research focuses on health information behaviors in the context of social media. His work has been published at prestigious

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    Shaoxiong Fu is an associate professor and head of Department of Information Management Science at College of Information Management of Nanjing Agricultural University, Nanjing, China. He holds a PhD in information science from Wuhan University. He also worked as a visiting scholar at Department of Digitalization of Copenhagen Business School (Denmark). His current research focuses on health information behaviors in the context of social media. His work has been published at prestigious journals and leading conferences in information science and information systems, such as Information Processing & Management, Journal of Information Science, Behaviour & Information Technology, Proceedings of Association for Information Science and Technology, Pacific Asia Conference on Information Systems, and Hawaii International Conference on System Sciences.

    Xiaoyu Chen is an assistant professor at Department of Library, Information and Archives of Shanghai University, Shanghai, China. He holds a PhD in information studies from Nanyang Technological University, Singapore. His research interests focus on “3U”, namely, user information behavior, user cyberpsychology, and user-generated content, particularly in the context of digital technologies. His work has been published in peer-reviewed journals in information science and information management, such as Aslib Journal of Information Management, Behaviour & Information Technology, Information Processing & Management, International Journal of Medical Informatics, and Internet Research.

    Han Zheng is a PhD candidate at Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU, Singapore). He holds a Master of Science in knowledge management from NTU, and a Bachelor of business administration in tourism management from Universidad Complutense de Madrid (UCM), Spain. His current research focuses on online health informatics (e.g., cyberchondria). His work has been published in peer-reviewed academic journals such as Journal of the Association for Information Science and Technology, Internet Research, Computers in Human Behavior, Telematics & Informatics and Scientometrics.

    Mengxue Ou is an incoming PhD student at Wee Kim Wee School of Communication and Information of Nanyang Technological University, Singapore. She holds a Master by Research in communication studies from NTU, and a Bachelor of Art in journalism from Sun Yat-sen University, Guangzhou, China. Her research interests lie in health communication. Her work has been published in communication journals and conferences such as Communication Research, Annual Meeting of International Communication Association, and Annual Meeting of Association for Education in Journalism and Mass Communication.

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