The adoption of health, well-being, and safety applications among people with a low socio-economic position: A qualitative study

Abstract
BackgroundToday’s society is becoming increasingly digital. However, not everyone can use online information, communication, and support (e.g., people without mobile devices, Internet access, or digital skills), increasing existing inequalities and reducing accessibility to information and services. Hence, this study aims to gain insight into the facilitators and barriers influencing the adoption of health, well-being, and safety apps among citizens with a low socio-economic position (low SEP) and their preferred support in using these apps from both the viewpoint of the citizens as the professionals working with low SEP citizens.MethodsFrom May to August 2023, 11 adult citizens living in low SEP areas and 12 professionals in close contact with low SEP citizens were interviewed (N = 23). In semi-structured interviews, facilitators and barriers to app adoption, preferred support in using apps, and the desired communication regarding apps and its support were discussed based on the Theoretical Framework of Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Additionally, for each of the participants (citizens and professionals), three case studies were discussed; a health, well-being, and safety app. Verbatim transcription and thematic analysis were used to analyze this data.ResultsOver 40 facilitators and barriers to app adoption were found within the concepts of performance expectancy, effort expectancy, social influence, and facilitating conditions. There appeared to be a lot of overlap between the opinions in the interviews with citizens and professionals. Overall, important facilitators were, amongst others, a positive attitude towards digitization, an accessible and user-friendly design, users’ perceived added value of an app, and a physical service point for support. Important barriers were, amongst others, login difficulties, lack of digital literacy, lack of infrastructure, and the experienced overabundance of apps.ConclusionsThe results of the current study confirm that the TAM and the UTAUT provide a good theoretical framework to outline the factors related to the adoption of health, well-being, and safety apps among the low SEP population. With this, the study revealed that the adoption requires consideration of performance expectancy, effort expectancy, social influence, and facilitating conditions. Low SEP citizens with a positive attitude towards digitization do want relevant, safe, and user-friendly apps on their smartphones provided that it’s only a few apps, that they have added value, and that there is adequate support to use them. To achieve this, the facilitators and barriers outlined in the current study are important to keep in mind.