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Adoption of a preventive health program via website versus mobile phone app across neighborhoods with different socioeconomic conditions in the Netherlands: cross-sectional study (Preprint)


 BACKGROUND
 Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered online serving as a potential solution. The preventive health program examined in this study is a large-scale, open access online platform operating in the Netherlands, aimed at improving the health behaviors and wellness of its participants.
 
 
 OBJECTIVE
 This study examines differences in adoption of an online preventive health program across socioeconomic groups, whereby comparing between its two delivery means: website versus mobile phone app.
 
 
 METHODS
 The 83,466 participants in this cross-sectional, non-experimental study are individuals who have signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means is estimated using the Prentice, Williams and Peterson Gap-Time model (PWP-GT), with the measure of neighborhood socio-economic status (NSES) employed to distinguish between population segments with different socioeconomic characteristics. Registration to the health program is voluntary and free, not within a controlled study setting, allowing for observing the true rate of adoption.
 
 
 RESULTS
 The estimation results indicate that program adoption across socioeconomic groups varies depending on program’s delivery means. For the website version, higher NSES groups have a higher likelihood of program adoption compared to the lowest NSES group (hazard ratio [HR]=1.03; 95% confidence interval [CI]=1.01, 1.05). For the mobile phone app version, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared to the lowest NSES group (HR=0.94; 95% CI=0.91, 0.97).
 
 
 CONCLUSIONS
 Promoting preventive health programs using mobile phone apps can help increase program adoption among the lowest socioeconomic segment. Given the increasing usage of mobile phones among the disadvantaged population groups, structuring future health interventions to include mobile phone apps as means of delivery can support the stride towards diminishing health disparities.
