Why Patients Don’t Use Apps

There are many reasons to believe that digital health apps and other digital health interventions can help patients and address business and financial concerns. Unfortunately, like many consumer apps once downloaded apps are infrequently used or deleted and most are not clinically validated. In addition, few hospitals offer them.

The who, what, when, where, how and whys of patient use of digital health interventions (DHIs), including apps, is complicated.

A recent research article explains just how complicated are the barriers and facilitators of adoption and penetration. The authors reviewed the relevant literature on DHIs and used an empirically grounded theory, Normalization Process Theory (NPT), was used to underpin the process. NPT is a useful heuristic device to explain how people individually and collectively embed new interventions in everyday routine through four generative mechanisms: sense-making work; relational work; operational work; and appraisal work and it has been used successfully in other systematic reviews. In other words, the analysis looks at the factors determining whether and how users move from awareness to intention to decision to action to analysis and whether they sustain the behavior or drop it. What determines which patients will pay for an app is another part of the equation.

The analysis is not just applicable to patients, but to clinicians as well, who frequently make Type 1 and Type 2 technology adoption errors mostly due to behavioral and emotional reasons.

Four major themes and several subthemes related to barriers and facilitators to engagement and recruitment in DHIs emerged. The four main themes are: 1) personal agency and motivation (internal/external motivation); 2) personal life and values (cost/benefit to spend time) ; 3) engagement and recruitment approach (marketing); and 4) the quality of the DHI (value proposition and UX/UI issues).

Using this Digital health engagement model (DIEGO), the authors recommended:

There is a need to invest in raising the profile of digital health products and services so patients and the public are knowledgeable about them.

Technology that incorporates and enhances communication, social interaction, and relationships with formal and informal care providers and peers with similar health issues, both online and offline, may help ensure engagement and enrollment, as people can quickly and easily access the social support they need to manage their wellbeing.

Accreditation and endorsement by respected clinical organizations or clinicians will be an important factor promoting engagement with digital health.

Marketing and engagement activities should consider targeting not just the individuals with a given condition or health issue but their wider relational and support networks, whose input may be a crucial factor in deciding uptake of new digital health initiatives.

Digital health engagement and enrolment strategies along with the products and services should be better designed and tailored where possible to lessen rather than increase the self-care burden of treatment people endure. This could enable them to integrate digital health with their current lifestyle, as a one-size fits all approach is unlikely to be effective.

More investment in digital upskilling mechanisms and technical infrastructure is needed alongside engagement and recruitment strategies if digital health uptake is to be enhanced.


Better funding models need to be put in place to help ensure equity of access to digital health products and services.

The public should be made more aware of the potential security risks with digital health products and services and better regulations need to be put in place to protect them to encourage engagement. We will need to confront the AI arms race.

Here are some things you should know about dissemination and implementation and whether digital health technologies can reduce outcome disparities.

The digital health business sits at the interface of sick care and consumer product eCommerce. As such, choosing the right business model can determine success or failure, since it is one of the major determinants of product success or failure

Digital health interventions, including apps, will continue to grow. However, without addressing the barriers to adoption as described above, most will fail. The digital health industry and those that promote their development and deployment, including accelerators and incubators, as well as health service organizations , have an obligation to ensure that these issues are properly addressed with valid market research before launching companies or initiatives that will produce faulty products and services that sap confidence in their ability to work.

Maybe Alexa can solve the problems now that Amazon has announced a new version with a touch screen.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs