Table 3.

Determinants of engagement with health-related apps among nondigitally native adults who have chronic pain and coexisting symptoms of depression or anxiety.

Theme		Representative quote
Tools
	Goals: participants used health-related apps for education, accountability, and community.	“I primarily enjoy getting information from them.” (61-year-old female) “I’ve done [a fitness app]...and [a mental health app]. I know what I need to do each day, and I don’t have to worry about remembering it. So I can log in, and each day I know I need to tackle these kind of tasks.” (49-year-old female) “I use [an online health community app]. A lot of people have the same experiences I do. So that’s why I like it. The same thing that I go through—people not believing me—it gives you a lot of insights.” (51-year-old female)
	Function: in descending order, participants most commonly used apps for activity/fitness tracking; blood sugar, blood pressure, and weight tracking; mental health, mindfulness, and mood tracking; food/calorie tracking; medication refills and communication with a health care provider; and sleep assistance.	“I have a [fitness tracking] app for monitoring my steps and water. My oncologist, once I was finished with treatment, wanted me to make sure I walked 10 to 15,000 steps a day.” (60-year-old female)
	Tracking: participants predominantly used health-related apps to assist with tracking one or more elements of their health.	“The step counter is really probably the only one I use regularly.” (50-year-old female)
User design
	Selective enthusiasm for passive data: the majority of participants were open to passive collection of some types of data but not others due to privacy concerns. If an app does passively collect data, they strongly voiced a need for the app to clearly describe the purpose and extent upfront, with an option to opt out.	“I tend to steer away from apps that ask me that kind of information because I’m not comfortable being tracked in where I am, what I’m doing. I just find it intrusive. I mean, I put my weight on there, my height, it has my blood pressure and my heartrate—so that’s pretty personal, but location—I do not share... [Passive data tracking] is a little creepy.” (66-year-old female) “I want to be able to pick when I use [passive data]. I don’t want it to be able to use it and pick me. I mean, I need reminders to use [the app], but not by my location.” (62-year-old female)
	Low enthusiasm for gamification: most participants did not consider embedded games or rewards as a meaningful motivator to engage with a health-related app.	“I don’t know if I’m a typical guy or maybe not, but I don’t like games. When it comes to something like this, I’m not motivated by a reward. I would rather see [all my tool] options than, ‘Good boy, good boy.’ ...When it comes to counting my steps, it is nice at the end of the night to have hit my target or beyond. So in that sense, yes, an emotional reward is a good thing. But the reward is that I’ve accomplished what I want. I don’t need something extra on top of that.” (72-year-old male)
Timing of interactions
	Participants strongly preferred the ability to customize their timing of interaction with the app (eg, time and frequency of push notifications and ability to turn off push notifications).	“I like if it allows you to set what time you want [for check-ins].” (64-year-old female) “I would like the option [of changing the check in frequency].” (55-year-old female)
General app preferences
	Source: participants were more likely to use a health-related app if it is recommended by a medical professional or directly offered from their medical provider/hospital system.	“It’s normally based on advice from a medical professional that I would download something of this type.” (51-year-old male)