Mobile health: could user engagement be driven by the common good?

In the world of mobile health platforms — mHealth apps — user retention is a constant challenge, even when trust and practicality are the order of the day. A study led in part by NEOMA researcher Michael Andreas Zaggl shows that additional factors are at work. Drawing on an analysis of the real-world use of a menstrual app, the study has highlighted the crucial role of perceived social utility.

In a rapidly evolving digital landscape, health is not immune to the surge in innovation. From glucose tracking to medication reminders and post-op support, mHealth embraces the suite of apps and digital devices that simplify prevention, monitoring and healthcare management via smartphones and similar connected objects. This global market, which was valued at over $170 billion in 2024, could grow beyond $4 trillion by 2032. In France, the authorities are trying to regulate this surge by introducing quality benchmarks and an official registry.

Some mHealth apps have already demonstrated their value, not least in the fields of chronic disease, mental well-being and reproductive health. But there’s still a major roadblock: although users download the apps, their engagement is minimal. The question is: why? To win users over, developers typically prioritise two key functions: practical utility and data confidentiality. But what if a more basic motivating factor has gone unnoticed? The recent study co-authored by the NEOMA researcher sheds new light on engagement patterns, and calls for a rethink of design strategies.

Handy but underused apps

Many health apps are freely accessible and ethically designed, sometimes as non-profit initiatives. Their goal is not to capture our attention but to provide a service or power research. And yet, even the best-designed app can only be effective if it is used consistently over time. This is the essence of user engagement, a notion that refers to the frequency, consistency and diversity of uses of an app. 

To gain insight into the mechanisms that drive this engagement, the researchers examined real-world interactions with an mHealth app: Lucy. This free-to-download, NGO-designed menstrual tracking app helps users understand their cycles as well as contributing to research in women's health, particularly endometriosis. The scientists utilised this platform to explore how lived experience encourages active engagement… or leads to drop-off.

Is social utility a new driver of user engagement?

The study did not rely solely on users' self-reported intentions: it also analysed their actual behaviour, such as how often they used the app, how long they spent on it, and which features they accessed. The researchers looked at four factors: the perceived risks associated with using the app, the expected self-benefits, the potential impact on society and trust in the app.

The results were something of a surprise! Trust and personal benefit alone do not fully account for strong user engagement. What’s more, concerns about data privacy do not appear to be a significant barrier. The only factor genuinely associated with sustained use is the feeling of contributing to a collective cause: supporting research, for example, or advancing knowledge or working for the greater good.

This finding turns the usual assumptions about the design of mHealth apps on its head. It suggests that in specific — personal — contexts, usage is motivated more by the perception of social utility than individual benefit. 

Utility is also based on collective well-being 

The results of the study cannot be universally extended to all mHealth solutions: the research focused on a specific case, and the outcomes should be interpreted with caution. At the same time, the scientists spotlighted a dynamic that is often overlooked in design strategies: user engagement can also be driven by a sense of contributing to a common goal. Showcasing the collective impact of data, highlighting its role in driving progress and nurturing a sense of belonging to a useful community — these are all key drivers that should be embedded in apps from the design stage. Rather than diminishing the need for security, transparency or individual efficiency, this approach invites us to view the user not simply as a user but also as an actor in the public health ecosystem.

This stance resonates with the recent findings of the Haute Autorité de Santé (French Health Authority), which notes that existing standards are geared towards technical, legal and medical factors. The issue of user engagement is seldom explored from the perspective of social drivers or ethical experience. And yet, these aspects are crucial if mHealth is to become a keystone of public health.

It follows that, in an ever more saturated ecosystem, it is in designers’ best interests to broaden their conceptual framework. And it is perhaps here that digital loyalty comes into play — in this subtle balance between personal autonomy and the feeling of benefiting a larger community.

Find out more

Tsirozidis, G., Kirk, U. B., & Zaggl, M. A. (2025). Benefits for thee, not for me? mHealth engagement through the lens of privacy calculus theory and trust. Behaviour & Information Technology. https://doi.org/10.1080/0144929X.2025.2485395