Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research (Preprint)

Abstract

UNSTRUCTURED Over the past quarter-century, mobile health (mHealth) technologies experienced dynamic shifts in adoption rates, adaptation strategies, and instances of abandonment. Understanding the underlying factors driving these trends is crucial for optimizing interventions' design, implementation, and sustainability using these technologies. The evolution of mHealth adoption witnessed a progressive trajectory, initially marked by cautious exploration and subsequently accelerated by advancements in technology, increasing smartphone penetration, and growing acceptance of digital health solutions among both healthcare providers and patients. However, alongside widespread adoption, challenges related to usability, interoperability, privacy concerns, and socioeconomic disparities emerged, necessitating ongoing adaptation efforts. While many mHealth initiatives have successfully adapted to address these challenges, abandonment of technologies remains prevalent, often attributed to unsustainable business models, inadequate user engagement, and insufficient evidence of effectiveness. This paper utilizes the innovation-adoption Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to frame a review of the interplay between the academic and industry sectors on patterns of adoption, adaptation, and abandonment using three major mHealth innovations as examples: health-related text messaging, mobile applications and wearables, and the use of social media for health communication. Health text messaging demonstrated considerable potential as a tool for health promotion, disease management, and patient engagement. The proliferation of mobile apps and devices facilitated a transition from in-person and in-clinic practice to mobile and wearable-centric solutions ranging from simple activity trackers to sophisticated health monitoring devices. Initially characterized by simple text-only interactions via methods such as chat rooms and online forums, social media underwent a paradigm shift with the emergence of platforms like MySpace and Facebook, paving the way for the era of mass communication through social media. The rise of microblogging and visual-centric platforms like Twitter, Instagram, Snapchat and TikTok, as well as the integration of live streaming and augmented reality features, exemplifies ongoing innovation within the social media landscape. The last 25 years have seen remarkable strides in adopting and adapting mHealth technologies, driven by technological innovation and growing recognition of their potential to revolutionize healthcare delivery. Nevertheless, continued efforts are needed to address persistent challenges and mitigate instances of abandonment, ensuring that mHealth interventions realize their full potential in improving health outcomes and advancing equitable access to care.