SELF-REPORTED MOBILE HEALTH APP ENGAGEMENT AND HEALTH-PROMOTING BEHAVIOUR AMONG INDONESIAN ADOLESCENTS: THE MODERATING ROLES OF SOCIAL SUPPORT AND DIGITAL LITERACY
DOI:
https://doi.org/10.70332/jkp.v4i1.64Keywords:
Bandung; cross-sectional study; digital literacy; health-promoting behaviour; self-reported mHealth engagement; moderation analysis; perceived social supportAbstract
Objective: Mobile health applications are increasingly used to support adolescent health promotion, yet the association between adolescents' self-reported engagement with these applications and health-promoting behaviour may depend on psychosocial resources and digital competencies. This study examined the moderating roles of perceived social support and digital literacy in the association between self-reported mobile health app engagement and health-promoting behaviour among Indonesian adolescents. Methods: A quantitative cross-sectional study was conducted among 240 adolescents aged 13-18 years from secondary schools in Bandung City and Bandung Regency, West Java, Indonesia, selected using multistage proportionate stratified random sampling. Data were collected using validated self-report instruments and analysed using descriptive statistics, Pearson correlation, hierarchical multiple regression, and regression-based moderation analysis with demographic covariates controlled. Result: Self-reported mobile health app engagement was positively correlated with health-promoting behaviour (r = .42, p < .001). Perceived social support and digital literacy were significant independent predictors, and both interaction terms were significant, suggesting that the association between self-reported mobile health app engagement and health-promoting behaviour was stronger among adolescents with higher perceived social support and digital literacy. The final model explained 44.9% of the variance in health-promoting behaviour. Consclussion: These findings suggest that adolescent mobile health programmes should integrate digital health literacy development and socially supported engagement strategies to strengthen health promotion outcomes.
References
Aguinis, H., Beaty, J. C., Boik, R. J., & Pierce, C. A. (2005). Effect size and power in assessing moderating effects of categorical variables using multiple regression: A 30-year review. Journal of Applied Psychology, 90(1), 94-107. https://doi.org/10.1037/0021-9010.90.1.94
Aloi, M. A., Caldwell, P. H., Taba, M., Kang, M., Skinner, S. R., Bray, L., & Scott, K. M. (2025). Co-designing an online educational resource to help adolescents improve their digital health literacy. BMC Public Health, 25, Article 1870. https://doi.org/10.1186/s12889-025-22949-0
Baumann, H., Fiedler, J., Wunsch, K., Woll, A., & Wollesen, B. (2022). mHealth interventions to reduce physical inactivity and sedentary behavior in children and adolescents: Systematic review and meta-analysis of randomized controlled trials. JMIR mHealth and uHealth, 10(5), e35920. https://doi.org/10.2196/35920
Colder Carras, M., Aljuboori, D., Shi, J., Date, M., Karkoub, F., Garcia Ortiz, K., Abreha, F. M., & Thrul, J. (2024). Prevention and health promotion interventions for young people in the context of digital well-being: Rapid systematic review. Journal of Medical Internet Research, 26, e59968. https://doi.org/10.2196/59968
Conley, C. S., Raposa, E. B., Bartolotta, K., Broner, S. E., Hareli, M., Forbes, N., Christensen, K. M., & Assink, M. (2022). The impact of mobile technology-delivered interventions on youth well-being: Systematic review and 3-level meta-analysis. JMIR Mental Health, 9(7), e34254. https://doi.org/10.2196/34254
Council for International Organizations of Medical Sciences. (2016). International ethical guidelines for health-related research involving humans. CIOMS.
Deslippe, A. L., De-Jongh Gonzalez, O., Buckler, E. J., Ball, G. D. C., Ho, J., Bucholz, A., Morrison, K. M., & Masse, L. C. (2023). Do individual characteristics and social support increase children's use of an mHealth intervention? Findings from the evaluation of a behavior change mHealth app, Aim2Be. Childhood Obesity, 19(7), 435-442. https://doi.org/10.1089/chi.2022.0055
Eaton, C., Vallejo, N., McDonald, X., Wu, J., Rodriguez, R., Muthusamy, N., Mathioudakis, N., & Riekert, K. A. (2024). User engagement with mHealth interventions to promote treatment adherence and self-management in people with chronic health conditions: Systematic review. JMIR mHealth and uHealth, 12, e50508. https://doi.org/10.2196/50508
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160. https://doi.org/10.3758/BRM.41.4.1149
Hawkins, A., Taba, M., Caldwell, P. H. Y., Kang, M., Skinner, S. R., & McCaffery, K. (2025). Enhancing digital health literacy in adolescents: Evaluation of a co-designed educational app. BMC Public Health, 25, Article 3869. https://doi.org/10.1186/s12889-025-25022-y
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Press.
Kim, K., Shin, S., Kim, S., & Lee, E. (2023). The relation between eHealth literacy and health-related behaviors: Systematic review and meta-analysis. Journal of Medical Internet Research, 25, e40778. https://doi.org/10.2196/40778
Laksmita, O. D., Chung, M.-H., Liao, Y.-M., & Chang, P.-C. (2020). Multidimensional Scale of Perceived Social Support in Indonesian adolescent disaster survivors: A psychometric evaluation. PLOS ONE, 15(3), e0229958. https://doi.org/10.1371/journal.pone.0229958
Li, Z., Lu, F., Wu, J., Bao, R., Rao, Y., Yang, Y., & Wang, H. (2024). Usability and effectiveness of eHealth and mHealth interventions that support self-management and health care transition in adolescents and young adults with chronic disease: Systematic review. Journal of Medical Internet Research, 26, e56556. https://doi.org/10.2196/56556
Mancone, S., Corrado, S., Tosti, B., Spica, G., & Diotaiuti, P. (2024). Integrating digital and interactive approaches in adolescent health literacy: A comprehensive review. Frontiers in Public Health, 12, 1387874. https://doi.org/10.3389/fpubh.2024.1387874
Norman, C. D., & Skinner, H. A. (2006). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27
Raeside, R. (2025). Advancing adolescent health promotion in the digital era. Health Promotion International, 40(2), daae172. https://doi.org/10.1093/heapro/daae172
Sari, E. N. (2023). The Indonesian digital health landscape. Health Intervention and Technology Assessment Program. https://www.hitap.net/en/documents/187528
Sequi-Dominguez, I., Cavero-Redondo, I., Alvarez-Bueno, C., Lopez-Gil, J. F., Martinez-Vizcaino, V., & Pascual-Morena, C. (2024). Effectiveness of eHealth interventions promoting physical activity in children and adolescents: Systematic review and meta-analysis. Journal of Medical Internet Research, 26, e41649. https://doi.org/10.2196/41649
Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261-264. https://doi.org/10.4103/0019-5154.182410
Singh, B., Ahmed, M., Staiano, A. E., Vasiloglou, M. F., Gough, C., Petersen, J. M., Yin, Z., Vandelanotte, C., Kracht, C., Fiedler, J., Timm, I., Dallinga, J., Sivakumar, B., Baumann, H., Huong, C., Wunsch, K., Suarez-Reyes, M., Schoeppe, S., Button, A. M., Spring, K., & Maher, C. (2025). Lifestyle eHealth and mHealth interventions for children and adolescents: Systematic umbrella review and meta-meta-analysis. Journal of Medical Internet Research, 27, e69065. https://doi.org/10.2196/69065
Taba, M., Allen, T. B., Caldwell, P. H. Y., Skinner, S. R., Kang, M., McCaffery, K., & Scott, K. M. (2022). Adolescents' self-efficacy and digital health literacy: A cross-sectional mixed methods study. BMC Public Health, 22, 1223. https://doi.org/10.1186/s12889-022-13599-7
Tabrizi, J. S., Doshmangir, L., Khoshmaram, N., Shakibazadeh, E., Abdolahi, H. M., & Khabiri, R. (2024). Key factors affecting health-promoting behaviors among adolescents: A scoping review. BMC Health Services Research, 24, 58. https://doi.org/10.1186/s12913-023-10510-x
Talens, C., da Quinta, N., Adebayo, F. A., Erkkola, M., Heikkila, M., Bargiel-Matusiewicz, K., Ziolkowska, N., Rioja, P., Lys, A. E., Santa Cruz, E., & Meinila, J. (2025). Mobile- and web-based interventions for promoting healthy diets, preventing obesity, and improving health behaviors in children and adolescents: Systematic review of randomized controlled trials. Journal of Medical Internet Research, 27, e60602. https://doi.org/10.2196/60602
UNICEF Indonesia. (2025). Indonesia adolescent health profile 2024. UNICEF. https://www.unicef.org/indonesia/health/reports/adolescent-health-profile
Van Baelen, F., De Regge, M., Lariviere, B., Verleye, K., Schelfout, S., & Eeckloo, K. (2022). Role of social and app-related factors in behavioral engagement with mHealth for improved well-being among chronically ill patients: Scenario-based survey study. JMIR mHealth and uHealth, 10(8), e33772. https://doi.org/10.2196/33772
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gotzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLOS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296
Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The Health-Promoting Lifestyle Profile: Development and psychometric characteristics. Nursing Research, 36(2), 76-81.
Wang, J.-W., Zhu, Z.-C., Zhang, S.-L., Fan, J., Jin, Y., Gao, Z.-L., Chen, W.-D., & Li, X. (2024). Effectiveness of mHealth app-based interventions for increasing physical activity and improving physical fitness in children and adolescents: Systematic review and meta-analysis. JMIR mHealth and uHealth, 12, e51478. https://doi.org/10.2196/51478
Wang, X., Yue, T., & Mo, P. K. H. (2022). The associations among cognitive social factors, eHealth literacy and health-promoting behaviors in Chinese adolescents. Health Promotion International, 37(6), daac143. https://doi.org/10.1093/heapro/daac143
Wani, C., McCann, L., Lennon, M., & Radu, C. (2024). Digital mental health interventions for adolescents in low- and middle-income countries: Scoping review. Journal of Medical Internet Research, 26, e51376. https://doi.org/10.2196/51376
Wijaya, M. C., & Kloping, Y. P. (2021). Validity and reliability testing of the Indonesian version of the eHealth Literacy Scale during the COVID-19 pandemic. Health Informatics Journal, 27(1), 1460458220975466. https://doi.org/10.1177/1460458220975466
World Health Organization. (2021). Global strategy on digital health 2020-2025. World Health Organization. https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf
World Health Organization. (2025). Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053
Zhou, L., Bao, J., Setiawan, I. M. A., Saptono, A., & Parmanto, B. (2019). The mHealth App Usability Questionnaire (MAUQ): Development and validation study. JMIR mHealth and uHealth, 7(4), e11500. https://doi.org/10.2196/11500
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/s15327752jpa5201_2
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Jurnal Keperawatan PPNI Jawa Barat
This work is licensed under a Creative Commons Attribution 4.0 International License.
