Influence of the Business Revenue, Recommendation, and Provider Models on Mobile Health App Adoption: Three-Country Experimental Vignette Study

Francisco Lupianez-Villanueva Lupianez-Villanueva, Frans Folkvord*, Mariek Vanden Abeele

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review


Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits of mHealth for patients and health care providers, scientific research examining factors explaining the adoption level of mHealth tools remains scarce.

Objective: We performed an experimental vignette study to investigate how four factors related to the business model of an mHealth app affect its adoption and users' willingness to pay: (1) the revenue model (ie, sharing data with third parties vs accepting advertisements); (2) the data protection model (General Data Protection Regulation [GDPR] -compliant data handling vs nonGDPR-compliant data handling); (3) the recommendation model (ie, doctor vs patient recommendation); and (4) the provider model (ie, pharmaceutical vs medical association provider). In addition, health consciousness, health information orientation, and electronic health literacy were explored as intrapersonal predictors of adoption.

Methods: We conducted an experimental study in three countries, Spain (N=800), Germany (N=800), and the Netherlands (N=416), to assess the influence of multiple business models and intrapersonal characteristics on the willingness to pay and intention to download a health app.

Results: The revenue model did not affect willingness to pay or intentions to download the app in all three countries. In the Netherlands, data protection increased willingness to pay for the health app (P

Conclusions: The finding that people want their data protected by legislation but are not willing to pay more for data protection suggests that in the context of mHealth, app privacy protection cannot be leveraged as a selling point. However, people do value a doctor recommendation and apps manufactured by a medical association, which particularly influence their intention to download an mHealth app.

Original languageEnglish
Article number17272
Number of pages13
JournalJMIR mHealth and uHealth
Issue number6
Publication statusPublished - 4 Jun 2020


  • mHealth adoption
  • experiment
  • mobile apps
  • self-monitoring
  • privacy paradox
  • business model
  • data protection
  • recommendation
  • health consciousness
  • health information orientation
  • eHealth literacy
  • CARE

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