Recommending high-quality health apps: Identifying key behavioral determinants of healthcare professional behavior

Healthcare professionals (HCPs) commonly see the potential of health apps for their patients, but in practice do not actively recommend them during consultation. As quality concerns have been identified as a key barrier, a health and wellness app assessment framework and related quality label was previously developed. Yet, even when health apps are of high quality, recommendation behavior may not necessarily follow due to other factors that are yet to be identified and targeted. The main aim of this study was to explore a wide range of HCP behavioral determinants and identify the key determinants of HCP app recommendation behavior. We used the TDF-checklist, which is based on the Theoretical Domains Framework (TDF), an evidence-based framework for the systematic assessment of behavioral determinants of HCP behavior, and adapted it to the study context. 290 Catalan HCPs filled in the survey. For all determinants, room for improvement (deviation from the maximum), relevance (correlation with anticipated behavior), and the potential for change (based on combining room for improvement and relevance) were assessed. A large majority of HCPs indicated they would recommend high-quality apps to their patients. Overall, HCPs were motivated, but more room for improvement was found for capability and opportunity-related domains. Anticipated recommendation behavior correlated strongest with motivational factors like beliefs about consequences and beliefs about capabilities. The potential for change was highest for nature of the behaviors (habit), beliefs about capabilities and knowledge. When implementing the label, efforts should focus on promoting habit formation for recommending high-quality apps, boosting confidence of HCPs, and providing further knowledge regarding health apps.