{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:25:07Z","timestamp":1777551907829,"version":"3.51.4"},"reference-count":86,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mobile interventions for health promotion (mHealth) are promising behaviour change tools. Yet they are infrequently used, and research suggests that use may be unevenly distributed in the population, potentially widening existing health inequalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study tested for individual and joint associations between socio-demographic characteristics and nutrition and physical activity app use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>\n                      Nationally representative samples for Austria, Germany and Italy were recruited with\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u20091974 participants in total. In an online survey, participants reported on nutrition and physical activity app use as well as a range of relevant socio-demographic characteristics associated with social inequality according to PROGRESS-Plus (age, gender, education, income, employment status, rural vs. urban residency, Austrian\/German\/Italian citizenship, migration history, minority status, and sexual orientation).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Except for residency and migration status, all socio-demographic characteristics were associated with mHealth app (non-)use if analysed independently. A latent class analysis revealed four distinct classes of mHealth app (non-)users. \u2018Young and diverse citizens\u2019 (characterised by young age and lowest proportion of heterosexuals) and \u2018economically strong employees\u2019 (characterised by highest levels of education and income) were more likely to use mHealth apps compared to \u2018established retirees\u2019 (characterised by largest share of retired individuals) and \u2018low-income workers\u2019 (characterised by lowest levels of education and income).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age, education, income and employment are crucial inequality indicators for mHealth app use. These results confirm the existence of a digital health divide in Europe that urgently needs addressing to promote digital health for all.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/s2wya\">https:\/\/osf.io\/s2wya<\/jats:ext-link>\n                      (Austria and Germany),\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/tpu2m\">https:\/\/osf.io\/tpu2m<\/jats:ext-link>\n                      (Italy).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076261429621","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T02:16:49Z","timestamp":1774577809000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Conjoint analysis of social inequality indicators in diet and physical activity app (non-)users: Representative online surveys in Austria, Germany and Italy"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3655-8842","authenticated-orcid":false,"given":"Laura M","family":"K\u00f6nig","sequence":"first","affiliation":[{"name":"University of Vienna"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7065-9820","authenticated-orcid":false,"given":"Lucia","family":"Volpi","sequence":"additional","affiliation":[{"name":"University of Vienna"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4462-0095","authenticated-orcid":false,"given":"Theresa JS","family":"Koch","sequence":"additional","affiliation":[{"name":"University of Vienna"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Weber A Haderer M Hofmann R et al. A digital app-supported general practitioner-led weight loss program improves food literacy and intake in adults in rural Germany: Secondary outcomes of the HAPpEN pragmatic trial. medRxiv."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2196\/31665"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01172-y"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12903"},{"key":"e_1_3_3_6_2","unstructured":"World Health Organization. Global strategy on digital health 2020\u20132025. World Health Organization 2021."},{"key":"e_1_3_3_7_2","unstructured":"GREEN PAPER on mobile Health (\u201cmHealth\u201d) [press release]. Brussels: European Commission 2014."},{"key":"e_1_3_3_8_2","volume-title":"eHealth action plan 2012\u20132020 \u2013 innovative healthcare for the 21st century","author":"European Commission","year":"2012","unstructured":"European Commission. eHealth action plan 2012\u20132020 \u2013 innovative healthcare for the 21st century. Brussels: European Commission, 2012."},{"key":"e_1_3_3_9_2","unstructured":"European Commission. eHealth policy 2017. Available at: https:\/\/ec.europa.eu\/health\/ehealth\/policy_en archived by webcite at http:\/\/www.webcitation.org\/6r9uMbtg6"},{"key":"e_1_3_3_10_2","unstructured":"Stewart C. Share of health app users in selected countries as of 2022 Statista. 2022. Available at: https:\/\/www.statista.com\/forecasts\/1181436\/share-of-health-app-users-by-country"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0275689"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.4924"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-021-01349-4"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.2196\/16299"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.8261"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6838"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-016-0492-7"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2196\/49148"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5604"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2018.07.02"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.838509"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-023-02055-6"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076221129093"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.08.005"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13542"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01405-0"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.70057"},{"key":"e_1_3_3_28_2","unstructured":"World Health Organization. WHO European Regional Obesity Report 2022. 2022."},{"key":"e_1_3_3_29_2","first-page":"269","article-title":"Educational inequality versus income inequality: an empirical investigation","volume":"52","author":"Sa\u011flam BB","year":"2021","unstructured":"Sa\u011flam BB. Educational inequality versus income inequality: an empirical investigation. Econ Soc Rev (Irel) 2021; 52: 269\u2013299.","journal-title":"Econ Soc Rev (Irel)"},{"key":"e_1_3_3_30_2","unstructured":"eurostat. Individuals \u2013 devices used to access the internet (version: 16 December 2025) 2025. Available at: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/isoc_ci_dev_i\/default\/table?lang=en"},{"key":"e_1_3_3_31_2","unstructured":"World Bank Group. World Bank Country and Lending Groups n.d. Available at: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519"},{"key":"e_1_3_3_32_2","unstructured":"eurostat. Population and population change statistics (version: 6 July 2025) 2025. Available at: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Population_and_population_change_statistics"},{"key":"e_1_3_3_33_2","unstructured":"eurostat. Unemployment by sex and age \u2013 annual data (version: 8 January 2026) 2026. Available at: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/une_rt_a\/default\/table?lang=en"},{"key":"e_1_3_3_34_2","unstructured":"eurostat. GDP per capita in PPS (version: 13 January 2026) 2026. Available at: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/tec00114\/default\/table?lang=en"},{"key":"e_1_3_3_35_2","unstructured":"Population in private households by educational attainment level and NUTS 2 region [Internet]. 2025 [cited 16 January 2026]. Available at: https:\/\/ec.europa.eu\/eurostat\/en\/web\/products-datasets\/-\/EDAT_LFSE_04"},{"key":"e_1_3_3_36_2","unstructured":"eurostat. Life expectancy at birth by sex (version: 11 September 2025) 2025. Available at: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/tps00205\/default\/table?lang=en"},{"key":"e_1_3_3_37_2","unstructured":"Statistisches Bundesamt. K\u00f6rperma\u00dfe der Bev\u00f6lkerung nach Altersgruppen 2023. Available at: https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Gesundheit\/Gesundheitszustand-Relevantes-Verhalten\/Tabellen\/koerpermasse-insgesamt.html"},{"key":"e_1_3_3_38_2","unstructured":"eurostat. Person distribution by body mass index educational attainment level sex and age (version 20 October 2025) 2025. Available at: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/ilc_hch10\/default\/table?lang=en"},{"key":"e_1_3_3_39_2","unstructured":"K\u00f6nig LM Ruf A Koch TJS et al. (Digital) health survey in a representative German and Austrian sample OSFRegistries2024 May 6. Available at: https:\/\/osf.io\/s2wya"},{"key":"e_1_3_3_40_2","unstructured":"K\u00f6nig LM Koch TJS Volpi L. (Digital) health survey in a representative Italian sample 2024. Available at: https:\/\/osf.io\/tpu2m"},{"key":"e_1_3_3_41_2","unstructured":"K\u00f6nig LM Koch TJS. Who uses nutrition and fitness apps? Representative survey in Italy 2024 August 23. Available at: https:\/\/osf.io\/m24k5."},{"key":"e_1_3_3_42_2","unstructured":"K\u00f6nig LM Koch TJS. (Digital) health survey in a representative German and Austrian sample 2024 May 6. Available at: https:\/\/osf.io\/uab3w"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"e_1_3_3_44_2","unstructured":"Statistisches Bundesamt. Bev\u00f6lkerung: Deutschland Stichtag Altersjahre. In: Bundesamt S editor. 2022."},{"key":"e_1_3_3_45_2","unstructured":"Statistisches Bundesamt. Bev\u00f6lkerung nach Nationalit\u00e4t und Geschlecht (Quartalszahlen) 2023. Available at: https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Bevoelkerung\/Bevoelkerungsstand\/Tabellen\/liste-zensus-geschlecht-staatsangehoerigkeit.html#651186"},{"key":"e_1_3_3_46_2","unstructured":"OECD. Adult education level (indicator). 2021. Available at: https:\/\/data.oecd.org\/eduatt\/adult-education-level.htm#indicator-chart"},{"key":"e_1_3_3_47_2","unstructured":"Statistik Austria. Bev\u00f6lkerung nach Alter\/Geschlecht 2024. Available at: https:\/\/www.statistik.at\/statistiken\/bevoelkerung-und-soziales\/bevoelkerung\/bevoelkerungsstand\/bevoelkerung-nach-alter\/geschlecht"},{"key":"e_1_3_3_48_2","volume-title":"Frauen und m\u00e4nner in \u00f6sterreich","author":"Bundeskanzleramt","year":"2021","unstructured":"Bundeskanzleramt. Frauen und m\u00e4nner in \u00f6sterreich. Wien: Bundeskanzleramt, 2021."},{"key":"e_1_3_3_49_2","unstructured":"Instito Nazionale Di Statistica. Annuario Statistico Italiano. Rome 2024. Contract No.: 4 April 2025."},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2025.108562"},{"key":"e_1_3_3_51_2","doi-asserted-by":"crossref","unstructured":"Volpi L K\u00f6nig LM. Symptoms and distress across the menstrual cycle in a representative sample of Austrian and German people who menstruate: a cross-sectional study. OSFPreprints. 2025 August 6.","DOI":"10.31219\/osf.io\/q32nf_v1"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1111\/aphw.70077"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.7.4.355"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.11.3.170"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scp.2023.101072"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjhp.12670"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvp.2022.101815"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1080\/10705510701575396"},{"key":"e_1_3_3_59_2","first-page":"440","article-title":"Ten frequently asked questions about latent class analysis","volume":"4","author":"Nylund-Gibson K","year":"2018","unstructured":"Nylund-Gibson K, Choi AY. Ten frequently asked questions about latent class analysis. Trans Issues Psychol Sci 2018; 4: 440.","journal-title":"Trans Issues Psychol Sci"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781003158769"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvb.2016.07.004"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1080\/10705511.2014.919825"},{"key":"e_1_3_3_63_2","unstructured":"Clark SL Muth\u00e9n B. Relating latent class analysis results to variables not included in the analysis. Los Angeles California USA. 2009."},{"key":"e_1_3_3_64_2","first-page":"1","article-title":"Auxiliary variables in mixture modeling: using the BCH method in Mplus to estimate a distal outcome model and an arbitrary secondary model","volume":"21","author":"Asparouhov T","year":"2014","unstructured":"Asparouhov T, Muth\u00e9n B. Auxiliary variables in mixture modeling: using the BCH method in Mplus to estimate a distal outcome model and an arbitrary secondary model. Mplus Web Notes 2014; 21: 1\u201322.","journal-title":"Mplus Web Notes"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12232454"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1080\/10447318.2018.1456150"},{"key":"e_1_3_3_67_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12911-016-0359-3","article-title":"Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies","volume":"16","author":"O\u2019Connor S","year":"2016","unstructured":"O\u2019Connor S, Hanlon P, O\u2019Donnell CA, et al. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 2016; 16: 1\u201315.","journal-title":"BMC Med Inform Decis Mak"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.2196\/20037"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-025-00433-x"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.3109\/17538157.2014.948171"},{"key":"e_1_3_3_71_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6709"},{"key":"e_1_3_3_72_2","first-page":"1","article-title":"Sociodemographics and digital health literacy in using wearables for health promotion and disease prevention: cross-sectional nationwide survey in Germany","volume":"46","author":"Pan C-C","year":"2024","unstructured":"Pan C-C, De Santis KK, Muellmann S, et al. Sociodemographics and digital health literacy in using wearables for health promotion and disease prevention: cross-sectional nationwide survey in Germany. J Prevent 2024; 46: 1\u201321.","journal-title":"J Prevent"},{"key":"e_1_3_3_73_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-021-01218-4"},{"key":"e_1_3_3_74_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-050212-185634"},{"key":"e_1_3_3_75_2","doi-asserted-by":"publisher","DOI":"10.1177\/0020731419885093"},{"key":"e_1_3_3_76_2","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2016.09.01"},{"key":"e_1_3_3_77_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0266016"},{"key":"e_1_3_3_78_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165908"},{"key":"e_1_3_3_79_2","doi-asserted-by":"publisher","DOI":"10.1207\/s15324796abm2702_5"},{"key":"e_1_3_3_80_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-020-0224-8"},{"key":"e_1_3_3_81_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-024-07937-w"},{"key":"e_1_3_3_82_2","unstructured":"Mercer L Al Masri M Rocha D et al. The mechanisms underpinning the digital health divide: A scoping review of interventions for weight-related behaviours. Manuscript submitted for publication. 2024."},{"key":"e_1_3_3_83_2","doi-asserted-by":"publisher","DOI":"10.1080\/21642850.2025.2493139"},{"key":"e_1_3_3_84_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9030357"},{"key":"e_1_3_3_85_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13142-016-0453-1"},{"key":"e_1_3_3_86_2","doi-asserted-by":"publisher","DOI":"10.1080\/21614083.2021.2014047"},{"key":"e_1_3_3_87_2","first-page":"193229682211216","article-title":"The German fast track toward reimbursement of digital health applications (DiGA): opportunities and challenges for manufacturers, healthcare providers, and people with diabetes","volume":"18","author":"Schliess F","year":"2022","unstructured":"Schliess F, Affini Dicenzo T, Gaus N, et al. The German fast track toward reimbursement of digital health applications (DiGA): opportunities and challenges for manufacturers, healthcare providers, and people with diabetes. J Diabetes Sci Techn 2022; 18: 19322968221121660.","journal-title":"J Diabetes Sci Techn"}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261429621","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076261429621","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261429621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:56:16Z","timestamp":1777398976000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076261429621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":86,"alternative-id":["10.1177\/20552076261429621"],"URL":"https:\/\/doi.org\/10.1177\/20552076261429621","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"article-number":"20552076261429621"}}