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Currently submitted to: JMIR Mental Health

Date Submitted: Jul 5, 2019
Open Peer Review Period: Jul 5, 2019 - Jul 12, 2019
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“Stress - Is there a ‘good’ app for that?” Attitudes as a key determinant of the acceptance of stress management apps in Germany: Survey Study

  • Jennifer Apolinário-Hagen; 
  • Severin Hennemann; 
  • Lara Fritsche; 
  • Marie Drüge; 
  • Bernhard Breil



Chronic stress is a major public health concern. Mobile health applications (mHealth apps) may help promoting coping skills in daily life and prevent stress-related complaints. However, little is known about the acceptance of apps for stress management and predictors for their uptake in target populations.


The aim of this cross-sectional pilot study was to determine the public acceptance (behavioral use intention) of stress management apps and to explore its determinants based on an adapted and extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. Another purpose was to explore preferences in terms of the readiness to use mHealth apps in case of distress compared to other common mental health services.


A convenience sample from Germany completed a 54-item self-administered Web-based survey covering acceptance of mHealth and 25 potential predictors. Following significant zero-order-correlation testing, multiple hierarchical regression analysis was performed with 3 blocks: (1) background and stress variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants (i.e., performance-, effort expectancy, social influence, and facilitating conditions). The readiness to use mHealth apps in comparison to nine other mental health services (e.g. information website, psychological counselling) was analyzed using paired t-tests.


Out of 141 participants (mean age=34.84 years, SD=11.09; 61.0% female, 86/141). Acceptance was moderate on average (M=3.10, SD=1.03, min=1 to max=5). Nearly half of the participants (48.9%; 69/141) indicated prior mHealth use, which was associated with significantly higher acceptance of stress coping apps and more positive attitudes and beliefs (all P<.01). Multiple hierarchical regression including four out of 11 variables (R2=.62; P=.01) identified attitude toward using mHealth (ß=.69, P<.001), skepticism/perceived risks of mHealth (ß=-.14, P=.01) and severity of stress symptoms (ß=.12, P=.03) as significant predictors of acceptance, whereas mHealth use remained insignificant (ß=.04, P=.54). In contrast, the UTAUT determinants added no further predictive contribution to the overall model (all P>.05). The readiness to use mHealth was equal to or significantly higher than for most service types, except for websites that were preferred over all service types.


This study indicates that attitudes in terms of affect toward use may be at least as influencing on the acceptance of stress coping apps as more elaborated beliefs, such as performance expectancies. Hence, the early stage of mHealth adoption in Germany makes it worthwhile putting more emphasis on the emotional aspects of use. To improve the uptake of mental health apps, such information could be best disseminated via health websites. Clinical Trial: Not applicable


Please cite as:

Apolinário-Hagen J, Hennemann S, Fritsche L, Drüge M, Breil B

“Stress - Is there a ‘good’ app for that?” Attitudes as a key determinant of the acceptance of stress management apps in Germany: Survey Study

JMIR Preprints. 05/07/2019:15373

DOI: 10.2196/preprints.15373


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