# Interpretable Machine Learning Models for Analyzing Determinants Affecting the Use of mHealth Apps Among Family Caregivers of Patients With Stroke in Chinese Communities: Cross-Sectional Survey Study

## TL;DR

This study uses machine learning to identify factors influencing the use of mHealth apps by caregivers of stroke patients in China, aiming to improve app design and adoption.

## Contribution

The study introduces interpretable machine learning models and SHAP analysis to identify key factors influencing mHealth app adoption among caregivers of stroke patients.

## Key findings

- Logistic regression and random forest models were top performers in predicting mHealth app use.
- Educational level, age, and patient self-care ability were key factors in app adoption.
- Hedonic motivation and usage habits significantly influenced app use behavior.

## Abstract

Mobile health (mHealth) apps are believed to be an effective method to support family caregivers to better care for patients with stroke. This study’s purpose was to explore the status and the influencing factors of mHealth app use among family caregivers of patients with stroke via machine learning (ML) models.

This study aimed to understand the status quo of mHealth app use among community family caregivers of patients with stroke and the factors influencing their use behavior. Six ML models were used to construct the classifier, and the Shapley Additive Explanations (SHAP) algorithm was introduced to interpret the best ML model.

In this cross-sectional study, family carers of patients with stroke were recruited. Data on their basic profile and mHealth app use were obtained through face-to-face questionnaires. Hedonic motivation, usage habits, and other relevant information were additionally measured among app users. A total of 12 models were constructed using six ML algorithms. The top-performing logistic regression and random forest models were further analyzed with SHAP to interpret key influencing factors.

A total of 360 family caregivers of patients with stroke were included in this study from March 2023 to November 2023, of which 206 (57.2%) reported having used mHealth apps. Of the 6 ML models, the logistic regression model performed the best in terms of whether caregivers used the mHealth app, with an area under the receiver operating characteristic curve of 0.753 (95% CI 0.698‐0.802), accuracy of 0.694 (95% CI 0.647‐0.742), sensitivity of 0.748 (95% CI 0.688‐0.806), and specificity of 0.623 (95% CI 0.547‐0.698). SHAP analysis showed that the top 5 most influencing factors were educational level, age, the patient’s self-care ability, the relationship with the cared-for individual, and the duration of illness. The random forest model performed best in terms of use behavior with an area under the receiver operating characteristic curve of 0.773 (95% CI 0.725‐0.818), accuracy of 0.602 (95% CI 0.534‐0.665), sensitivity of 0.476 (95% CI 0.420‐0.533), and specificity of 0.769 (95% CI 0.738‐0.797). The SHAP analysis revealed that hedonic motivation, habits, occupation, convenience conditions, and effort expectations were the 5 most significant influencing factors.

The research results indicate that the software developers and policymakers of mHealth apps should take the abovementioned influencing factors into consideration when developing and promoting the software. We should focus on the older adults with lower educational levels, lower the threshold for software use, and provide more convenient conditions. By grasping the hedonistic tendencies and habitual usage characteristics of users, they can provide them with more concise and accurate health information, which will enhance the popularity and effectiveness of mHealth apps.