User engagement in digital health interventions

Abstract

Developers and owners of information systems are often interested in how users use thesystem. For example, analyzing user engagement can help to see at what point a system is likely to stop being used, which in turn helps to improve the system and establish a longer-term user relationship.

This literature review studies engagement in digital health interventions – information systems that have the purpose of helping users improve their health and are deployed by healthcare providers. The goal was to explore what engagement is and how it is measured and clarify the difference between words like adherence, compliance, retention, attrition, and others. This was done with an etymological touch, because as expected digital health interventions' nomenclature combines medical, business, and information systems lingo.

Based on this research, user engagement is commonly defined as the “degree to which the user uses the intervention”. Engagement can mean usage, but usage is more limited to the quantity of use such as frequency and duration of interactions. In contrast, engagement is a more qualitative measure that assesses the depth and quality of users' interaction with the system including evidence of changes in user behavior as a result of using an intervention. Patients, actively engaging with digital health interventions, are also more likely to adhere to their treatment plans. However, it is important to note that engagement and adherence should not be used as synonyms. Semantic differences were identified for several word pairs, and future research recommended distinguishing particularly between adherence and engagement, adherence and compliance, and engagement and usage.

Research for enhancing user engagement with digital health interventions is important. This thesis helps by clarifying the complex terminology of this interdisciplinary topic.