Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions
Introduction
Engagement with health interventions is a precondition for effectiveness; this is a particular concern for digital behavior change interventions (DBCIs), that is, interventions that employ digital technologies such as the Internet, telephones, and mobile and environmental sensors.1 Maintaining engagement can be especially difficult when DBCIs are used without human support, typically leading to high levels of dropout and “non-usage attrition,”2, 3 whereby participants do not sustain engagement with the intervention technologies. This paper discusses current approaches to conceptualizing and measuring engagement, and considers key issues relevant to promoting effective engagement.
This paper is one in a series developed through a process of expert consensus to provide an overview of questions of current importance in research into engagement with DBCIs, and to identify outstanding conceptual and methodologic issues.1 An international steering committee invited established and emerging experts to form a writing group to contribute to this process. The scope, focus, and conclusions were formulated initially by the committee and writing group, and then further discussed and modified with input from 42 experts contributing to a multidisciplinary international workshop. As such, the paper is necessarily selective and does not exhaustively review the relevant literature or propose particular models or solutions, but provides a critical reflection on the state of the art. The insights gained from this process are summarized in the concluding table as guidance based on research to date and priority topics for future research.
Some of the insights into engagement that emerged are specific to DBCIs, which have features that are not shared with other forms of intervention delivery—in particular, the potential to automatically record and respond to how the user is engaging with the intervention. However, many of the challenges confronting DBCI use are shared with other types of intervention—for example, the need for users to engage with the behavior change. Consequently, the unique potential of DBCIs to record engagement and behavior in detail over time is likely to generate important new insights that have relevance to engagement with other behavior change interventions.
Section snippets
Conceptualizing Engagement
The term engagement has been used in different ways in engagement research, making it challenging to synthesize the models and measures that have been proposed. Some researchers focus principally on engagement with digital technology, drawing on disciplines such as human–computer interaction, psychology, communication, marketing, and game-based learning.4 In this approach, engagement is typically studied in terms of intervention usability and usage, and factors that influence these. For
Promoting Effective Engagement
This section first introduces techniques for promoting effective engagement, identifying substantive gaps in knowledge and directions for future investigation, and then considers two key topics in engagement research: tailoring to individual needs (including the needs of those with lower levels of literacy and computer literacy) and combining DBCIs with human support.
Conclusions
Significant progress has been made in recent years in understanding the nature of and requirements for engagement, and particularly in recognizing the importance of carrying out in-depth mixed methods research into how people engage with DBCIs. Table 2 summarizes key guidance points emerging from research to date and highlights areas for further work. Future research would benefit from defining engagement more consistently and appropriately, appreciating that more engagement does not
Acknowledgments
This 2016 theme issue of the American Journal of Preventive Medicine is supported by funding from the NIH Office of Behavioral and Social Sciences Research (OBSSR) to support the dissemination of research on digital health interventions, methods, and implications for preventive medicine.
This paper is one of the outputs of two workshops, one supported by the Medical Research Council (MRC)/National Institute for Health Research (NIHR) Methodology Research Program (PI Susan Michie), the OBSSR
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This article is part of a theme section titled Digital Health: Leveraging New Technologies to Develop, Deploy, and Evaluate Behavior Change Interventions.