Digital health interventions (DHIs), are health promotion attempts, delivered primarily through the internet (‘eHealth’) and through mobile devices (‘mHealth’). They hold promise in preventing and treating a host of lifestyle diseases, as they can be delivered in a scalable, cost-effective, timely and convenient manner. But they also suffer from the ‘Law of Attrition;’ the observation that, in any digital health trial, a substantial proportion of users drop out before completion or stop using the application.
This is a serious issue, as DHIs cannot live up to their promise and improve health if they are not used. No matter how well-crafted and evidence-based the intervention, active ingredients proven to effect health behaviour change simply cannot work if the technological components that house them are not accessed by participants. As such, lack of adequate engagement with DHIs poses a barrier to evaluating the effectiveness of these interventions.
But why don’t participants engage with these interventions? There can be many reasons. One qualitative study found that those who dropped out of an eHealth intervention reported their low motivation came from frustrating technology, irrelevant and incomprehensible content, prioritisation of other activities and the lack of face-to-face encounters. This speaks to two factors influencing disengagement: 1. Technology-related issues and 2. Person-related (e.g. their beliefs, cognitions and values).
Participants give up their precious time to take part in research. Researchers therefore owe it to participants to design effective interventions that are in line with their values, user-friendly and even enjoyable – placing the least possible burden on participants to achieve a ‘win’ in terms of health behaviour change (cue the concept of ‘effective engagement’– previously thoughtfully discussed on this blog – here and here).
But how can we do this? The first step is to adequately define what engagement is within the domain of each unique study. The second to apply a person-based, reflective design approach and the third is to implement helpful strategies in facilitating engagement.