Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis

Olga Perski,Susan Michie,Ann Blandford,Robert West

doi:10.1007/s13142-016-0453-1

Abstract

“Engagement” with digital behaviour change interventions (DBCIs) is considered important for their effectiveness. Evaluating engagement is therefore a priority; however, a shared understanding of how to usefully conceptualise engagement is lacking. This review aimed to synthesise literature on engagement to identify key conceptualisations and to develop an integrative conceptual framework involving potential direct and indirect influences on engagement and relationships between engagement and intervention effectiveness. Four electronic databases (Ovid MEDLINE, PsycINFO, ISI Web of Knowledge, ScienceDirect) were searched in November 2015. We identified 117 articles that met the inclusion criteria: studies employing experimental or non-experimental designs with adult participants explicitly or implicitly referring to engagement with DBCIs, digital games or technology. Data were synthesised using principles from critical interpretive synthesis. Engagement with DBCIs is conceptualised in terms of both experiential and behavioural aspects. A conceptual framework is proposed in which engagement with a DBCI is influenced by the DBCI itself (content and delivery), the context (the setting in which the DBCI is used and the population using it) and the behaviour that the DBCI is targeting. The context and “mechanisms of action” may moderate the influence of the DBCI on engagement. Engagement, in turn, moderates the influence of the DBCI on those mechanisms of action. In the research literature, engagement with DBCIs has been conceptualised in terms of both experience and behaviour and sits within a complex system involving the DBCI, the context of use, the mechanisms of action of the DBCI and the target behaviour.

Highlights

A substantial number of Internet-connected adults use some forms of digital technology to monitor or modify their health: estimates vary between 20 and 80% [1,2,3]
critical interpretive synthesis (CIS) is useful when a review seeks to identify a definition of a phenomenon, as it aims to produce a higher-order structure or conceptual framework (Bsynthesising argument^), which is grounded in the concepts (Bsynthetic constructs^) identified in the reviewed articles [32]
Engagement; while the former involves contributing to the intervention through posting in an Measures relating to the integrated conceptualisation of online discussion forum, the latter involves read- engagement ing what others have written without comment- Based on the literature synthesis, we suggest that all ing, known as Blurking^ [57]

Summary

Introduction

A substantial number of Internet-connected adults use some forms of digital technology to monitor or modify their health: estimates vary between 20 and 80% [1,2,3]. Implications Practice: The use of a shared conceptual framework for engagement with digital behaviour change interventions (DBCIs) should promote more rapid advances in developing methods to improve it. Policy: A shared conceptualisation of engagement with DBCIs can be used to help policymakers and commissioners to set standards against which to evaluate DBCIs. Research: The proposed conceptual framework can be used to generate testable hypotheses about how to improve engagement. (DBCIs), defined as B...a product or service that uses computer technology to promote behaviour change^ [4], can, for example, be delivered through computer programs, websites, mobile phones, smartphone applications (apps) or wearable devices. This systematic review, which follows the Cochrane Collaboration’s Handbook of Systematic Reviews of Interventions [15], examines how engagement has been construed and measured in the behavioural science, computer science and human-computer interaction (HCI)

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Conclusion