Mapping the process of engagement with digital health interventions : an exploratory multiple case study

Abstract

Digital health is increasingly important for healthcare delivery, but its impact is frequently limited by a lack of user engagement. Engagement is established as a multifaceted construct, including affective, cognitive, and behavioural components, but there is a lack of clarity in the conceptualisation and measurement of these components and a gap in knowledge around the relationships between the different components. To address this gap, this thesis will examine how affective, cognitive, and behavioural components of engagement interact with each other over the process of engagement with different types of digital health interventions and how this could improve the design of beneficial digital tools. The thesis applied an exploratory multiple case study approach examining three mixed-methods evaluations of digital health interventions. Each case was examined individually to develop themes relating to engagement, usability, and acceptability and to generate a mapping of the relationships between the different components of engagement. Pattern matching, explanation building, and cross-case synthesis techniques were used to compare the individual case findings and examine similarities and differences in the patterns of engagement. A thematic synthesis explored key factors influencing engagement across the interventions and how contextual factors could shape their relevance. This thesis makes an original contribution by developing a framework comprising: definitions of the components of engagement, a model mapping their relationships over the process of engagement, and recommendations for how to support them in digital health interventions. The framework highlights the close and reciprocal associations between the three different components and the importance of considering all components when evaluating and designing interventions. While this framework is still preliminary, it extends previous research by providing a structure to guide intervention developers and researchers aiming to better understand digital health engagement and how particular barriers can be addressed to improve behavioural and clinical outcomes.