Engagement and usage of a digital intervention for people with lower levels of health literacy

Abstract

Background: Little is known about how people with lower levels of health literacy engage with web-based behaviour change interventions and there are important unanswered questions about how best to meet the needs of this population. This international study aimed to address these by developing and testing a web-based intervention to promote motivational determinants of physical activity in people with Type 2 diabetes. Our objective was to determine whether audio-visual presentation and interactivity (quizzes, planners, tailoring) could overcome the ‘digital divide’ through making digital interventions more engaging and effective for people with all levels of health literacy. Methods: We adopted the Person-Based Approach to develop an intervention for trialling in the UK, Ireland, Austria, Germany, and Taiwan, comparing the interactive intervention to a plain text version. Self-reported measures were collected at baseline and follow-up. Intervention usage was objectively recorded for all users and analysed to explore usage patterns. Findings: In total, 1041 people with type 2 diabetes took part in the trial. Participants in both intervention groups, and all health literacy levels showed significant improvements in health literacy outcomes as a result of looking through the web pages. Visual analysis of intervention usage revealed remarkably similar patterns in how the intervention was used by health literacy level, age, gender, country, time since diagnosis, physical activity level, or change in physical activity attitude. Discussion: A good, clear design and Person-Based intervention development may be more important than interactivity and audio-visual presentations when developing accessible digital health interventions.