Engagement with digital behaviour change interventions: a structured review using techniques from critical interpretive synthesis

Abstract

Background: Engagement with digital behaviour change interventions (DBCIs) is essential for them to be effective. Evaluating engagement is therefore a priority; however, a shared definition of engagement is lacking. This review aims to 1) develop an integrative definition of engagement with DBCIs that is grounded in the literature, and 2) specify the direct and indirect influences on engagement and its relationship with intervention effectiveness in a conceptual framework. Methods: Four electronic databases (MEDLINE, PsycINFO, ISI Web of Knowledge, ScienceDirect) were searched. Backward and forward reference chaining was employed to identify additional articles of interest. We identified 115 articles that met the inclusion criteria: studies employing experimental or non-experimental designs with adult participants explicitly or implicitly making reference to engagement with DBCIs. Data were synthesised using techniques from Critical Interpretive Synthesis. Findings: An integrative definition of engagement with DBCIs is proposed, emphasising its experiential and behavioural aspects. In addition, a conceptual framework is proposed in which the role of engagement within a broader context of DBCIs is considered: engagement is directly influenced by intervention features and the user context, which includes characteristics of the population (e.g. individual characteristics) and the setting of DBCI use. User context also exerts an indirect influence on engagement; the effect of intervention features on engagement is moderated by the user context. Discussion: The proposed definition of engagement and conceptual framework can be used to generate testable hypotheses for future research. The use of a shared definition of engagement will increase efficiency of knowledge accumulation.