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

Olga Perski, Ann Blandford, Robert West, Susan Michie, Olga Perski, Ann Blandford, Robert West, Susan Michie

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.

Keywords: Behaviour change interventions; Conceptual framework; Digital; Engagement; Systematic review; eHealth; mHealth.

Conflict of interest statement

Ethical responsibilities of authors

All authors have approved the final manuscript and agree with its submission to Translational Behavioural Medicine. All authors have contributed equally to the scientific work and are responsible and accountable for the results. We confirm that this manuscript has not been previously published (partly or in full) and that the manuscript is not being simultaneously submitted elsewhere. We confirm that the data have not been previously reported elsewhere and that no data have been fabricated or manipulated to support our conclusions. No data, text or theories by others are presented as if they were the authors’ own. The authors have full control of all data, which are accessible upon request.

Conflict of interest

OP, SM and AB declare that they have no conflict of interest. RW undertakes research and consultancy and receives fees for speaking from companies that develop and manufacture smoking cessation medications.

Figures

Fig 1
Fig 1
PRISMA flow diagram of the study selection process [42]
Fig 2
Fig 2
Conceptual framework of direct and indirect influences on engagement with DBCIs. Transparent boxes indicate concepts. Concepts can be defined as abstract ideas that are derived from either direct or indirect evidence [149]. Blue boxes indicate attributes of concepts. Attributes can be defined as properties that characterise a concept [150]. Solid black arrows indicate relationships between concepts and attributes. Arrows with transparent heads indicate an influence of a concept.

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