What Works Best to Engage Participants in Mobile App Interventions and e-Health: A Scoping Review

Enhancing participant engagement is considered a key priority for wellness and health care, especially as health care undergoes a shift toward the integration of digital technologies (e.g., mobile apps, health care monitors, and online portals with their consumer interfaces).^1,2 Technological systems play a critical role in enhancing participant engagement.^1,2 Among urban and low-income mothers, the use of smart-device technology for communication was a particularly important contributor to higher retention in longitudinal studies.³ Providing digital health tools has not only led to an increase in study participation adherence rates,⁴ but it has also contributed to measurable improvements in health care outcomes across several conditions. For instance, greater patient activation in their health care improved patient adherence to treatment prescriptions.⁵ Participants’ use of web portals to augment treatment of diabetes demonstrated improved glycemic control across multiple studies.^6–8 Other studies have seen improvements in participants with HIV,⁹ with coronary artery disease,¹⁰ and with depression,^11–13 highlighting how impactful the implementation of these tools can be across different clinical populations.

Schoeppe et al.¹⁴ emphasized common strategies that successful mobile interventions often use, such as goal setting, self-monitoring, and performance feedback in their app design. To our knowledge, however, there has not been a scoping review of the specific components of mobile intervention apps that increase engagement. Common across all digital health tools are the focus on increased patient engagement and “empowerment,” which is a result of several qualities inherent in these tools. Most of these technological systems improve patients’ communication with and access to health care providers,^1,2,15 and provide patients with more comprehensive information about their health on demand.^2,15 While these qualities are common across successful tools and play a large part in improving patient self-management and decreasing stress,² improved engagement is no guarantee.

Furthermore, measuring engagement is a challenge that has likely contributed to our lack of knowledge on app components that effectively increase this important metric. There are now several measures that quantify the amount of engagement that patients feel toward the digital tools and apps that are being developed,^2,15 but these are not widely used and engagement measurements are not standardized across studies. Some examples of such measures are the Patient Activation Measure (PAM¹⁶), Mobile App Rating Scale (MARS¹⁷), and the Patient Health Engagement scale (PHE-s¹⁸). These measures create a quantifiable standardized method by which researchers can measure the phenomenon of user engagement during program development, and are important considerations when creating new digital tools for patients and clinical research participants.