WP1: Real-Time Engagement
Achievement 1: Optimized Conceptualization of Engagement
We applied theory triangulation to reconceptualize engagement with DHIs, synthesizing Postphenomenology, Social Practice Theory, and Social Cognitive Theory into the Dynamic EngagEment Process framework for DHIs (DEEP-DHI). This framework views engagement as a dynamic, context-dependent process shaped by individual, environmental, and material factors. It moves beyond static, usage-based definitions and supports design and evaluation grounded in lived experience. Manuscript under review.
Achievement 2: Engagement Measurement—A Review of Reviews
This review synthesizes how engagement with DHIs is measured. Twenty-four reviews were included, with measures categorized as subjective (e.g. TWEETS, SUS, interviews) or objective (e.g. app use, session duration, feature use, tracking data). Conceptual clarity across studies is lacking; many definitions are inconsistent, highlighting a need for alignment between conceptualizations and measures. Manuscript in preparation.
Achievement 3: Longitudinal Engagement Experience—EMA Study
Using qualitative methods, this study explored how engagement dimensions shift over time in eight self-identified engaged DMHI users. Data included interviews, think-aloud sessions, and repeated open-ended EMA questions. Preliminary results show fluctuating BCA engagement. Notably, low behavioral use sometimes co-occurred with cognitive or affective engagement. Findings reinforce that engagement is dynamic and influenced by routines, goals, and context. Manuscript in preparation.
WP2: Strategies for Individual Engagement
Achievement 4: Scoping Review on Engagement Strategies
The review mapped strategies used across DHIs and examined design and measurement approaches; 14 papers formed the preliminary synthesis. Common strategies included gamification, reminders, and digital prompts. Frameworks used included persuasive system design, behavior change taxonomy, and gamification. Engagement was often measured behaviorally, but inconsistently reported. Findings reveal a fragmented landscape and emphasize the need for clearer, more tailored strategies. Manuscript in preparation.
Achievement 5: Design Perspectives on Engagement
Thirteen interviews with multidisciplinary DHI developers revealed four themes: (1) varied definitions of engagement, (2) strategies like digital coaches and simplicity, (3) reliance on frameworks (e.g. co-design, persuasive design), and (4) challenges in tailoring and sustaining engagement. Developers underscored the central yet often overlooked role of engagement in DHI design. Manuscript in preparation.
WP3: Verify Engagement as a Mechanism of Impact
Achievement 6: Engagement Patterns as Predictors of Outcomes
Secondary analysis of data of a factorial trial showed that engagement trajectories (e.g. increasing or recovering engagement) predicted better outcomes than early engagement alone. Sustained or improving engagement over time led to more positive effects, underscoring engagement as a dynamic mechanism of impact. Manuscript in preparation.
Achievement 7: Personalization, Choice, and Adaptiveness Study
In a two-week mixed-methods study, 34 students were assigned to either a engagement-based or symptom-based DMHI. Engagement, satisfaction, and effectiveness were assessed through questionnaires and interviews. While no significant differences were found in outcomes, students in the engagement group and those who didn’t switch reported higher satisfaction and engagement. Interviews emphasized the value of autonomy and adapting to a better-fit DMHI. Manuscript in preparation.
Achievement 8: Implementing Engagement—A Social Practice Perspective
This viewpoint study applied Social Practice Theory to digital health use. Using cases like EHRs and self-tracking, we argue that engagement and implementation should be seen as embedded in broader health practices, not isolated behaviors. We call for shifting research focus from promoting “use” to fostering sustainable digital health practices and integrating interdisciplinary perspectives. Manuscript under review.
