Engagement and recruitment to digital health interventions – what factors determine participation? A systematic review of qualitative studies
People are beginning to utilise a range of digital health products and services for various purposes such as preventative health, chronic disease management and independent living. However, many factors affect people’s decision to engage with and sign up to digital health interventions. This systematic review of qualitative studies aims to identify and synthesise the literature on barriers and facilitators to engagement and enrolment in digital health interventions.
Six online bibliographic databases - PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library - were searched for qualitative studies discussing factors affecting engagement and recruitment to a wide range of digital health interventions being used in routine care. Examples include ‘telemedicine’, ‘mobile applications’, ‘personal health records’ and ‘social networking’. Only English language studies between 2000 and 2015 were included. A novel tool known as text mining, along with additional search strategies were used to refine search results and identify 1,448 relevant records. Two reviewers independently screened titles, abstracts and full papers and conducted quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory. Burden of Treatment Theory was then used as a lens to develop preliminary propositions and recommendations for future work in this sphere.
Nineteen publications included in the review. Four overarching themes were identified that affected decisions to engage with and sign up to a digital health intervention. Firstly, personal agency and motivation was a significant factor, with individuals who were eager to improve their health and liked the choice and control digital health products and services offered being more likely to engage with digital health services. Secondly, personal lifestyle also influenced people’s decision as those with busy careers and family responsibilities, those who valued the security and privacy of their health data or had poor literacy skills and access to technology tended not to register for digital health. Thirdly, engagement and recruitment were mediated by the strategy used to reach and enrol individuals, as those who received personal recommendations, support from clinicians or direct and tailored marketing about a health technology found it easier to enrol. Finally, the quality of the digital interaction or information as well as the usability of the platform was key to encouraging people to sign up to use it. Using these findings, a taxonomy of recruitment strategies has been developed.
This review summarises and highlights the complexity of engagement and recruitment processes and the issues that need to be addressed before people commit to digital health. A conceptual model of digital health engagement processes is presented and existing knowledge gaps identified in an effort to improve the initial phases of the digital health implementation journey.