Best Practices and Recommendations for Digital Interventions to Improve Engagement and Adherence in Chronic Illness Sufferers

Abstract

Abstract. Chronic illnesses cause considerable burden in quality of life, often leading to physical, psychological, and social dysfunctioning of the sufferers and their family. There is a growing need for flexible provision of home-based psychological services to increase reach even for traditionally underserved chronic illness sufferer populations. Digital interventions can fulfill this role and provide a range of psychological services to improve functioning. Despite the potential of digital interventions, concerns remain regarding users’ engagement, as low engagement is associated with low adherence rates, high attrition, and suboptimal exposure to the intervention. Human–computer interaction (e.g., theoretical models of persuasive system design, gamification, tailoring, and supportive accountability) and user characteristics (e.g., gender, age, computer literacy) are the main identified culprits contributing to engagement and adherence difficulties. To date, there have not been any clear and concise recommendations for improved utilization and engagement in digital interventions. This paper provides an overview of user engagement factors and proposes research informed recommendations for engagement and adherence planning in digital intervention development. The recommendations were derived from the literature and consensualized by expert members of the European Federation of Psychology Associations, Psychology and Health Standing Committee, and e-Health Task Force. These recommendations serve as a starting point for researchers and clinicians interested in the digitalized health field and promote effective planning for engagement when developing digital interventions with the potential to maximize adherence and optimal exposure in the treatment of chronic health conditions.

Patients’ experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

“…Stretched treatment time has been found to prevent attrition amongst youths with chronic pain [28]. A request for a stretched deadline might be a signal of attrition [35]. Although extra time to finish an assignment might be helpful for some, it risks disrupting treatment process and structure.…”

“…It has been suggested that therapeutic guidance might be necessary to help patients engage in IACT [22]. It has also been suggested that patients with chronic conditions as pain, with comorbid depression and social withdrawal, are less likely to engage in a new treatment approaches, due to previous unsatisfied treatment attempts [35]. The present treatment contained weekly homework assignments which encouraged participants to apply what they had learnt and practice new skills.…”

“…Nor is it clear how it would affect participants' perception of autonomy or self-efficacy. Patients with chronic illnesses, especially pain and those with long duration of symptoms are at risk for dropping out of internet delivered treatments [35,36]. Their motivation to engage are recommended to focus upon, especially the benefits of internet delivered interventions for their specific needs [35].…”

“…Patients with chronic illnesses, especially pain and those with long duration of symptoms are at risk for dropping out of internet delivered treatments [35,36]. Their motivation to engage are recommended to focus upon, especially the benefits of internet delivered interventions for their specific needs [35]. Also, shared decision-making and person-centered communication has been described as important for fostering self-management skills [21].…”

“…Patient attrition in internet interventions is another under-researched area [11,36]. As the risks of attrition might be difficult to discover prospectively [35], more knowledge is needed about the reasons behind attrition and its negative effects [4]. Wider research have shown that self-discovery, acceptance and self-efficacy may enable self-management, meanwhile distress and declined motivation have been described as hindrances [21].…”