Beyond clicks and downloads: a call for a more comprehensive approach to measuring mobile-health app engagement

Abstract

Downloading a mobile health (m-health) app on your smartphone does not mean you will ever use it. Telling another person about an app does not mean you like it. Using an online intervention does not mean it has had an impact on your well-being. Yet we consistently rely on downloads, clicks, ‘likes’ and other usage and popularity metrics to measure m-health app engagement. Doing so misses the complexity of how people perceive and use m-health apps in everyday life to manage mental health conditions. This article questions commonly used behavioural metrics of engagement in mental health research and care, and proposes a more comprehensive approach to measuring in-app engagement.

Exploring engagement with health apps: the emerging importance of situational involvement and individual characteristics

“…Attention is often given as to what constitutes optimal engagement but, perhaps, there is a need to also consider what constitutes optimal disengagement. It is likely that “ideal” engagement progression is app specific (O’Brien et al , 2020). Future research could explore this further and help identify how health apps can be designed to facilitate optimal engagement and support behaviour change.…”

“…Furthermore, individuals with shorter-term explicit goals (those with body image higher-order goals in this sample) may more quickly disengage as their goals may be more promptly achieved. Therefore, it is essential that the individual user context and their out-of-app goals are considered as they are likely to influence the engagement process (O’Brien et al , 2020). Further complexity may be added depending on how apps, and other tools, are used as part of broader health behaviour change (Cole-Lewis et al , 2019).…”

“…Health apps differ from other apps as engagement expression or intensity may represent different outcomes depending on the condition, behaviour and individual. O’Brien et al (2020) argue that a more holistic view of user engagement is required that considers the intended user and their related context. For example, increased use of a mental health app may represent worsening health and be a less desirable engagement indicator (O’Brien et al , 2020).…”

“…O’Brien et al (2020) argue that a more holistic view of user engagement is required that considers the intended user and their related context. For example, increased use of a mental health app may represent worsening health and be a less desirable engagement indicator (O’Brien et al , 2020). The optimal time for engagement is unknown and is likely to differ by individual user and engagement context (Michie et al , 2017).…”

The Extent of Engagement With Telehealth Approaches by Patients With Advanced Cancer: Systematic Review

“…The frequency of interactions with the intervention was presented most commonly, although the way in which this was done varied greatly across the studies, and there is a limited ability to understand what this means in the context of the intervention and the proposed and expected engagement needed for clinical utility. For example, people with advanced cancer have fluctuating needs, and a higher level of engagement with an intervention may not relate to the success of the intervention itself but be reflective of worsening outcomes for the patient [ 69 ]. In addition, patients may have their symptom management needs met early on in the intervention and may not need further follow-up, which may not be indicative of poor engagement with the intervention per se.…”