Engagement and Retention: Measuring Breadth and Depth of Participant Use of an Online Intervention

Couper, Mick P.; Alexander, Gwen; Zhang, Nanhua; Little, Roderick J. A.; Maddy, Noel; Nowak, Michael A.; McClure, Jennifer B.; Calvi, Josephine; Rolnick, Sharon J.; Stopponi, Melanie A.; Johnson, Christine Cole

doi:10.2196/jmir.1430

Cited by 215 publications

(240 citation statements)

References 30 publications

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“…As participants in the PAL scheme had complete freedom to choose how they used the website, a higher frequency of hits on a particular website component across the days on which the participant 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 chose to log on was expected to reflect a higher level of interest (and willingness to engage) in that aspect of the intervention. This was also in line with previous studies of engagement in web-based interventions using log-in frequency as a measure of engagement [26, [28][29][30][31][32].…”

Section: Engagement Variablessupporting

confidence: 91%

“…using the PA monitoring system to record PA, accessing the study website) were not related to PA at six months in contrast to the findings of several previous studies [9,57]. One plausible explanation is that our indicators may not have sufficiently [13,14,27,30,31]. Furthermore, the website was a mode of intervention delivery for the PAL study (the main intervention components were the financial incentive; placing sensors in outdoor environment; self-monitoring).…”

Section: Intervention Engagement and Physical Activitycontrasting

confidence: 83%

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Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

Murray¹,

French²,

Patterson³

et al. 2018

Preprint

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Loyalty (PAL) scheme. AbstractBackground: Investigating participant engagement and levels of non-usage attrition can help researchers identify which are the likely 'active ingredients' operating in eHealth interventions. Research on engagement can identify which intervention components predict health outcomes. Research on non-usage attrition is important to make recommendations for retaining participants in future studies. Objective:To investigate engagement and non-usage attrition in the Physical Activity Loyalty (PAL) scheme, a six month complex physical activity (PA) intervention implemented in workplaces in Northern Ireland (NI). The intervention included financial incentives with reward redemption, and self-regulation techniques. Specific objectives included: (1) To determine whether engagement in specific intervention components predicted PA at six months; (2) To determine whether engagement in specific intervention components predicted mediators targeted by the intervention at six months; (3) To investigate rates, and predictors, of non-usage attrition for participants recording daily activity via the PAL scheme PA monitoring system and logging onto the PAL scheme website. Methods:PA was assessed at baseline and six months using pedometers (Yamax Digiwalker CW-701, Japan).Markers of engagement and website use, PA monitoring system use and reward redemption were collected throughout the scheme. Random-effects generalised least squares (GLS) regressions determined whether engagement with specific intervention components predicted six month PA and mediator variables (mediators).Cox proportional hazards regressions were used to investigate predictors of non-usage attrition (i.e. days until first two week lapse). Results:A multivariable GLS regression model showed frequency of hits on the monitoring and feedback One example of an internet-delivered intervention was the Physical Activity Loyalty (PAL) scheme, implemented in workplaces in Northern Ireland (NI). The PAL scheme was a complex PA intervention which offered financial incentives and other behaviour change techniques (BCTs) delivered via the study website to increase workplace PA (recorded by outdoor sensors located within 2 km of the workplace). Paradoxically, results showed there was a small but significant decline in pedometer steps/day at six months relative to baseline, for the intervention group compared to controls, which dissipated at 12 months [4]. Mediation and moderation analyses showed that decreases in PA were partially mitigated by positive indirect effects through the constructs of integrated regulation, intrinsic motivation and habit measured at six months whilst the negative intervention effect was moderated by participants' perceptions of availability of PA opportunities in the workplace environment [5]. The current report aims to further investigate mechanisms of behaviour change for participants in the PAL scheme by examining usage rates for specific intervention components, predictors of usage rates, and whether usage was related ...

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Section: Engagement Variablessupporting

confidence: 91%

Section: Intervention Engagement and Physical Activitycontrasting

confidence: 83%

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

Murray¹,

French²,

Patterson³

et al. 2018

Preprint

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“…As in other online intervention studies, there is considerable variability within our sample for how frequently the Web site was used. [25][26][27][28][29] Little is known about the most appropriate mix of features and their level of use as predictors of the effectiveness of online interventions, so there is much to learn from studies such as this one. Additional analyses related to patterns of engagement in the pregnancy intervention for appropriate gestational weight gain are underway.…”

Section: Discussionmentioning

confidence: 99%

The Theory, Development, and Implementation of an e-Intervention to Prevent Excessive Gestational Weight Gain: e-Moms Roc

Graham

Uesugi²,

Niederdeppe³

et al. 2014

Telemedicine and e-Health

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Background: Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (eMoms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women. Materials and Methods: Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features. Results: An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools. Conclusions: To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.

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“…Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].…”

Section: Introductionmentioning

confidence: 99%

A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

188

177

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A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

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Engagement and Retention: Measuring Breadth and Depth of Participant Use of an Online Intervention

Cited by 215 publications

References 30 publications

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

The Theory, Development, and Implementation of an e-Intervention to Prevent Excessive Gestational Weight Gain: e-Moms Roc

A conceptual review of engagement in healthcare and rehabilitation

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