@Article{info:doi/10.2196/57827,
author="Goodday, Sarah M
and Karlin, Emma
and Brooks, Alexa
and Chapman, Carol
and Harry, Christiana
and Lugo, Nelly
and Peabody, Shannon
and Rangwala, Shazia
and Swanson, Ella
and Tempero, Jonell
and Yang, Robin
and Karlin, Daniel R
and Rabinowicz, Ron
and Malkin, David
and Travis, Simon
and Walsh, Alissa
and Hirten, Robert P
and Sands, Bruce E
and Bettegowda, Chetan
and Holdhoff, Matthias
and Wollett, Jessica
and Szajna, Kelly
and Dirmeyer, Kallan
and Dodd, Anna
and Hutchinson, Shawn
and Ramotar, Stephanie
and Grant, Robert C
and Boch, Adrien
and Wildman, Mackenzie
and Friend, Stephen H",
title="Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="3",
volume="26",
pages="e57827",
keywords="wearables; wearable; mHealth; mobile health; app; apps; application; applications; engagement; adherence; retention; participatory medicine; participatory; DHT; digital health technology; DHTs; digital health technologies; digital health; mobile phone",
abstract="Background: Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. Objective: The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Methods: Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. Results: The median proportion of participants retained in the study across the 6 studies was 77.2{\%} (IQR 72.6{\%}-88{\%}). The probability of staying in the study stayed above 80{\%} for all studies during the first month of study participation and stayed above 50{\%} for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80{\%} and 90{\%}, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50{\%}, IQR 20{\%}-75{\%}: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Conclusions: Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user. ",
issn="1438-8871",
doi="10.2196/57827",
url="https://www.jmir.org/2024/1/e57827",
url="https://doi.org/10.2196/57827"
}