• Lucy Yardley, Bonnie J Spring, Heleen Riper, Leanne G Morrison, David H Crane, Kristina Curtis, Gina C Merchant, Felix Naughton, and Ann Blandford.
• Department of Psychology, University of Southampton, Southampton, United Kingdom. Electronic address: l.yardley@soton.ac.uk.
• Am J Prev Med. 2016 Nov 1; 51 (5): 833-842.

AbstractThis paper is one in a series developed through a process of expert consensus to provide an overview of questions of current importance in research into engagement with digital behavior change interventions, identifying guidance based on research to date and priority topics for future research. The first part of this paper critically reflects on current approaches to conceptualizing and measuring engagement. Next, issues relevant to promoting effective engagement are discussed, including how best to tailor to individual needs and combine digital and human support. A key conclusion with regard to conceptualizing engagement is that it is important to understand the relationship between engagement with the digital intervention and the desired behavior change. This paper argues that it may be more valuable to establish and promote "effective engagement," rather than simply more engagement, with "effective engagement" defined empirically as sufficient engagement with the intervention to achieve intended outcomes. Appraisal of the value and limitations of methods of assessing different aspects of engagement highlights the need to identify valid and efficient combinations of measures to develop and test multidimensional models of engagement. The final section of the paper reflects on how interventions can be designed to fit the user and their specific needs and context. Despite many unresolved questions posed by novel and rapidly changing technologies, there is widespread consensus that successful intervention design demands a user-centered and iterative approach to development, using mixed methods and in-depth qualitative research to progressively refine the intervention to meet user requirements.Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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