Engagement in Digital Health- Measurement in the Crosshairs

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The digital health space is experiencing exponential growth. A key area for health care to consider is how well these digital therapeutics work as part of care delivery. Traditionally, health care will look at outcomes to determine if they will add a solution into their pipeline. How digital therapeutics translate the evidence base is a key lens health care leaders will look at. Often companies have very slick marketing for their products which often glosses over the areas health care leaders look for- this frankly is a turn-off and can negatively impact perceptions of the company.

A new paper in the Journal of Medical Internet Research by Camille Short from the University of Adelaide teases out the importance of measuring engagement in digital therapeutic solutions so we can delineate the true impact of the solutions.  It is not unreasonable to think usage overtime would inform adherence but there are many ways to assess engagement. Qualitative and quantitive methods are necessary for this nascent space and can take the form of open interview questions, focus groups, questionnaires, sensor data and usage data like logins, lessons, sessions completed and in apps that have interactive elements how well users are connecting with others (peers). Currently, the state of the evidence will focus on one of these dimensions (like usage) which is necessary but not sufficient to convince health care leaders of their value. Bias may also exist with focus groups and open-ended questions where social desirability in responses may hinder the true value of the solution so counterbalancing that bias with quantitative metrics will be important.

Common sense would dictate the more someone uses a solution to more likely they are to be successful in managing their health, however, does use equal superior outcomes? The arc of engagement may differ for different health issues, for example, if someone uses a mindfulness app for a month to help with mood and sleep do we consider it a failure if usage drops after a month? Or, perhaps the sleep and mood issues have resolved so they no longer feel they “need” the app anymore- the relationship between usage, engagement, and outcomes may not necessarily be linear so new methods to parse out engagement are warranted.

It is clear that a mixed methods approach to tease out the engagement-outcomes arc is warranted and Short and colleagues call for deeper structured metrics in the qualitative and quantitative domains so digital therapeutics can add this into their deployment strategies. Advancements in how these solutions get embedded into population health management will be the way forward as one line of B to B for these solutions to increase uptake.


Thanks for reading – Trina

(Opinions are my own)




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