Perski, Olga; (2018) Engagement with Digital Behaviour Change Interventions: Conceptualisation, Measurement and Promotion. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Digital behaviour change interventions (DBCIs) can help people change various health behaviours; however, engagement is low on average and there is a positive association of engagement with intervention effectiveness. The extent to which this relationship is confounded or subject to reverse causality is unclear, and evidence-based models of how to promote engagement are lacking. Progress is hindered by the existence of multiple definitions and measures of engagement; this hampers attempts to aggregate data in meta-analyses. Using smartphone applications (apps) for smoking cessation and alcohol reduction as case studies, this thesis investigated how to conceptualise and measure engagement and identified factors that influence engagement with DBCIs in general, and with apps for smoking cessation and alcohol reduction in particular. Six studies using qualitative and quantitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which synthesised existing conceptualisations and generated an integrative definition of engagement with behavioural and experiential dimensions, and a conceptual framework of factors that influence engagement with DBCIs. Studies 3 and 4 involved the development and evaluation of a self-report measure of the behavioural and experiential dimensions of engagement. Studies 2, 5 and 6 used mixed-methods to identify factors that influence engagement with apps for smoking cessation and alcohol reduction. Engagement with DBCIs can usefully be defined in both behavioural and experiential terms: the self-report measure demonstrated promising psychometric properties and was underpinned by two distinct factors, labelled ‘Experiential Engagement’ and ‘Behavioural Engagement’. Design features that support users’ motivation to change, foster their beliefs about the perceived usefulness and relevance of the technology, and spark their interest were found to be most important in the promotion of engagement with apps for smoking cessation and alcohol reduction. These findings can be used to inform the design of new, or modification of existing, apps for these behaviours.

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