Patterns of User Engagement with Mobile- and Web-Delivered Self-Care Interventions for Adults with T2DM: A Review of the Literature
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Technology-delivered interventions can improve the health behaviors and clinical outcomes of persons with diabetes, but only if end users engage with these interventions. To summarize the current knowledge on engagement with technology-based interventions, we conducted a review of recent mobile- and web-delivered intervention studies for adults with type 2 diabetes published from 2011 to 2015. Among 163 identified studies, 24 studies satisfied our inclusion criteria. There was substantial variation in how intervention engagement was reported across studies. Engagement rates were lower among interventions with a longer duration, and engagement decreased over time. In several studies, older age and lower health literacy were associated with less engagement, and more engagement was associated with intervention improvement in at least one outcome, including glycemic control. Future technology-based intervention studies should report on engagement, examine and report on associations between user characteristics and engagement, and aim to standardize how this is reported, particularly in longer trials.
KeywordsTechnology Internet Mobile Intervention Engagement Diabetes Review
Drs. Nelson and Osborn are supported by NIH/NIDDK R01-DK100694, and Dr. Osborn is also supported by K01-DK087894. Dr. Cherrington is supported by NIH/NIDDK P30-DK07962.
Compliance with Ethical Standards
Conflict of Interest
Lyndsay A. Nelson, Taylor D. Coston, Andrea L. Cherrington, and Chandra Y. Osborn declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Centers for Disease Control and Prevention. Reports to Congress: Diabetes Report Card. 2014.Google Scholar
- 2.Osborn C, Mayberry L, Kim J. Medication adherence may be more important than other behaviors for optimizing glycemic control among low-income adults. J Clin Pharm Ther. 2016.Google Scholar
- 13.Nelson LA, Mulvaney SA, Gebretsadik T, Ho YX, Johnson KB, Osborn CY. Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes. J Am Med Inform Assoc. 2015.Google Scholar
- 18.Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. ESRC Methods Program. 2006;15:047–71.Google Scholar
- 21.•Bell AM, Fonda SJ, Walker MS, Schmidt V, Vigersky RA. Mobile phone-based video messages for diabetes self-care support. J Diabetes Sci Technol. 2012;6:310–9. This study grouped users by their level of engagement in order to examine which group experienced the most improvement in A1c.Google Scholar
- 23.Dobson R, Carter K, Cutfield R, Hulme A, Hulme R, McNamara C, et al. Diabetes Text-Message Self-Management Support Program (SMS4BG): a pilot study. JMIR mHealth uHealth. 2015;3. e32.Google Scholar
- 30.Torbjørnsen A, Jenum AK, Smastuen MC, Arsand E, Holmen H, Wahl AK, et al. A low-intensity mobile health intervention with and without health counseling for persons with type 2 diabetes. Part 1: baseline and short-term results from a randomized controlled trial in the norwegian part of Renewing Health. JMIR mHealth uHealth. 2014;2:e52.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.•Jethwani K, Ling E, Mohammed M, Myint UK, Pelletier A, Kvedar JC. Diabetes connect: an evaluation of patient adoption and engagement in a Web-based remote glucose monitoring program. J Diabetes Sci Technol. 2012;6:1328–36. This study provided a thorough description of Website engagement patterns and compared differences in outcomes between users who were more or less engaged.Google Scholar
- 44.Nelson LA, Bethune MC, Lagotte A, Osborn CY. The usability of diabetes MAP: a Web-delivered intervention for improving medication adherence. JMIR Human Factors. 2016.Google Scholar