Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review

Abstract

There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥ 18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.

The Goldilocks Dilemma on Balancing User Response and Reflection in mHealth Interventions: Observational Study

“…The ordering of the text messages was variable across participants, and due to the observational nature of this study, we cannot determine the extent that ordering may have impacted results; however, the average response rates and trends across message versions and waves provide general insights on how these variations may impact engagement. Finally, we did not assess the impact of engagement on outcomes, as this fell outside the scope of our study; however, other studies in digital health have examined this association [ 38 , 39 ].…”

The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis

“…Examples of user experience outcomes include user satisfaction, acceptability, attention, and usability [ 22 ]. Similarly to previous reviews, engagement could be assessed via any objective or subjective quantitative measure, for example, via embedded data collection systems (ie, DHI analytics) or observation (eg, eye tracking) or as measured using self-reported questionnaires or surveys (eg, user satisfaction questionnaires) [ 26 , 27 ].…”

“…Finally, the impact of strategies on health risk outcomes was mixed, with only 41% (14/34) of overweight-and obesity-related outcomes, 73% (24/33) of physical activity-related outcomes, and 47% (7/15) of nutrition-related outcomes found to be positive and in the hypothesized direction. Although previous reviews have demonstrated the effectiveness of DHIs in improving health outcomes [25][26][27], this is the first review to synthesize the effects of strategies to improve engagement with DHIs on health outcomes, and so comparisons cannot be drawn.…”

“…Such findings are concerning as there is evidence suggesting that the health impact of DHIs may be enhanced by greater engagement; for example, a review by Donkin et al [ 25 ] of 33 DHI studies found that the number of log-ins was associated with an improvement in health behavior outcomes, including fruit and vegetable intake, weight status, smoking, and physical activity. More recently, a systematic review of DHIs targeting physical activity found a significant positive relationship between physical activity and user engagement (subjective experience, activities completed, and log-ins) [ 26 ], and another review of DHIs targeting nutrition found early evidence of an association between DHI use and dietary intake [ 27 ].…”

Translation of nutrigenomic research for personalised and precision nutrition for cancer prevention and for cancer survivors

“…In the short-term (3 months), higher-frequency feedback produced larger improvements in overall diet quality as well as in markers of adiposity but only differences in body weight and BMI remained significant at 6 months [ 142 ]. Although not focused specifically on personalised nutrition, a recent systematic review that synthesized the evidence for associations between DHI engagement and dietary intake reported that some evidence supported an association with usage of the digital support but that this evidence was inconsistent [ 143 ].…”