The Concept and Components of Engagement in Different Domains Applied to eHealth: A Systematic Scoping Review

Abstract

Within the context of eHealth interventions, a shared understanding of what constitutes engagement in and with eHealth technologies is missing. A clearer understanding of engagement could provide a valuable starting point for guidelines relating to the design and development of eHealth technologies. Given the cross-disciplinary use of the term "engagement," investigating how engagement (and its components) is conceptualized in different domains could lead to determining common components that are deemed important for eHealth technological design. As such, the aim of this paper was 3-fold: (a) to investigate in which domains engagement features, (b) to determine what constitutes engagement in these different domains, and (c) to determine whether there are any common components that seem to be important. A comprehensive systematic scoping review of the existing literature was conducted in order to identify the domains in which engagement is used, to extract the associated definitions of engagement, and to identify the dimensionality or components thereof. A search of five bibliographic databases yielded 1,231 unique records. All titles, abstracts, and full texts were screened based on specific inclusion and exclusion criteria. This led to 69 articles being included for further analyses. The results showed that engagement is used in seven functional domains, categorized as follows: student (n = 18), customer (n = 12), health (n = 11), society (n = 10), work (n = 9), digital (n = 8), and transdisciplinary (n = 1) domains. It seems that some domains are more mature regarding their conceptualization and theorizing on engagement than others. Further, engagement was found to be predominantly conceptualized as a multidimensional construct with three common components (behavior, cognition, and affective) shared between domains. Although engagement is prolifically used in different disciplines, it is evident that little shared consensus as to its conceptualization within and between domains exists. Despite this, engagement is foremost seen as a state of being engaged in/with something, which is part of, but should not be confused with, the process of engagement. Behavior, cognition, and affect are important components of engagement and should be specified for each new context.

Psychometric Evaluation of the TWente Engagement with Ehealth Technologies Scale (TWEETS): Evaluation Study

“…When looking at the reasons behind DHI use, the concept of engagement often emerges as a predictor for effectiveness [ 8 - 10 ]. In a broad sense, engagement is often seen as how involved or occupied someone is with something, and as something that is related to a positive outcome, such as effectiveness.…”

“…Adherence only says something about the objective usage of a DHI and indicates whether or not a participant uses the DHI as was intended by the developers [ 5 ]. In some, but not all, conceptualizations of engagement, the usage of a DHI is part of engagement [ 8 ]. Moreover, in all conceptualizations of engagement, it encompasses other aspects as well, which refer more to the reasons behind using a DHI.…”

“…In order to gain more insight into how engagement can be defined and conceptualized within the context of DHIs, a recent review looked at the definitions and components of engagement in various domains such as students, health, and digital engagement [ 8 ]. This review concluded that engagement contains emotional, behavioral, and cognitive components.…”

“…Yet the definition chosen in that review also does not seem to fully encompass the emotional, behavioral, and cognitive components of engagement. The field of engagement to DHIs still needs a “clear, tailored, and domain-specific definition of the construct, which captures the associated emotional, behavioral, and cognitive components present within the given context” [ 8 ].…”

MyStrengths, a Strengths-Focused Mobile Health Tool: Participatory Design and Development

“…However, focusing on use alone is not necessarily enough, and as Kelders [ 33 ] argues, one should also take into consideration users’ sense of involvement with and enjoyment of the mHealth tools. Together, these 3 aspects make up what can be referred to as engagement [ 34 , 35 ]. To increase users’ engagement with tools or services, the use of design approaches known from the world of games, typically called gamification or gameful designs, is increasingly popular [ 36 - 39 ].…”