Engagement of Users in Digital Health Applications: Scoping Review

Clinical Snapshot

Key Findings

• P Value: Not applicable for scoping review

• Effect Size: Not applicable for scoping review

• Primary Outcome: Four main perspectives on mHealth engagement identified: usage metrics, subjective user experiences, hybrid approach, and goal-oriented perspective

• Nnt Or Sensitivity: 52 studies included from 1416 screened (3.7% inclusion rate)

• Confidence Interval: Not applicable for scoping review

Clinical Application

Highly feasible - provides conceptual framework for improving mHealth engagement strategies Relevant to Australian digital health initiatives including My Health Record, telehealth expansion, and PBS-funded digital therapeutics. Aligns with TGA guidance on software as medical devices Healthcare providers implementing mHealth interventions, digital health researchers, and health technology developers

Abstract

BACKGROUND: Mobile health (mHealth) uses mobile technology as a tool for prevention and health promotion. Research indicates that user engagement is crucial for effective mHealth interventions and improved health outcomes. However, many studies report low adoption rates, rapid decline after initial use, and a lack of acknowledgment of user implications in achieving outcomes. Thus, conceptualizing participation in mHealth is essential to identify key determinants for engaging users. OBJECTIVE: This scoping review aims to identify and characterize the attributes and definitions of user engagement in mHealth, examine engagement methods, and analyze barriers and facilitators influencing participation. METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, Scopus, Web of Science, and PubMed databases were searched for publications between 2000 and 2025 with a 2-stage selection process. RESULTS: Out of 2489 articles identified, 1416 were screened, and 52 met the inclusion criteria. Half were recently published in the last 5 years (2020-2025). Existing literature focused on digital interventions for specific populations and health topics. Analysis revealed four main perspectives on engagement in mHealth: (1) usage metrics, (2) subjective user experiences, (3) a hybrid approach that combines both, and (4) a goal-oriented perspective (behavior change or health outcomes). CONCLUSIONS: To understand the complexity and multifactorial nature of participation, it is relevant to conceptualize it as a dynamic mechanism enabling users to achieve their objectives. Both quantitative use and subjective user experience should be integrated to reach the optimal intervention dose. Recognizing users' evolving needs, uniqueness, and their socioenvironmental context interdependence, it is essential to involve users in all stages (design, implementation, and iterative evaluation of mHealth). Findings will inform an e-Delphi study to establish consensus on engagement criteria.

References

1. 1.Aktas, M., Cambon, L., & Aromatario, O. (2026). Engagement of Users in Digital Health Applications: Scoping Review. JMIR mHealth and uHealth. https://doi.org/10.2196/66002