JMIR Publications

ABSTRACT

Background:

A high rate of disengagement has been reported as a common concern regarding mHealth interventions. Well-designed mHealth interventions support a positive user experience. To address this issue, it is necessary to summarizes the design features that improve user engagement based on research in the past 10 years, during which time the popularity of mHealth interventions has rapidly increased due to the use of smartphones.

Objective:

To summarize the published literature to answer the question “Which design features improve user engagement with mobile health (mHealth) interventions?” and guide the design of future mHealth interventions.

Methods:

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists. Five databases, namely, PubMed, Web of Science, Cochrane Library, Ovid EMBASE, and Ovid PsyclNFO, were searched for English and Chinese papers published from January 2009 to June 2019. All selected articles were imported into NVIVO 11. Thematic analysis was undertaken to assess the design features in all articles following the steps developed by Thomas & Harden. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality.

Results:

A total of 35 articles were included. The investigated mHealth interventions were mainly used in unhealthy lifestyle (N=17) and chronic disease (N=10) prevention programmes. A mobile phone application (N=24) was the most common delivery method. Qualitative (N=22) and mixed methods (N=9) designs were widely represented. The synthesis identified the following 7 themes that influenced user engagement: personalization (N=29), reinforcement (N=23), communication (N=20), navigation (N=17), credibility (N=16), message presentation (N=16) and interface aesthetic (N=7). A checklist was developed that contains the above 7 design features and the corresponding 29 specific implementations deriving from the original studies.

Conclusions:

The systematic review and thematic synthesis identified useful design features that make an mHealth intervention more user-friendly. We generated a checklist with evidence-based items to enable the easy reference of our findings by developers. Future evaluations should use more robust quantitative approaches (including RCTs) to elucidate the relationships between design features and user engagement.