Engagement as a driver of innovative interventions rather than a band-aid for more of the same

By Dr. Camille Short, Research Fellow at the Freemasons Foundation Centre for Men’s Health, University of Adelaide

If you are a digital health researcher like I am you’ve probably asked yourself something like ‘how can I get my users to complete the entire program or utilise the intervention for longer?’  The answer most of us have come to is that we need to “increase engagement”.  In hindsight, I think we are asking the wrong questions…

A good colleague of mine introduced me to the term “Deus ex machina” when collaborating on a paper about the role of enjoyment in serious games.  I think it also applies here.  Deus ex machina is a Latin term that signifies a plot device whereby a seemingly unsolvable problem is suddenly resolved by the inspired and unexpected intervention of something new.

I think many of us are tempted to use “increased engagement” as a deus ex machine for the small effect sizes, high non-usage attrition, and unrepresentative samples commonly observed in our research. If we can just increase engagement with our 8 module, 3 month intervention, requiring weekly goal setting then we will see larger behaviour changes sustained among a more diverse sample….right? I’m not so sure.  Or at least, I think we can do better.

That is not to say that I’m against designing more engaging interventions. I am all for increased engagement (clearly). It is more that we shouldn’t start with an intervention (i.e., more of the same) and then try and increase engagement with it. This is especially clear when you start to think of engagement as being about interest, and attention and involvement in the behaviour change process, rather than as an amount of time people spend online. When we think about engagement in this way then we may start to ask better questions. For example, perhaps we could ask ‘how can we use technology in the most minimal way, requiring the smallest possible time commitment, to plunge people into the behaviour change process and help them succeed?’.  As a physical activity researcher I think that would be a better question, as I’m not really about bums in seats after all.

Another question we might ask is how we can use theory to increase attention, interest and positive vibes, and what the possible impact of that may be.  If you are like me, you might feel like you have developed an intervention that was “good in theory”, targeting all of the most important determinants of behaviour with good strategies, but it didn’t really work in practice. If so, it is probably fair to say that we missed some theory… It shouldn’t really be possible to have an intervention that is good in theory but bad in practice.  Not if you have included theory about how to apply it in practice…

Questions to consider

Is it unreasonable to expect people to utilise digital health tools in an ongoing way? Should we rethink how we provide this kind of support? What theories are relevant? What is the role of user-centred design?

Can we expand our behaviour change tool box? Are there new strategies we can use that will be more engaging?

Bio

Camille is a senior behavioural scientist and research fellow at the Freemasons Foundation Centre for Men’s Health at the University of Adelaide in Australia. She is also co-chair of the ISBNPA e&mHealth special interest group (@isbnpa_emh). Her research focuses on the development and evaluation of e&mealth behaviour change interventions, with particular focus on persuasive communication and enhancing user engagement. She has attracted over 1 million AUD in research funding and currently holds a prestigious National Health and Medical Research Council Fellowship awarded by the Australian Government. You can follow her on twitter @CamilleShort_au