{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:27:57Z","timestamp":1792636077423,"version":"4.5.0"},"reference-count":321,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157\/292, 53.8%), involved people with diabetes (51\/292, 17.5%), targeted medication adherence (98\/292, 33.6%), and comprised apps (220\/292, 75.3%). The principal findings were as follows: (1) &gt;60 unique terms were used to define user engagement; \u201cuse\u201d (102\/292, 34.9%) and \u201cengagement\u201d (94\/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160\/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99\/195, 50.8%) reported &gt;1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76\/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60\/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56\/292) of the studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42022289693<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/50508","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T13:57:36Z","timestamp":1722261456000},"page":"e50508","source":"Crossref","is-referenced-by-count":104,"title":["User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic 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