A Priori Theory Approach to Conceptualizing Engagement with Digital Mental Health Interventions

Background: Digital Mental Health Interventions (DMHIs) show different levels of effectiveness for different people. A construct that can explain these differences is engagement. Engagement is traditionally referred to as users' behavioral, cognitive, and affective investment. Even though a holistic, dynamic, and contextual nature of engagement has been suggested, most research measures it as a monodisciplinary, narrow, and static construct. Moreover, most engagement frameworks within eHealth are often constructed by adopting variables and relationships from different fields without establishing a prior theoretical foundation. This theoretical disconnectedness can be the reason for conceptual and methodological confusion. This study aims to conceptualize engagement based on interdisciplinary theories.

Method: The study followed an a priori theory approach analyzing Postphenomenology, Social Practice Theory, and Social Cognitive Theory. These theories were chosen because they reflect engagement's holistic, dynamic, and contextual nature. Based on the analysis and integration of these theories, we crafted the first version of a conceptual framework for engagement with DMHIs.

Findings: The novel conceptual framework offers a process-based perspective to engagement with DMHIs by distinguishing different types of engagement: engagement states, modes, and processes. Engagement states represent different combinations of behavioral, cognitive, and affective engagement, while modes describe the specific ways individuals engage with these interventions. Engagement states and modes shape the engagement process people experience with DMHIs.

Conclusion: The novel framework shows the multifaceted structure of engagement with DMHIs and calls for more nuanced methods and measures to identify different engagement states and modes. These states and modes appear as building blocks of the engagement process, and they can help us uncover the patterns of different engagement processes. The framework addresses the need for a more dynamic, holistic, and contextual conceptualization of engagement and provides future directions for a clearer understanding of engagement with DMHIs.