How is Engagement Defined Across Health Care Services and Technology Companies? A Systematic Review

Area of Science:

• Digital Health
• Health Informatics
• Human-Computer Interaction

Background:

• The post-coronavirus disease era (2020-2025) has seen rapid growth in digital health startups.
• Defining and operationalizing user engagement is critical for the success of digital health solutions.
• Lack of standardized engagement definitions hinders effective evaluation and comparison of digital health interventions.

Purpose of the Study:

• To systematically examine how digital health startups define and operationalize engagement.
• To analyze the types and dimensional focus of engagement definitions used by digital health startups.
• To develop a framework for standardizing engagement definitions in the digital health sector.

Main Methods:

• Systematic review of publicly available information from digital health startups (2020-2025).
• Extraction and coding of engagement definitions by type (explicit, implicit, nondefinition) and dimensional focus (behavioral, cognitive, affective, social).
• Development of a taxonomy and a 5-level engagement definition maturity model based on findings.

Main Results:

• Analysis of 64 engagement definitions from 30 startups revealed that only 18.8% were explicit.
• Implicit (45.3%) and nondefinitions (35.9%) were prevalent, with a dominant behavioral focus (64.1%).
• Significant associations were found between definition type and dimensional focus (P<.05).

Conclusions:

• Digital health startups predominantly employ implicit or undefined engagement concepts, heavily emphasizing behavioral aspects.
• The proposed taxonomy and maturity model offer standardization for engagement definitions.
• These frameworks aim to enhance measurement consistency, enable meaningful comparisons, and establish effectiveness evaluation baselines.