Conceptualization, Operationalization, and Measurement of Adherence to Patient-Facing Digital Health Applications:...

Area of Science:

• Digital Health
• Medical Adherence
• Health Informatics

Background:

• Traditional medical adherence definitions are challenged by patient-facing digital health applications (DHAs).
• DHAs generate usage data but lack standardized metrics for 'adequate' use across diverse populations and conditions.
• Increasing integration of DHAs into regulatory and reimbursement frameworks necessitates clearer adherence standards.

Purpose of the Study:

• To systematically review the conceptualization, operationalization, and measurement of adherence in patient-facing DHAs.
• To compare adherence approaches in DHAs within formal regulatory/reimbursement settings versus those outside.
• To inform the development of a unified adherence framework for digital health interventions.

Main Methods:

• Scoping review following Joanna Briggs Institute methodology and PRISMA-ScR guidelines.
• Comprehensive literature search of PubMed, Scopus, and Web of Science (2020-2025).
• Machine learning-assisted screening and independent data extraction by three reviewers.

Main Results:

• Initial database searches yielded over 15,000 records, reduced to 7,052 unique records after deduplication.
• Full results are slated for submission to a peer-reviewed journal by the end of 2026.
• The review is part of the DEKODE project, funded by the German Federal Joint Committee's Innovation Fund.

Conclusions:

• Clarifying adherence concepts and measurements in DHAs is crucial for consistent evidence generation.
• Findings will support evidence-based policy, international harmonization of standards, and health economic evaluations for digital health.
• The review aims to establish a conceptual and empirical framework for adherence in DHAs, applicable globally.