Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 4, 2025
Date Accepted: Jul 4, 2025
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Defining and Measuring Engagement and Adherence in Digital Mental Health Interventions: Protocol for an Umbrella Review
ABSTRACT
Background:
Digital Mental Health Interventions (DMHIs) offer scalable solutions to address mental health needs, particularly among marginalized populations. However, engagement and adherence rates in DMHIs are often suboptimal, limiting their potential impact. Despite the growing body of literature on DMHI engagement, there is no consensus on how engagement and adherence are defined and measured across studies. Understanding these variations is crucial to improving DMHI intervention design, evaluation, and outcomes.
Objective:
Using the PCC Framework to frame the objectives, this umbrella review aims to synthesize existing systematic reviews, meta-analyses, and scoping reviews to identify how engagement and adherence are defined and measured in DMHIs. Additionally, the review seeks to explore factors that may influence DMHI engagement and adherence.
Methods:
A systematic search of peer-reviewed literature will be conducted across major electronic databases following PRISMA guidelines. Eligible studies will include systematic reviews, meta-analyses, and scoping reviews published in English for the past 10 years that examine engagement and/or adherence in DMHIs. Data will be extracted and synthesized to identify definitions, measurement methods, and influencing factors. Risk of bias will be assessed using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Findings will be presented using a mixed-methods convergent integrated approach, identifying and synthesizing themes across the included quantitative and qualitative study results.
Results:
The study is expected to be conducted over a 6-month period. The review will provide a comprehensive summary of how engagement and adherence are operationalized across existing literature. It will highlight commonalities, inconsistencies, and gaps in definitions and measurement methods. Additionally, the review will outline key factors that influence engagement and adherence, including individual, technological, and contextual elements.
Conclusions:
This umbrella review will contribute to a more nuanced understanding of engagement and adherence in DMHIs, informing future intervention design and evaluation. The findings will support the development of standardized definitions and measurement frameworks, ultimately enhancing the effectiveness and inclusivity of DMHIs. Clinical Trial: PROSPERO International prospective register of systematic reviews CRD42025637603; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42025637603
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