Most of us have downloaded a health app with good intentions. For a few days, we log meals, track symptoms, practice breathing exercises, or complete daily goals. Then life gets busy, the notifications become irritating, and the app quietly disappears into a folder we rarely open.
When this happens with a health app, it is tempting to describe the user as “disengaged”. But that word can hide more than it explains. Did the app fail to feel relevant? Was it difficult to use during a symptom flare? Did entering data become another task on an already challenging day? Or had the person simply gained what they needed and no longer required it?
These questions were at the heart of our recently published overview of systematic reviews on engagement with mobile health apps for adults living with long-term physical health conditions, in JMIR mHealth and uHealth. We brought together 19 systematic reviews, covering 262 individual studies and 98 health apps, to understand how engagement is defined, whether it is linked to better health outcomes, and what helps people continue using an app.
Exploring the findings beyond the numbers
One of the main findings was that researchers often talk about engagement without clearly defining it. Almost three-quarters of the reviews did not provide a definition, while others treated engagement as the same thing as usage or adherence. In practice, this meant counting logins, minutes spent in an app, or tasks completed.
Those numbers can be useful, but they only tell us what happened on the screen. They do not tell us whether an app became meaningfully integrated into someone’s life, whether the person found its content valuable, or whether they used it enough to benefit. A person who opens an app every day is not necessarily deeply engaged; equally, someone who uses it only when symptoms worsen may be using it exactly as intended.