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Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

O�Connor, Siobhan; Hanlon, Peter; O�Donnell, Catherine A.; Garcia, Sonia; Glanville, Julie; Mair, Frances S.


Siobhan O�Connor

Peter Hanlon

Catherine A. O�Donnell

Sonia Garcia

Julie Glanville

Frances S. Mair


Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts.

PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results.

Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature.

This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them.

Systematic review registration
International Prospective Register of Systematic Reviews CRD42015029846


O’Connor, S., Hanlon, P., O’Donnell, C. A., Garcia, S., Glanville, J., & Mair, F. S. (2016). Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Medical Informatics and Decision Making, 16(120),

Journal Article Type Article
Acceptance Date Sep 3, 2016
Online Publication Date Sep 15, 2016
Publication Date 2016-12
Deposit Date Oct 10, 2016
Publicly Available Date Sep 27, 2017
Journal BMC Medical Informatics and Decision Making
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 16
Issue 120
Keywords Health Informatics; eHealth; digital health; engagement; recruitment
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