Initial Testing of Digital Therapeutics to Enhance Physical Activity Engagement and Adherence

Overview

This study conducted a 14-day formative test of a digital therapeutic (DTx) aimed at improving affective response during physical activity among inactive adults with overweight or obesity. It assessed digital engagement, compliance with digital assessments, and behavioral adherence to non-digital intervention strategies. Findings highlight the complex interplay between digital engagement, compliance, and behavioral adherence in DTx interventions.

Background

Digital Therapeutics (DTx) leverage mobile and wearable technologies to deliver behavior change interventions across health domains, including physical activity (PA). While DTx offer scalable, cost-effective solutions, challenges such as technical issues, user burden, and confusion between intervention engagement and compliance may affect efficacy. Engagement refers to participants' interaction with digital intervention components, whereas compliance relates to responding to digital assessments. Behavioral adherence involves executing non-digital tasks promoted by the intervention, serving as an intermediate indicator of intervention success. Given the low rates of PA among adults with overweight or obesity, enhancing affective response to PA via DTx may improve sustained activity levels.

Data Highlights

The study involved a 14-day intervention targeting physically inactive adults with overweight or obesity, focusing on enhancing affective response during physical activity. Digital engagement was measured by participants' interactions with intervention notifications and tasks, compliance was assessed via responses to ecological momentary assessments (EMA) and device wear time, and behavioral adherence was evaluated through completion of non-digital behavioral goals. The study highlighted potential issues such as participant confusion between engagement and compliance notifications, which could affect data validity and intervention fidelity.

Key Findings

• Digital engagement with intervention strategies and compliance with assessment procedures are distinct but may influence each other in DTx.
• Participants may experience burden or frustration due to frequent digital notifications, impacting engagement and compliance.
• Confusion between notifications for engagement versus compliance can lead to compromised data validity, such as meaningless responses to obtain incentives.
• Behavioral adherence to non-digital intervention tasks serves as an important intermediate measure of intervention effectiveness beyond digital interactions.
• Positive affective response to physical activity is linked to future engagement but does not guarantee sustained adherence without supportive intervention components.
• DTx interventions have shown promise in improving physical activity metrics but require careful design to balance engagement, compliance, and adherence.

Clinical Implications

Clinicians and researchers implementing DTx for physical activity should monitor and differentiate digital engagement and compliance to ensure data validity and intervention fidelity. Addressing user burden from frequent notifications and clarifying the purpose of digital prompts can enhance participant experience and adherence. Incorporating measures of behavioral adherence to non-digital tasks provides valuable insight into intervention impact beyond digital interactions.

Conclusion

This formative study underscores the importance of evaluating engagement, compliance, and behavioral adherence in digital therapeutic interventions targeting physical activity. Optimizing these factors is critical to maximizing intervention effectiveness and ensuring valid outcome assessments.

Related Resources & Content

1. Article Source 2024 -- Implementing and Assessing Digital Therapeutic Approaches to Enhance Physical Activity