Clinical Scorecard: Implementing and Assessing Digital Therapeutic Approaches to Enhance Physical Activity: Initial Testing of Engagement, Compliance, and Adherence

At a Glance

Key Highlights

• DTx interventions use digital notifications and interactions for both delivery and evaluation, enabling scalable behavior change interventions.
• Engagement (interaction with intervention) and compliance (response to assessment procedures) are distinct but interrelated digital behaviors critical to intervention fidelity.
• Behavioral adherence to nondigital tasks within DTx serves as an intermediate indicator of intervention effectiveness on health behaviors.

Guideline-Based Recommendations

Diagnosis

• Identify physically inactive adults with overweight or obesity who may benefit from PA-enhancing DTx.

Management

• Implement DTx interventions that provide digital push notifications for behavior change strategies such as goal-setting, planning, and self-monitoring.
• Incorporate both digital engagement strategies and nondigital behavioral tasks to promote physical activity.

Monitoring & Follow-up

• Track digital intervention engagement via interaction metrics (e.g., clicks, task completion).
• Monitor compliance with digital assessment procedures such as ecological momentary assessments (EMA) and device wear time.
• Assess behavioral adherence to nondigital intervention components as an intermediate outcome.

Risks

• Be aware of potential participant burden from frequent digital notifications leading to annoyance or disengagement.
• Monitor for compromised data validity if participants confuse compliance incentives with engagement tasks, potentially leading to meaningless responses.
• Consider that low engagement may correlate with low compliance, affecting data completeness and generalizability.

Patient & Prescribing Data

Physically inactive adults with overweight or obesity in the USA

DTx can improve affective response to physical activity and promote increased activity levels, but success depends on maintaining both digital engagement and compliance.

Clinical Best Practices

• Differentiate clearly between digital notifications for intervention engagement and those for assessment compliance to avoid participant confusion.
• Use incentives judiciously to encourage compliance without compromising data quality.
• Design DTx to minimize technological burden and user frustration to enhance sustained engagement.
• Evaluate both digital engagement and behavioral adherence to fully understand intervention effectiveness.

Related Resources & Content

• Digital Therapeutics and Behavior Change
• Physical Activity and Health Outcomes
• Ecological Momentary Assessment in Digital Health