Defining and Measuring Engagement and Adherence in Digital Mental Health Interventions: Protocol for an Umbrella Review.

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 design, evaluation, and outcomes.

OBJECTIVE

Using the population, concept, context 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, this 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 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies will include systematic reviews, meta-analyses, and scoping reviews published in English in 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 Joanna Briggs Institute (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

This study is expected to be conducted over a 6-month period. The search, conducted in early March 2025, initially identified 5087 papers. An additional 35 papers were found through manual handsearching of BMC Digital Health. These totals were recorded prior to the removal of duplicates. This umbrella review is expected to be conducted with screening, quality assessment, and data extraction streamlined through the Covidence platform. The screening and selection of studies will be performed in month 1, followed by data extraction and quality appraisal in months 2 and 3. Data synthesis and integration will take place in months 4 and 5, and writing conclusions and preparing the manuscript will occur in month 6. This 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, this review will outline the 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.

TRIAL REGISTRATION

PROSPERO CRD42025637603; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025637603.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73438.