Digital health interventions like SmokeFree.gov have taught us a lot about the things that motivate users to make better choices.
In the digital age, health interventions are no longer the unidirectional campaigns of days gone by. Now, user ‘engagement’ is the buzzword—and much of the research on digital interventions presented at the Society for Research on Nicotine and Tobacco’s (SRNT) 2018 Annual Meeting zeroed in on this strategy.
Several of our team members who support the National Cancer Institute’s (NCI) Smokefree.gov initiative played leading roles in the conference’s conversation, presenting on the role and influence of user engagement across Smokefree.gov text message programs, mobile applications, websites, and social media accounts.
Tobacco control programs were early adopters in the digital revolution, and much of the developing evidence base for the potential of digital efforts to support behavioral change has come from digital efforts to support smoking cessation. More than 42 million American adults smoke cigarettes, costing the U.S. more than $289 billion each year in medical care and lost productivity. Although almost 70% of current smokers say they want to quit, relapse is incredibly common—particularly within the first few days after quitting.
Engaging smokers in cessation interventions and campaigns is crucial to helping them access information and support along their quit journey, and presenters at SRNT addressed key questions for those hoping to harness the digital revolution to improve health.
What Do We Mean by Engagement? How Do We Measure It?
Definitions and measurements of engagement vary according to the intervention or campaign medium. In social media-based campaigns, for example, users can engage with the intervention in a vast number of ways, for instance liking or commenting on posts, or reading posts and sharing the information with others.
In a text messaging campaign on the other hand, such as NCI’s SmokefreeTXT, users can opt into and out of the program at any time, respond to questions at whim, and request additional campaign messages as little or as often as they wish – which each represent unique measures of engagement.
Are All Types of Engagement Equal?
To better understand how different measures of engagement relate to each other, our teams are working to disentangle the "hierarchy of engagements" within social media interventions. The Smokefree.gov team presented the concept of a marketing funnel to model users’ movement from general awareness of an intervention to deeper, more meaningful engagement.
For example, a user who shares an intervention campaign's social media post on their personal page may be considered more deeply engaged than a user who simply "likes" that post. The model allows the team to classify different types of engagement within a hierarchy, thus allowing them to create a social media strategy that more effectively engages users.
However, understanding the hierarchy of engagement metrics goes beyond creating an effective social media strategy. In the digital space, where collecting data on health behavior outcomes like cessation is often difficult or infeasible, these measures of “deep engagement” serve as some of our best proxies of ultimate outcomes.
Being able to distinguish different types of engagement is a crucial piece of understanding overall effectiveness of a given campaign or intervention in reaching behavior change.
As digital health interventions grow, it is essential to consider new avenues for understanding, measuring, and improving user engagement. Novel approaches such modeling social media engagement can be valuable tools for organizations to keep participants interested and to support their health goals over time. Our team members involved in Smokefree.gov and beyond are continually innovating new approaches to better serve clients and engage the public.
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About the Authors
Laura Vercammen, Health Communications Research Coordinator
Emily Grenen, Associate
Alice Murray, Digital Engagement Specialist