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BackgroundEngagement emerges as a predictor for the effectiveness of digital health interventions. However, a shared understanding of engagement is missing. Therefore, a new scale has been developed that proposes a clear definition and creates a tool to measure it. The TWente Engagement with Ehealth Technologies Scale (TWEETS) is based on a systematic review and interviews with engaged health app users. It defines engagement as a combination of behavior, cognition, and affect. ObjectiveThis paper aims to evaluate the psychometric properties of the TWEETS. In addition, a comparison is made with the experiential part of the Digital Behavior Change Intervention Engagement Scale (DBCI-ES-Ex), a scale that showed some issues in previous psychometric analyses. MethodsIn this study, 288 participants were asked to use any step counter app on their smartphones for 2 weeks. They completed online questionnaires at 4 time points: T0=baseline, T1=after 1 day, T2=1 week, and T3=2 weeks. At T0, demographics and personality (conscientiousness and intellect/imagination) were assessed; at T1-T3, engagement, involvement, enjoyment, subjective usage, and perceived behavior change were included as measures that are theoretically related to our definition of engagement. Analyses focused on internal consistency, reliability, and the convergent, divergent, and predictive validity of both engagement scales. Convergent validity was assessed by correlating the engagement scales with involvement, enjoyment, and subjective usage; divergent validity was assessed by correlating the engagement scales with personality; and predictive validity was assessed by regression analyses using engagement to predict perceived behavior change at later time points. ResultsThe Cronbach alpha values of the TWEETS were .86, .86, and .87 on T1, T2, and T3, respectively. Exploratory factor analyses indicated that a 1-factor structure best fits the data. The TWEETS is moderately to strongly correlated with involvement and enjoyment (theoretically related to cognitive and affective engagement, respectively; P |
