Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments

Laura Esther Bijkerk*, Anke Oenema, Nicole Geschwind, Mark Spigt

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


BACKGROUND: Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement.

METHODS: We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended.

RESULTS: Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time.

CONCLUSIONS: Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.

Original languageEnglish
Pages (from-to)155-166
Number of pages12
JournalInternational Journal of Behavioral Medicine
Issue number2
Early online date16 May 2022
Publication statusPublished - Apr 2023


  • Behavior change
  • Engagement
  • Health behavior
  • Intervention
  • Mental health
  • Psychotherapy
  • TIME


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