User engagement in mobile apps for people with schizophrenia: A scoping review.

Over the past decade, there has been an increase in the number of mobile apps designed for mental health proposes and mHealth has been perceived as a promising approach to help people with schizophrenia to manage their condition. However, adoption rates are relatively low and long-term user engagement is a major issue. The aim of this study is to identify and better understand what strategies and factors may influence user engagement and facilitate prolonged use of apps for people with schizophrenia to better manage their illness. A scoping review was conducted in accordance with the Arksey and O'Malley scoping review framework and following PRISMA ScR guidelines. The sources consisted of searching four electronic databases. Rayyan software was used for this study selection process and a narrative approach was used to synthesize the extracted data. A total of 28 studies which met the inclusion criteria were identified. The engagement strategies included push notifications, message prompts, personalization, application customization, goal setting, game-like features, use of different multimedia formats, social connectedness, support (peers and professionals), reliability of content and quality of feedback received. Some demographic factors may influence adherence such as age, gender, education level and socioeconomic status. Other factors also may play a role impacting engagement: health status, data privacy and security, involvement in design process, incentives for participation, app usage fitting in the user routines, initial training, and constant technical support. Included studies present high heterogeneity in outcome measures and thresholds criteria to assess engagement. Understanding what influences engagement and how to measure it is essential to enhance the design of mobile apps and deliver scalable solutions to help people with schizophrenia better manage their illness in their real-world uptake.