Key Features of Engagement Strategies in Nutrition Apps for Adults: Scoping Review.

backgroundNutrition apps offer scalable opportunities to support dietary behavior change and prevent chronic diseases. Their success depends on sustained user engagement, which is essential yet challenging to achieve and, consequently impacts the long-term effectiveness of these digital tools. Engagement strategies have been widely explored in digital health, but a comprehensive synthesis focusing on nutrition apps for adults is lacking.

objectiveThis scoping review aimed to map the current engagement approaches and metrics implemented in nutrition apps targeting adults and to identify how user engagement is defined across studies.

methodsWe conducted a search of the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies published from January 1, 2013, to June 30, 2024. The inclusion criteria included original adult interventional or observational studies that evaluated nutrition apps and reported user‑engagement strategies or metrics. Two reviewers independently screened records in Covidence, with discrepancies resolved by a third reviewer. Data were charted across study characteristics, engagement strategies, and engagement metrics and then synthesized narratively.

resultsA total of 59 studies that used apps to improve dietary behaviors were included in our analysis, including randomized controlled trials, observational trials, and mixed methods studies. Most of these apps were designed for adults who were overweight and obese. The studies were primarily conducted in North America and Europe and were randomized controlled trials or nonrandomized intervention studies, with varying durations and sample sizes. Engagement strategies varied widely, and engagement was typically measured by frequency of specific function use and frequency of app use, followed by retention rate. The most common engagement strategies reported in studies were push notifications (n=29, 49%), behavioral theory integration (n=24, 41%), personalization and customization (n=19, 32%), and goal‑setting features (n=18, 31%). Only 31% (n=18) of studies provided an explicit definition of "user engagement," and definitions were highly heterogeneous. Engagement measurement was dominated by quantitative system‑recorded metrics, including time and frequency of using specific functions (n=38, 64%), app use frequency (n=34, 58%), and retention (n=17, 29%). Few studies assessed qualitative or long‑term engagement dimensions, and long‑duration studies rarely integrated adaptive or contextualized engagement mechanisms. Research apps more frequently used theory‑driven strategies compared with commercial apps, which tended to emphasize streamlined user experience.

conclusionsAlthough several engagement strategies are commonly used, their implementation is inconsistent and often lacks grounding in conceptual frameworks. Research in the future needs to prioritize the use of common definitions for user engagement and measurement criteria while implementing user-centered design methods and using multiple research approaches to study the complex patterns of user engagement. The evidence base for engagement strategies needs strengthening because it will support the development of sustainable nutrition mobile health interventions.