Sieverink F, Kelders SM, van Gemert-Pijnen JEWC. (2017). Clarifying the concept of adherence to eHealth technology: Systematic review on when usage becomes adherence. Journal of Medical Internet Research. 19(12): e402. doi: 10.2196/jmir.8578
Researchers extended a World Health Organization definition of adherence (i.e., the extent that a patient’s behavior corresponds to recommendations from a health care provider) to digital health, defining adherence as use of technology relative to an empirically, theoretically, or rationally justified benchmark of intended use. Researchers conducted a literature review of studies evaluating health technology to examine how adherence is operationalized and justified. Researchers categorized articles based on an identified intended level of use and justification for the intended level of use to operationalize adherence. Researchers reviewed 62 articles. Most articles described technology that targeted mental health (31) or lifestyle (25). Adherence was most often operationalized by the number of modules completed (30), or the number of days, weeks, or months the technology was used (19). Most articles operationalized adherence with no identified level of intended use (e.g. more use is better adherence; 34), 23 articles operationalized adherence relative to a level of intended use without justification, and 5 articles operationalized adherence relative to a justified level of intended use. Justification for intended levels of use were based on participants’ responses to assessments, past research, and participants’ medication use.