Factors affecting engagement in online healthcare patient information: a narrative review of the literature

Background: The online world is rapidly becoming the primary source of healthcare information. There is a pressing need for online healthcare content not only to be accurate but also engaging. Improved engagement of people with online healthcare content has the potential to inform but also to influence behavioural change to make healthier choices. Factors associated with better engagement with online healthcare content have previously not been well considered. Objective: To identify factors which may improve engagement with online healthcare content and develop a framework to be considered when creating such content. Methods: The Pubmed and MEDLINE databases were searched up to January 2020 and manual cross checking of reference lists of relevant articles was performed. No restrictions on the study type were put. Abstracts and titles were reviewed by two authors independently for relevance. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Our search returned a total of 814 articles, 56 of which met our inclusion criteria. Studies tended to be observational, non-controlled studies, and a few quasi-experimental studies. Overall, there was significant heterogeneity in the types of interventions and outcome assessments making quantitative assessment difficult. Consensus of all authors resulted in seven categories forming the basis of a framework to assess quality of engagement in online healthcare content : 1. Textual information; 2. Discussion groups; 3. Video content; 4. Visuals/ Pictograph; 5. Accessibility; 6. Stage of patient journey; 7. Credibility and completeness of information. Conclusions: Healthcare providers should recognise barriers to understanding as well as barrier to adherence with treatment. When producing online healthcare patient information, healthcare providers should consider the categories described which may improve engagement with the content being created