What makes online substance-use interventions engaging? A systematic review and narrative synthesis

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Background: Online substance-use interventions are effective in producing reductions in harmful-use. However, low user
engagement rates with online interventions reduces overall effectiveness of interventions. Identifying optimal strategies with
which to engage users with online substance-use interventions may improve usage rates and subsequent effectiveness.
Objectives: (1) To identify the most prevalent engagement promoting strategies utilised to increase use of online substanceuse
interventions. (2) To determine whether the identified engagement promoting strategies increased said use of online
substance-use interventions.
Review methods: The reviewed followed Cochrane methodology. Databases were searched for online substance-use interventions
and engagement promoting strategies limited by study type (randomised controlled trial). Due to heterogeneity
between engagement promoting strategies and engagement outcomes, meta-analytic techniques were not possible.
Narrative synthesis methods were used.
Results: Fifteen studies were included. Five different engagement promoting strategies were identified: (1) tailoring;
(2) delivery strategies; (3) incentives; (4) reminders; (5) social support. The most frequently reported engagement promoting
strategies was tailoring (47% of studies), followed by reminders and social support (40% of studies) and delivery strategies
(33% of studies). The narrative synthesis demonstrated that tailoring, multimedia delivery of content and reminders are
potential techniques for promoting engagement. The evidence for social support was inconclusive and negative for
Conclusions: This review was the first to examine engagement promoting strategies in solely online substance-use interventions.
Three strategies were identified that may be integral in promoting engagement with online substance-use
interventions. However, the small number of eligible extracted studies, inconsistent reporting of engagement outcomes
and diversity of engagement features prevent firmer conclusions. More high-quality trials examining engagement are
Original languageEnglish
JournalDigital Health
Early online date1 Jan 2018
Publication statusE-pub ahead of print - 1 Jan 2018


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