Related Notes: - [[Low use doesn't mean no use; people can re-engage the app overtime]] - [[202501210943 Factors affecting effects to digital interventions are supportive engagement with staff, guidance, longer period]] - [[How to use potentially use Digital Phenotyping for Addiction Management]] - [[Less than 1 per cent of users complete all their sessions]] - [[20230823 Define Engagement]] - [[Digital Phenotyping]] *It is very difficult to maintain high level of user engagement especially if it's unguided and completely self-help.* ### Attrition and Abandonment Dynamics The primary limitation of unguided, consumer-grade digital tools is rapid user attrition. Across free-living datasets, the median abandonment rate of health and wellness apps is approximately $70\%$ within the first 100 days. This attrition rate varies considerably across specific app categories, reflecting the difficulty of maintaining engagement in the face of addictive behaviours: - **Alcohol Cessation Apps:** Display the highest rates of abandonment, with $95\%$ to $97\%$ of users discontinuing use within 100 days of download. - **Mental Health Apps:** Experience high attrition rates ranging from $89\%$ to $92\%$ in naturalistic environments. - **Dietary and Nutritional Apps:** Suffer a $86\%$ abandonment rate over the same period. - **Physical Activity Apps:** Display relatively higher retention, with abandonment rates ranging from $54\%$ to $75\%$ # Reasons for Attrition A systematic review of qualitative data identified twenty-two distinct reasons for abandonment, grouped into six primary domains: technical and functional issues, privacy concerns, poor user experience (such as confusing interfaces), lack of expert personalization, time and financial costs, and evolving user needs. These real-world attrition patterns contrast with clinical trials of PDTs. In the pivotal trial for the reSET application, the dropout rate was exceptionally low at $12\%$. However, this adherence was driven by structured clinical support, twice-weekly therapist reviews, and contingency management incentives, with patients earning an average of $\$277$ in cash-value prizes over the 12-week study. ==Importantly, long-term follow-up showed that when these external incentive structures ended, the therapeutic difference between the intervention and control groups was no longer statistically significant. This highlights the difficulty of translating short-term digital engagement into sustained, long-term behavioural change.== This challenge is also evident in trials of the insomnia and depression therapeutic _Somryst_, which experienced a $58\%$ attrition rate at 6 weeks. Patients who completed fewer than four of the six active modules showed no significant clinical improvement compared to standard control groups, emphasizing that a minimum threshold of digital engagement is required to achieve therapeutic efficacy.