Understanding engagement with digital health interventions designed for adults with hearing loss and tinnitus: A mixed-method systematic review

Background: Hearing loss and tinnitus are pervasive disabilities globally, which significantly impact individuals' quality of life. Integrating Digital Health Interventions (DHIs) with traditional audiological management has proven beneficial for hearing loss and tinnitus management. Although it is established that DHI engagement is important for the real-world effectiveness of DHIs, there is a lack of systematic evidence aiming to understand engagement with DHIs in audiology. Purpose: This systematic review identified factors associated with hearing healthcare DHI engagement to inform future DHI development and research in audiology. Methods: Adhering to Synthesis without Meta-Analysis guidelines, we conducted a mixed-methods systematic review using a convergent integrated approach. A comprehensive search across seven databases until December 16, 2023, identified 62 studies meeting inclusion criteria. Data extraction involved modifying the Joanna Briggs Institute (JBI) extraction form and deductive coding using the Perski et al. (2017) framework to identify factors related to engagement. Results: The review revealed a diverse range of factors associated with DHI engagement in the audiology literature. Conclusion: Analysis within the Perski et al. (2017) framework highlighted the importance of user-related constructs, such as enhancing DHI accessibility, empowering users, and aligning DHIs with user needs and lifestyles in facilitating engagement. Due to the limited number of studies focusing on engagement as the primary outcome, we based our inferences on secondary outcomes and discussions from the available literature. While this review consolidates existing knowledge on engagement, it underscored the imperative for more in-depth investigations into engagement with hearing healthcare DHIs.