Table 1.

Operational Definitions of Patient Engagement Metrics with Relevant Examples

TTM Processes of Change9,17	Operational Definition
Cognitive/Affective Processes
Consciousness Raising	Finding and learning new facts, ideas, and tips that support smoking cessation
	• Presents statistics about annual smoking rates and deaths;
	• Provides general information about the dangers of smoking and benefits of quitting
Self-Reevaluation	Identifying smoking as part of one’s identity
	• Asks user to image him or herself as a smoker or non-smoker
Dramatic Relief	Experiencing the negative emotions that go along with smoking tobacco
	• Tracks cigarette cravings
	• Discusses how emotions are altered by smoking tobacco and/or quitting
Environmental Reevaluation	Realizing the negative impact of smoking on the social and physical environment.
	• Describes how smoking tobacco has an effect on other people
	• Reminds users about the social benefits of quitting smoking
Behavioral Processes
Self-Liberation	Making a firm commitment to quit smoking
	• Establish a quit date, with the possibility to share it with online friends/community
Counterconditioning	Substituting smoking tobacco with an alternative healthy behavior
	• Instructs user to press “smoke” or “crave” options on the app, play a game provided by the app, or talk with someone or exercise when they crave cigarettes
Helping Relationship	Using social support to quit smoking
	• Provides users the opportunity to exchange information on social media or email;
	• Allows users to communicate through an online community
Reinforcement Management	Increasing the rewards for quitting and decreasing awards for smoking
	• Receives awards, badges, or updates on a daily, weekly, or monthly basis
	• Receives push-button notifications to messages or alert users of their progress
Stimulus Control	Removing cues to smoke and adding cues to resist the temptation to smoke
	• Shows user the time/date/mood where they are most likely to smoke/crave
	• Instructs users to avoid locations and people where cigarette cravings occur
mHealth Literacy Strategies13,18	Operational Definitions
Plain Language Dimension
Paragraph Length	• Paragraphs are less than 8 sentences or 250 words
Meaningful Headings	• Headings are shown and they are descriptive or accurate to the page
Non-Technical Language	• Simple, non-scientific or technical jargon
Sentence Length	• Sentences are less than 20 words
Personal Pronouns	• User is referred to as “you” or the app system as “we”
Present Tense	• Present or future tense is used; past tense is avoided
Active Voice	• Sentences are formatted in the active voice, not the passive voice
Usability Dimension
Search/Browse Bar	• In-app search functionality is available
Screen Control Options	• The font and its size can be adjusted in the app settings
Homepage Accessibility	• Top/bottom menu always provides a “home” or “dashboard” option
Linear Navigation Path	• App is navigated in a linear fashion (e.g., pg 1 to pg 2 to pg 3; not pg 1 to pg 3)
Navigation Menu	• App pages are easily accessible (e.g., has page/function icons at the bottom/top)
Images for Learning	• Images (e.g., charts, graphs, photos) are displayed and supplement page content
Color Scheme	• Dark fonts and light backgrounds are used, not dark background and light font
Interactivity Dimension
Online Community	• App integrates with an online community/discussion forum unique to the app
Email Integration	• App integrates with a user’s email address for easy sharing and contact
Social Media Integration	• App integrates with social media (e.g., Facebook, Twitter) for sharing and contact
Audio/Visual Multimedia	• Videos or audio are used to supplement and navigate the content on the app
Tailored Content	• Demographic information, number of cigarettes/cravings, and money spent per cigarette pack is monitored and used to guide tracking features and education.