Digital health interventions—delivered via technologies including text messages, apps and websites—are increasingly common for supporting chronic disease self-care. Although studies have focused on improving patient engagement with these interventions, limited research has addressed the association between engagement and clinical outcomes.
Lyndsay Nelson, Ph.D., Andrew Spieker, Ph.D., and colleagues evaluated multiple statistical approaches for understanding this association including moderation, mediation and a modified instrumental variable analysis. They applied the approaches to two recent randomized controlled trials that used text messages to support medication adherence in patients with Type 2 diabetes or hypertension.
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