According to a study published in the Journal of Medical Internet Research, measuring adherence to technology in electronic health (eHealth) evaluations is an underdeveloped and improperly applied concept.

As eHealth evaluation tools like smartphones and activity tracker become more commonplace in clinical research, measuring exactly how often patients use these devices becomes linked to outcomes. However, clinical studies have differing standards of what adherence to technology actually means. In this study, researchers aimed to provide insight into how adherence has been used in previous eHealth studies to improve future research.

Led by Floor Sieverink, MSc, MA, researchers conducted a review into how the use of technology was measured, how adherence to different types of technologies was operationalized and if the use of the technology was justified. Overall, 62 eHealth studies were included in the review.

Results showed that, of the 62 studies, 34 operationalized adherence as “the more use, the better,” while 28 described a threshold for intended use of technology. Of these 28, six reported justified use of technology.

“The results of this review showed that to date, justifications for intended use are often missing in evaluations of adherence,” wrote Sieverink and colleagues. “Therefore, it can be concluded that adherence to eHealth technology is an underdeveloped and often improperly used concept in the existing body of literature. When defining the intended use of a technology and selecting valid measures for adherence, the goal or the assumed working mechanisms should be leading. Adherence can then be standardized, which will improve the comparison of adherence rates to different technologies with the same goal and will provide insight into how adherence to different elements contributed to the outcomes.”