Between regulatory functions and emotional burden: balancing engagement in digital health interventions for self-care in chronic illness

Introduction Digital Health Interventions (DHIs) are increasingly used to support self-care in chronic illness. The clinical utility of these technologies for health is well established, but there is limited understanding of psychological and emotional processes that sustain long-term engagement with these technologies. This qualitative study investigates how individuals with hypertension experience and attribute meaning to their engagement with digital self-monitoring tools. Methods McCarron’s engagement model—specifically the “retain” phase—and Braun and Clarke’s reflexive thematic analysis were used to analyze 35 semi-structured interviews with adults who used ICT-enabled blood pressure monitors and smart scales. Results In the retain phase, engagement in DHIs is characterized by 3 main themes: (1) Reassurance and Sense of Control Over Health Status through Digital Tools; (2) Engaged but Ambivalent and Anxious: The Emotional Cost of Monitoring; (3) Connected Through Data as Numbers Redefine the Therapeutic Dialog. Discussion From the results we identified five psychological functions of engagement with digital monitoring tools, each showing both functional and non-functional or ambivalent expression. Engagement with DHIs cannot be reduced to simple observable behavior, but must be understood as a dynamic, iterative and situated process, supported by the regulatory functions in the context of self-care. Clinicians, psychologists, and designers are therefore called upon to recognize and value the psychological functions implicit in DHIs in order to promote truly sustainable, meaningful, and person-centered care practices and engagement.