title: More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention.
abstract: BACKGROUND
  There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP).
  
  
  METHODS
  HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20-30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned.
  
  
  RESULTS
  Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction.
  
  
  CONCLUSIONS
  Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Nina B
authors.initials: NB
authors.lastname: Baltierra
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: kmuessig@email.unc.edu.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Pike
authors.affiliation: Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: LeGrand
authors.affiliation: Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Sheana S
authors.initials: SS
authors.lastname: Bull
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Hightow-Weidman
mesh_terms: D000328:Adult; D040421:Cell Phone; D006293:Health Promotion / Q000379:methods*; D018451:Homosexuality, Male; D006801:Humans; D020407:Internet; D008297:Male; D008491:Medical Informatics Applications; D063731:Mobile Applications; D010865:Pilot Projects; D055815:Young Adult
keywords: HIV; Internet; Intervention; Men who have sex with men; Mobile phone