Between Regulatory Functions and Emotional Burden: Balancing Engagement in Digital Health Interventions for Self-Care in Chronic Illness

Daniela Lemmo^1*Roberto Bianco²Fabrizio Mezza¹Vincenzo De Luca³Maddalena Illario³Guido Iaccarino⁴MARIA FRANCESCA FREDA¹

• ¹Department of Humanities, University of Naples Federico II, Naples, Italy, Naples, Italy
• ²Department of Mental, Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Caserta, Italy, Caserta, Italy
• ³Department of Public Health, University of Naples Federico II, Naples, Italy, Naples, Italy
• ⁴Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy, Naples, Italy

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. 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. 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 Dialogue. 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.