Designing for Engagement in mHealth: A Patient-Centered DSR Approach to Epilepsy Self-Tracking

Mobile health seizure diaries offer superior precision compared to paper logs (85% versus 67% in benchmarking), yet suffer from high dropout rates. The literature identifies poor user engagement as a critical limitation. In response, this study prioritizes engagement-centered design. Guided by Design Science Research, we conducted a systematic literature review and stakeholder interviews, yielding 71 functional and 29 non-functional requirements. Differences between literature and patient perspectives were prioritized by frequency and implemented in a cross-platform prototype. Evaluation using the user version of the Mobile App Rating Scale showed higher scores than the average of 26 benchmarked seizure apps: Engagement (+0.09), Functionality (+0.21), Aesthetics (+0.43), and Information (+0.76). Based on user feedback, we propose actionable design principles to support engagement: progressive disclosure, safety affordance, visual summaries, and cross-platform parity. This study contributes (1) a validated prototype, (2) a stakeholder-grounded requirement set, and (3) a replicable process for engagement-oriented mobile health development.