Learning to be Proficient? A Structural Model of User Dynamic Engagement in eHealth Behavioral Interventions

eHealth behavioral interventions have transformed how individuals manage their health and modify their lifestyles. Despite their growing popularity, many users gradually reduce or discontinue their participation over time. To understand this disengagement, we extend the Expectation-Confirmation Theory (ECT) by modeling user engagement as a dynamic learning process, where evolving perceptions of intervention effectiveness are shaped by ongoing experience. Leveraging a hierarchical Bayesian learning framework, we analyze users’ perception updates and how such dynamics influences engagement decisions. Our empirical results show that individuals’ learning performance appears to be lower for interventions with ambiguous instructions or those focused on short-term health outcomes. These interventions tend to generate noisier feedback that may hinder users’ ability to form accurate perceptions of intervention effectiveness, which may ultimately reduce sustained engagement. Given that eHealth behavioral interventions typically possess credence characteristics, where effectiveness may be difficult for users to evaluate directly, the need for clear, accessible information becomes especially critical. To help improve user learning and engagement, we propose several denoising strategies and evaluate them through counterfactual simulations. Our work extends ECT into healthcare settings and provides actionable insights for designing more supportive Health IT systems that foster informed decision-making and sustain user engagement.