Factors Influencing Digital Health Engagement of Older Adults with Multimorbidity during a Longitudinal Trial

Older adults with multimorbidity remain under-served by digital health self-management interventions, despite being among the highest users of healthcare. Their engagement with such technologies is poorly understood, particularly in real-world, longitudinal contexts. This paper presents a mixed-methods analysis of engagement with the ProACT self-management platform during a six-month trial involving older adults with multimorbidity. Drawing on quantitative usage data and qualitative interviews, we examine patterns of engagement with symptom and wellbeing monitoring and management, and explore the influence of age, gender, and triage nurse support. Findings reveal that engagement is non-linear, highly individualised, and shaped by clinical support, motivation, usability, and life context. Participants developed personalised routines, adjusting use based on symptom variability and life disruptions. Triage nurse support played a key role in sustaining engagement, offering reassurance, guidance and motivation. We offer implications for designing digital health technologies that support episodic, meaningful, and contextually adaptive use in later life.