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Without a structured approach to move users beyond enrollment and in-app interactions toward real-world behavior change, most DHIs will struggle to convert initial motivation into measurable and sustained clinical benefits ( Applied behavioral science provides the knowledge and tools to bridge this engagement-impact gap , yet integration into product lifecycles remains sporadic ( The ENGAGE Framework, a cyclical, six-step model for precision engagement in digital health interventions, integrates behavioral science, real-world measurement, and adaptive personalization to convert initial curiosity into sustained real-world behavior change

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Five studies have controlled sex 13,15,21,24,25 , while Awan 23 and Tafiadis et al