Preventive health technologies (hereafter PHT)—defined as any technology, device or digital solution that aims to improve the general health of the population—are increasingly gaining importance in the market. Particularly, 87.4 million consumers in the U.S. used at least one health & fitness app in 2020 (Statista, 2020), and the number of Fitbit users worldwide increased by roughly 350% between 2014 and 2020 (Statista, 2021). Additionally, this trend was further reinforced by the Covid-19 pandemic (Ang, 2020), and around 71,000 new health & fitness apps were launched in 2020 (Eaves, 2021).

PHT often target a behaviour change related to health-enhancing habits (e.g., the physical activity of customers, their nutrition or sleep patterns). As such, they promote an improvement in the lifestyle and wellbeing of the population and could be highly relevant in the fight against chronic diseases (WHO, 2021) and, thus, the rise of healthcare costs (Shortell, 2009). Consequently, the growing importance of PHT is not only bound to customers and companies, but also to society at large. Experimental studies suggest that PHT could indeed be effective in promoting behaviour change (e.g., Hosseinpour & Terlutter, 2019), although increased engagement with the technology was found to significantly improve its efficacy (Schoeppe et al., 2016). Thus, understanding the drivers of customer engagement with PHT is key to foster the creation of enduring health-enhancing habits.

Although the concept of customer engagement, defined as customers’ voluntary interactions with a product or brand (Hollebeek et al., 2019), has been extensively discussed in the literature, particular insights on customer engagement with PHT are scarce. The current literature has three major gaps when it comes to understanding why customers engage with PHT. First, studies on PHT mainly focus on their adoption and short-term use (e.g., Canhoto & Arp, 2017; Chen et al., 2020; Yousaf et al., 2021). While technology adoption is a necessary step in the process of engagement, it is not enough to sustain the expected preventive behaviours and create long-term habits (Canhoto & Arp, 2017). Second, the drivers of customer engagement are mainly studied with a brand (e.g., Fehrer et al., 2018; Hollebeek et al., 2014; Pansari & Kumar, 2017) or a community (e.g., Brodie et al., 2013; Dessart et al., 2015) as a focus, rather than a technology. Third, few investigations take place in the peculiar context that is healthcare (Berry, 2019; Berry & Bendapudi, 2007). As customer engagement is intrinsically linked to a specific context (Brodie et al., 2011; Hollebeek et al., 2019), dedicated focus on the drivers of customer engagement with PHT is needed to better understand the phenomenon.

To reach this objective, this investigation combines an extensive literature review, integrating and extending several streams of research (i.e., customer engagement, patient engagement, preventive healthcare, health technologies) with in-depth interviews with users of PHT to advance a comprehensive framework that captures the factors encouraging customers to engage with PHT. Data are currently being collected, and coded both inductively and deductively using NVivo 11. The analysis is expected to be complete by April 2022.

In the last decade, customer engagement has become a key concept in service research. Engagement is defined as “a dynamic and iterative process that reflects actors’ dispositions to invest resources in their interactions with other connected actors in a service system” (Brodie et al. 2020, p. 174). While the customer engagement literature is maturing, studies have predominantly focused on hedonic consumption contexts such as social media and brand communities, highlighting positive relationships and emotional triggers as antecedents of engagement behavior. However, the rich literature in customer behavior for hedonic versus utilitarian products and experiences indicates that engagement with utilitarian services such as healthcare or financial services is likely to involve different antecedents, processes, and outcomes. We therefore argue that knowledge from existing engagement research cannot be simply transferred to utilitarian service settings that are often relevant from a transformative service research perspective.

The objective of this article is to identify which assumptions in extant engagement research need to change, and what new research needs to be conducted to expand the coverage of engagement research to utilitarian settings. To achieve this, we draw on insights from the retirement planning context that represents a utilitarian service setting with low baseline levels of engagement. Past research shows that people spend less time planning for retirement than they devote to buying a television. This means that individual pension gaps may remain undetected, which is a serious problem even in wealthy countries like the US. Engagement with retirement planning is thus highly relevant for financial well-being.

This paper provides a systematic overview of the engagement as well as retirement planning literature to synthetize extant understanding on the nature, antecedents, and outcomes of engagement as well as interventions that can trigger engagement. Through our literature synthesis we develop a conceptual framework that is aimed at augmenting engagement research to encompass utilitarian services. Through this framework, we develop propositions that explicate differences between engagement in utilitarian vs hedonic settings, and indicate important future research areas in both streams of literature. Our analyses of the literature reveal that certain taken-for-granted assumptions in the engagement literature do not necessarily hold in utilitarian settings. By synthetizing insights from engagement and retirement planning research we a) identify assumptions in engagement research that need revising, and b) provide systematic guidelines for future research that needs to be conducted to augment the scope of engagement research.

This study problematizes some of the extant assumptions within engagement research by contrasting them against the “reality” of retirement planning. We thereby contribute to engagement research by expanding its boundaries and identifying questions that need to be addressed to foster engagement in utilitarian rather than hedonic service settings, and in customer well-being rather than firm focused settings. The developed insights broaden the scope of the existing engagement conceptualization and offer guidelines for moving the engagement field forward. The study also outlines how learnings from the engagement literature can help to address the lack of engagement in retirement planning.

Given the well‐documented relationship between lifestyle, disease burden, and healthcare costs, there is a greater need to investigate individual factors in health‐related attitudes and behaviors. Building on the extensive knowledge developed around engagement, in particular customer engagement, the current work (1) introduces the concept of health engagement and (2) investigates cultural drivers of the health engagement construct.

We adapt Hollebeek’s (2011) definition of customer engagement to a health context and introduce the concept of health engagement as individuals’ cognitive, emotional, and behavioral investments in health-related interactions centered around managing and taking care of their health. As such, health engagement generates a health-related state of mind in daily living that could ultimately improve quality of life through favorable psychological health and physical health outcomes.

Building on extant literature that considers the important role of health goal salience as a precursor to engaging an individual in health-related behaviors, we extend this concept by considering how an individual’s health goal salience explains the relationship between one’s cultural orientation and engagement with one’s health. In other words, we propose that the effects of Hofstede’s (2011) cultural dimensions on health engagement will be mediated by health goal salience.

Partial least squares (PLS) was used to test our conceptual model using survey data from 1, 208 participants across four countries (South Africa, Mexico, Portugal, and the United States). Results show that that uncertainty avoidance, long-term orientation, and indulgence are positively related to the salience of individuals’ health goals which, in turn, motivates health engagement and, by extension, improves physical and psychological health outcomes.

This study extends prior engagement research by introducing the concept of health engagement. Despite its importance, our knowledge of the engagement construct in a healthcare context, beyond the engagement of patients is still limited. Thus, by conceptually developing and empirically testing the concept of health engagement, the current research extends our theoretical understanding of the scope of the engagement construct. In addition, our results reveal that both psychological and physical health, facets that are generally considered aspects of an individual’s quality of life, are positively related to health engagement, further highlighting the relevance of this novel construct.

This work also improves our knowledge regarding factors shaping individuals’ engagement and embeds the engagement construct in a cultural context. Specifically, this study shows that health engagement is driven by the cultural aspects of uncertainty avoidance, long-term orientation, and indulgence and that health goal salience is a meaningful mediator in this process. Although a variety of antecedents of engagement have been documented in the literature (Dessart 2017; Leckie, Nayadzayo, and Johnson 2016; Pansari and Kumar 2017) our study is among the first to investigate cultural influences on the engagement construct.

With the greater call for improving public health, reducing healthcare costs, and decreasing the burden on the already overworked and understaffed healthcare system, improving our understanding regarding individuals’ health engagement, the focal construct of the current work, is a path forward to achieving these goals.