Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.

Rook, and Carol Whalen for their comments on earlier drafts. We are especially grateful for extended discussions with Roxane Cohen Silver concerning this article.

Many adolescents do not meet public health recommendations for moderate-to-vigorous physical activity (MVPA). In studies of variables influencing adolescent MVPA, one that has been understudied is the affective response to exercise. We hypothesized that adolescents with a more positive affective response to acute exercise would be more active. Adolescents (N = 124; 46% male) completed two 30-minute exercise tasks (above and below the ventilatory threshold [VT]), and wore Actigraph® accelerometers for 6.5 ± 0.7 days. Affective valence was assessed before, during and after each task. A more positive affective response during exercise below the VT was associated with greater participation in MVPA (p < .05). The results are consistent with the hypothesis that individuals who have a more positive affective response to exercise will engage in more MVPA. To promote greater participation in MVPA among adolescents, programs should be designed to facilitate a positive affective experience during exercise.

PROBLEM: Physical activity has been promoted as a means of enhancing self-concept, yet the evidence for this connection is far from compelling. In particular, experimental research investigating this association during adolescence, a period during which many youth struggle to maintain a positive self-image, is noticeably lacking. This study investigates the impact on self-concept of a 9-month physical activity intervention among sedentary adolescent females. METHOD: Female adolescents who were sedentary at baseline were assigned either to an exercise intervention or a comparison group as part of the controlled trial. The intervention was school-based, and assignment to groups was based on school attended. Intervention participants engaged in supervised activity 4 times per week and received didactic instruction promoting activity outside of school 1 day per week. Self-concept, physical activity participation, and cardiovascular fitness were assessed before, mid-way through, and after the 9-month intervention. RESULTS: The intervention had a significant positive impact on participation in vigorous activity and cardiovascular fitness. The intervention did not significantly influence any of the self-concept dimensions overall. There was, however, a three-way interaction such that there was an increase in global physical self-concept among those intervention participants who increased cardiovascular fitness. CONCLUSIONS: These findings indicate that a physical activity intervention among sedentary adolescent females enhanced global physical self-concept for a subset of intervention participants who manifested positive changes in fitness.

The normal-weight, physically active group was fitter and had greater lean body mass, stronger bones, and lower levels of inflammatory markers than did the normal-weight, sedentary group. In adolescent girls, the choice of a lifestyle involving high school sports is characterized by a circulating mediator and body composition pattern that, if sustained, is associated with generally lower long-term risk of cardiovascular disease and osteoporosis.