Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review (Preprint)

Abstract

BACKGROUND Digital interventions offer one solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness, however, retaining users’ engagement throughout the intervention is challenging. It remains unclear what strategies facilitate the engagement with digital interventions targeting mental health promotion. OBJECTIVE We conducted a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions targeting mental health promotion in adults. METHODS This scoping review adheres to the PRISMA guidelines for scoping reviews. The search was conducted in seven electronic databases until April 2020. The inclusion criteria for studies were: 1) adult (18 years+) users of digital interventions for mental health promotion from the general population, 2) any digital intervention for mental health promotion, 3) user engagement strategies described in intervention design. We extracted the following data items: study characteristics, digital intervention (type, engagement strategy), evaluation of engagement strategy (method and result specifying if the strategy was effective at facilitating engagement) and features of engagement (usage extent and subjective experience of users). RESULTS A total of 2766 studies were identified, and k = 16 studies met the inclusion criteria. The 16 studies included randomized controlled trials (k=6), studies analyzing process data (k=5), observational studies (k=3), and qualitative studies (k=2). Digital interventions for mental health promotion were either web-based (75%) or mobile-app-based (25%). The engagement strategies included: personalized feedback about intervention content or users’ mental health status; guidance of content and progress through e-coaching; social forum and interactivity with peers; content gamification; reminders; goal setting and rewards. The engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires/tools (k=4), usability data (k=5) or both (k=7). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, automated personalized feedback, or joint video conference session as an engaging feature. CONCLUSIONS Personalized support during the intervention, access to social support, and personalized feedback appear to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness (and cost-effectiveness) of different strategies required to facilitate user engagement in digital interventions for mental health promotion. CLINICALTRIAL Protocol registered in Open Science Framework from the Centre for Open Science (https://osf.io/egyv8).