Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review (Preprint)

Abstract

BACKGROUND Digital mental health interventions, that deliver mental health support via technologies such as a mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement, referring to a user’s uptake and sustained interactions with these interventions, varies. OBJECTIVE The aim of this systematic review is to identify common barriers and facilitators influencing user engagement with digital mental health interventions. METHODS A systematic search was conducted of the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies reporting qualitative and/or quantitative data were included. RESULTS 208 articles met the inclusion criteria. 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/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 While previous research suggests that digital mental health interventions can be useful in supporting mental health, contextual factors are important determinants as to whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating digital mental health interventions to help explain and understand user engagement, and can inform the design and development of new digital interventions.

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