Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey

Abstract

Background Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs. Objective This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e–mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs. Methods A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e–mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods. Results Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program’s content or effectiveness and data security, and normalization of using e–mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence. Conclusions EFIs have the potential to improve community uptake of e–mental health programs. They should focus on providing information on the content and effectiveness of e–mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.

Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey

“…Barriers include lack of trust, poor digital health literacy, low levels of confidence in using digital technology, and preferences for face-to-face interventions 17–20. Research indicates acceptability may increase when potential users are provided with information about intervention content and/or effectiveness18 81 and future research may wish to examine the provision of additional intervention information, including, for example, screenshots or videos, on recruitment rates.…”

A Brief Intervention to Increase Uptake and Adherence of an Internet-Based Program for Depression and Anxiety (Enhancing Engagement With Psychosocial Interventions): Randomized Controlled Trial

“…An overwhelming majority of participants who noted that they did not complete the program believed that a lack of time, or competing demands for their time, was a strong barrier to completing the program. However, having accountability to another person may assist in challenging this barrier [ 36 ], as it requires commitment and time to be set aside in advance. Nevertheless, this issue remains complex, as a requirement for human contact may deter some individuals from signing up for such a program.…”

“…We used principles of participatory design to create the EFI, as these can improve the perceived relevance and uptake of interventions for end users [ 35 ]. We developed the EFI through a focus group study [ 36 ] of community members who had personal lived experience of depression or anxiety, or both (n=24, four groups; male=3, female=21; see the study by Gulliver et al [ 36 ] for further details on the EFI and its development). As noted in our study [ 36 ], very few males participated in these groups.…”

“…We developed the EFI through a focus group study [ 36 ] of community members who had personal lived experience of depression or anxiety, or both (n=24, four groups; male=3, female=21; see the study by Gulliver et al [ 36 ] for further details on the EFI and its development). As noted in our study [ 36 ], very few males participated in these groups. Community members in the groups suggested that the EFI content should target barriers to using these programs through the provision of personalized symptom level feedback to demonstrate program needs, information about the program content, data security, program efficacy, and finally content challenging potential social norms around using E–MH programs (eg, the belief that others do not use E–MH programs).…”

The development and evaluation of a web-based well-being intervention, for inclusion within an existing health promotion programme, to support and encourage health related lifestyle behaviour change

“…Equally fewer clinical symptoms predicted better adherence (Christensen et al, 2009). While promoting effective engagement has identified the role of intrinsic motivation (Yardley et al, 2016) personal relevance, perceived barriers, expectations, self-efficacy and computer literacy (Beatty & Binnion, 2016;Gulliver et al, 2020;Kazlauskas et al, 2020;Perski et al, 2017).…”