Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial

Abstract

Background Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. Objective The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. Methods Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. Results The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=–2.184, P=.048) and a greater frequency of items completed (β at 3 months=–0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. Conclusions This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5693-1

Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

“…The participants in the intervention groups had a moderate level of patient engagement. The cumulative completion rates were 50.6%, 51.5%, and 50.8% at 1, 2, and 3 months, respectively, in the intervention group, which were comparable to other mHealth interventions [59]. The positive relationship between patient engagement and health outcomes has been confirmed in our previous study [59].…”

Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

“…Seventeen studies evaluated digital interventions that were unguided (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). Of these, nine reported a positive association between engagement and mental health outcomes (33, 34, 36, 39-41, 43, 47, 49) while eight did not find a significant association (35,37,38,42,(44)(45)(46)48).…”

Data_Sheet_1.DOCX

“…Of the 35 studies, 14 (40%) reported evidence that greater engagement with DMHIs was associated with statistically significant improvements in mental health symptoms at postintervention, and this was consistent across all engagement measures used if multiple measures were used in a single study (33, 34, 36, 39, 40, 50-52, 54, 55, 61, 63, 65, 66). Five studies (17.1%) reported mixed findings, where improvements in the primary mental health outcome were associated with some, but not all, measures of engagement (37,43,47,49,57). Sixteen studies (45.7%) did not find any significant association between engagement and post-intervention mental health outcomes (20, 35, 38, 41, 42, 44-46, 48, 53, 56, 58-60, 62, 64).…”

“…In the remaining 23 studies, participants were not formally diagnosed with a mental health condition but were screened for symptoms indicative of mental disorders. Of these studies, 12 reported a positive association between engagement and the primary mental health outcome (33,36,40,41,43,47,49,50,52,57,63,65) while the other 11 did not find a significant association (37, 38, 42, 44-46, 48, 58, 59, 62, 64).…”

“…Nine studies (33,38,40,48,49,57,58,63,65) investigated the relationship between engagement and depression-related symptoms. Of these, six reported a positive association between engagement and post-intervention symptoms (33,40,49,57,63,65) while three did not find any significant association (38,48,58).…”