Effective engagement strategies in digital interventions for mental health promotion: A scoping review
Creators: name: Saleem, Maham
name: Kühne, Lisa
name: De Santis, Karina Karolina
name: Brand, Tilman
name: Busse, Heide
Publisher: name: ZPID (Leibniz Institute for Psychology)
Year: 2021
Subjects: subject: 150

description: Background Scoping reviews provide an opportunity to broadly explore a specific field and to synthesize a heterogeneous body of knowledge (Tricco et al., 2018). Scoping reviews include a systematic search for literature, however, the risk of bias in studies is not assessed. This is because the major focus of scoping reviews is on the methods to measure the outcomes rather than the outcomes themselves. In this abstract, we present an example of such a scoping review in a rapidly developing field that is highly relevant during a global pandemic. Digital interventions offer a method to address the high demand for mental health promotion, especially when facing physical contact restrictions (Vigo et al., 2020). Although the market for digital interventions is rapidly growing, their effectiveness at improving mental health is limited in clinical trials (Weisel et al., 2019). Engagement with digital interventions is critical for their effectiveness especially in real-life settings outside of a research context (Szinay et al., 2020). Although several factors to promote and maintain user engagement have been identified (Szinay et al., 2020), it remains unclear what strategies facilitate the engagement with digital interventions targeting mental health promotion. Objective The objective of this scoping review is to identify strategies that facilitate user engagement with digital interventions targeting mental health promotion. Research question The research question of the current scoping review is: What are the strategies to facilitate user engagement with digital interventions for mental health promotion? Method/Approach This review was registered in OSF (https://osf.io/9xyg7) and it adheres to the PRISMA-ScR guidelines for scoping reviews (Tricco et al., 2018). Study selection and data coding were done by two authors independently and any inconsistencies were resolved by consensus. Eligibility criteria. The inclusion criteria 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. The exclusion criteria were: 1) clinical populations, 2) digital interventions for the treatment of mental health disorders; 3) no or inadequate information on the engagement strategies used in the intervention, 4) no primary data (reviews). Search strategy and study selection. The search was conducted in seven electronic databases: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Social Science Citation Index (SSCI), the Science Citation Index (SCI), the Emerging Sources Citation Index (ESCI) and PsycINFO. Databases were searched from inception to April 2020, with no language or publication type restrictions, using three main search terms: digital intervention AND (mental health promotion OR engagement) in titles/abstracts. A total of 2766 studies were identified, and k = 16 studies met inclusion criteria. Data items. We coded the following data items: study characteristics (citation, design, country of data collection), digital intervention (type, engagement strategy) and evaluation of engagement strategy (method and result specifying if the strategy was effective at facilitating engagement) and features of engagement (usability measures and subjective measures). Data synthesis. We synthesized the data narratively. Results Study characteristics. All k = 16 studies were published in 2013 to 2020, originated from Europe (k = 6), North America (k = 6) and Australia (k = 4). Studies designs included randomised controlled trials (RCTs; k = 6), secondary data analyses (k = 5), cohort studies (k = 3) and qualitative studies (k = 2). Digital interventions and engagement strategies Digital interventions for mental health promotion were either web-based (75%) or mobile-app-based (25%). The engagement strategies included: support for the content of the intervention, personalized feedback for content, guidance or e-coaching for content, social forum, flexibility, gamification, avatar customisation and reminders. Effective engagement strategies The engagement strategies were deemed effective based on user qualitative feedback or questionnaires/tools (k = 4), usability data (k = 5) or both (k = 7). Most of the studies identified the availability of personalized support throughout the intervention in the form of e-coaching guidance, peer support through a social platform, personalized feedback, or joint video conference sessions as an engaging feature. Features of engagement Engagement features were explored heterogeneously in all k = 16 studies: k = 9 studies explored usage frequency, duration, and amount; k = 6 studies explored subjective measures like affect, attention, and interest together with usage measures; k = 3 study explored the depth of engagement. Conclusions and implications Various engagement strategies have been reported in digital interventions for mental health promotion including individual and social support, personalised feedback, and reminders. User engagement was predominantly reported in terms of frequency, duration and amount; but also subjectively (affect, attention, interest). Solely two out of the 16 studies evaluated different types of engagement strategies. Personalized support during the intervention, access to social support and personalized feedback may work best to promote engagement. Findings need to be interpreted with caution as the included studies were heterogeneous, had small sample sizes and typically explored engagement strategies as a by-product only. All studies were from high-income settings, questioning the generalisability to other contexts. Despite the importance of user engagement for the effectiveness of digital interventions (Szinay et al., 2020), this area has not yet received much attention. Further research is needed on the effectiveness (and cost-effectiveness) of different types of strategies to facilitate user engagement with digital interventions for mental health.