JMIR Publications

ABSTRACT

Background:

There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Due to the accessibility, affordability and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies show DHI’s potential for improving MH outcomes in randomised controlled trials. However, modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the implementation and level of engagement with the DHI. Knowledge of the various modalities used to engage CYP could aid in the development of interventions that are acceptable and feasible.

Objective:

This review aimed to 1) identify modes of delivery used in CYP digital MH interventions, 2) explore influencing factors to usage and implementation, and 3) investigate ways in which the interventions have been evaluated and whether CYP engages in DHIs.

Methods:

A literature search was performed in the Cochrane Library, EMBASE, MEDLINE, and PsycINFO databases using three key concepts “child and adolescent mental health”, “digital intervention”, and “engagement”. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed utilising rigorous inclusion criteria and screening by at least two reviewers. The selected articles were quality assessed using the mixed methods appraisal tool (MMAT) and data were extracted to address the review aims. Data aggregation and synthesis was conducted and presented as descriptive numerical summaries and narrative synthesis.

Results:

This study identified six modes of delivery of DHIs from 83 articles and 71 interventions for engaging CYP: 1) websites, 2) games and computer-assisted programs, 3) apps, 4) robots and digital devices, 5) virtual reality, and 6) mobile text messaging. Two themes emerged highlighting “intervention-specific” and “person-specific” barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalise or create a profile, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving the various DHIs.

Conclusions:

The development of DHIs are increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP facing MH problems. This review identified the existing modalities and highlighted influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs. Clinical Trial: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018094815