Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 11, 2019
Date Accepted: Mar 12, 2020
Date Submitted to PubMed: May 22, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Approaches used for engaging children and young people in digital mental health interventions: A systematic review
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 interventions (DIs) have been developed and are being incorporated into MH treatment for CYP. Studies show DI’s potential for improving MH outcomes in randomised controlled trials. However, approaches 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 DI. Knowledge of the approaches used to engage CYP could aid in the development of interventions that are acceptable and feasible.
Objective:
This review aimed to 1) identify types of approaches 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 DI research.
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 screened 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 approaches from 83 articles and 71 interventions for engaging CYP: websites, games and computer-assisted programs, apps, robots and digital devices, virtual reality, and mobile text messaging. Two themes emerged highlighting “intervention-specific” and “person-specific” barriers and facilitators to CYP’s engagement. These themes encompass factors such as suitability, usability and acceptability of the DIs and motivation, capability and opportunity for the CYP using DIs. The literature highlighted that CYP had a preference for DIs 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% across the various digital approaches.
Conclusions:
The development of DIs are on the increase and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which approaches increase engagement and help CYP facing MH problems. This review identified the existing approaches and highlighted influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions. Additionally, identified factors provide important theoretical insights into how and why CYP engage in DIs. Clinical Trial: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018094815
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