JMIR Publications

ABSTRACT

Background:

There is growing interest in using mobile apps and online tools to support post-secondary student mental health, but most of these solutions have low user engagement. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to low user engagement in the context of mobile mental health apps for post-secondary students.

Objective:

This study aims to identify and describe factors that affected post-secondary students’ attitudes, behaviors, engagement and user experience with Thought Spot, a co-designed mental health app and online platform.

Methods:

Students who were given access to Thought Spot for six-months during a randomized trial of the intervention were invited to participate in one-on-one semi-structured interviews. The interviews explored participants’ overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts.

Results:

User satisfaction was mixed among Thought Spot users. The degree of engagement with the app appeared to be affected by factors that can be grouped into five themes: (1) Students valued detailed, inclusive, and relevant content; (2) User experience and lack of integration with other apps affected overall engagement and satisfaction; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time.

Conclusions:

Content, usability, user-centeredness and peer support are important determinants of user engagement with mobile mental health apps among post-secondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Doing so may inform the creation of interventions that best engage students and align with their mental health needs. Clinical Trial: ClinicalTrials.gov NCT03412461