Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 9, 2021
Date Accepted: Oct 29, 2021
Warning: This is an author submission that is not peer-reviewed or edited.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.
Engagement within a mobile phone-based life-skills intervention for adolescents and its association with participant characteristics and outcomes: a tree-based analysis
ABSTRACT
Background:
Mobile phone-delivered life-skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them.
Objective:
To determine engagement with a mobile phone-based life-skills program and its different components, and the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes.
Methods:
We performed secondary data analysis on a dataset from a study that compared a mobile phone-based life-skills intervention for adolescents recruited in (upper) secondary school classes to an assessment-only control group (N= 1’418). Throughout the six-month intervention, participants received one text message prompt per week that either introduced a life-skill topic, encouraged participation in a quiz or individual life-skills training, or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement with the overall program and with selected components of it. Stability of these decision trees was assessed using a resampling method and by graphical representation. Lastly, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regressions.
Results:
Adolescents took part in half of the interactions (23.6/50) prompted by the program, with text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to engage the most with the program. With respect to associations between engagement and intended outcomes, adolescents who engaged in contests were more likely to be non-smokers at follow-up compared to those who did not (Odds Ratio= 0.86, P = .02). Lastly, participants who engaged the most and least with the overall program were more likely to increase their well-being from baseline to six-month follow-up compared to those with average engagement (βs= 0.39, t = 2.66, P = .008, ΔR2 = .01, R2 = .24).
Conclusions:
The majority of adolescents participating in a digital life-skills program aiming at preventing substance use and promoting mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging as well as powerful across different educational levels. First results indicate that higher engagement with digital life-skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower engaged participants at follow-up, to certainly establish such associations.
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