JMIR Publications

ABSTRACT

Background:

Digital mental health interventions such as two-way, asynchronous messaging therapy are a growing part of the mental healthcare treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. Mapping the user experience in digital therapy may be facilitated by integrating theories from several fields. Specifically, health science’s Health Action Process Approach and human-computer interaction’s Lived Informatics Model may be usefully synthesized with relational constructs from psychotherapy process-outcome research to conceptualize the determinants of engagement in digital messaging therapy.

Objective:

The present study aimed to capture insights about digital therapy users’ engagement patterns through a qualitative analysis of focus group sessions. We sought to synthesize emergent intrapersonal and relational determinants of engagement into an integrative framework of engagement in digital therapy.

Methods:

A total of 24 focus group participants were recruited to participate in one of five synchronous focus group sessions held between October and November 2021. Participant responses were coded by two researchers using thematic analysis.

Results:

Coders identified 10 relevant constructs and 24 subconstructs that can collectively account for users’ engagement and experience trajectories in the context of digital therapy. These constructs were organized into a proposed Integrative Engagement Model of Digital Psychotherapy.

Conclusions:

Engagement in messaging therapy may be usefully approached through an interdisciplinary lens, linking constructs from health science, human-computer interaction studies, and clinical science in an Integrative Engagement framework. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT04507360