JMIR Publications

ABSTRACT

Background:

Digital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than traditional, face-to-face therapy. While efficacious dMH interventions are available, premature dropout and low engagement is common if delivered on a self-help basis.

Objective:

This study investigated the role of demographic and early engagement factors in predicting overall program engagement and continued engagement respectively, in a self-directed, internet-based Cognitive Behavioral Therapy program for adolescent anxiety, namely BRAVE Self-Help. It examined multiple measures of engagement, including task completion, homework completion, and depth of engagement. It also examined the moderating role of baseline anxiety severity.

Methods:

Data from 2850 adolescents aged between 12 and 18-years-old who participated in BRAVE Self-Help were analysed via a series of moderated regressions.

Results:

Results showed that early engagement was associated with continued engagement, demonstrated by early tasks (tasks completed in the first two sessions; R2=.035, P=<.001) and early depth (characters written in the first two sessions; R2=.08, P=<.001) predicting continued program depth (character count from sessions 3 to 10). Demographic factors and anxiety severity did not directly impact adolescents’ engagement in BRAVE Self-Help.

Conclusions:

These findings highlight the need to investigate ways to 1) enhance early engagement, and 2) better understand how to fully measure and capture all aspects of program engagement.