JMIR Publications

ABSTRACT

Background:

Digital interventions are promising for the prevention of substance use in young people. However, engagement with these interventions is often insufficient and their full potential cannot be realized. Given the established link between engagement in digital interventions and their effectiveness, understanding user factors for the involvement in e- and mhealth interventions is essential.

Objective:

This study aimed to identify (1) factors influencing user engagement in a mobile phone-based life-skills training program for substance use prevention among adolescents and (2) suggestions for program optimization.

Methods:

A qualitative study was conducted with N = 171 participants of the mobile health (mHealth) prevention program SmartCoach. The program provided individualized text messages to foster life-skill over a period of 4 months and proved to be effective in preventing the onset of cigarette and cannabis use. Semi-structured phone interviews were conducted with program participants in order to explore factors associated with program engagement and to gather suggestions for program optimization. Interviews were recorded, transcribed, and analyzed using thematic analysis with both inductive and deductive coding. The COM-B model and Theoretical Domains Framework (TDF) were employed to assess behavioral influences.

Results:

Key factors positively influencing program engagement included the timing of text messages, social influences and support, engaging and helpful content as well rewards (points and prizes). Conversely, barriers to engagement were identified as forgetfulness, short response time limits, limited time resources, lack of interest, concerns related to personal disclosure, and difficulty identifying with the challenge task type (posting). Suggestions for optimization included implementing reminders, providing better guidance for utilizing tips, allowing personalization of message timing and content, extending time limits for tasks, and reducing the concerns related to personal disclosure.

Conclusions:

The study confirms the critical role of timing, content relevance, and social support in enhancing engagement with digital interventions. Specific recommendations for optimizing the SmartCoach program were derived, highlighting the importance of reminders, personalization, and addressing concerns related to personal disclosure.