JMIR Publications

ABSTRACT

Background:

Although web–based mental health resources have the potential to assist millions, particularly those who cannot receive treatment, most mental health website visitors disengage before accessing resources that can help improve their mental health.

Objective:

We used a sequential multiple–assignment randomized trial to test whether personalized tailoring improved engagement on a self-guided mental health website.

Methods:

Data were collected via voluntary response sampling on the [masked for review] website. Inclusion criteria included residing in the United States and completing the PHQ-9 (N=77,551). Participants were first randomized to the demographics survey (ie, content-as-usual) or the Next Steps survey, which included additional tailoring questions. Participants who viewed the following screening results page were randomized to 1 of 5 conditions that featured generic or tailored responses and resources. Data were analyzed using logistic regressions.

Results:

Adding questions to inform tailoring did not increase the odds of disengaging (1.5%) compared to content-as-usual (1.4%; P=.09). Within participants who completed the demographics survey, tailoring resources to demographics reduced the odds of disengaging by 10% (b=–0.10, OR=0.90, 95% CI=0.87-0.94, P<.001) and increased the odds of clicking a featured resource by 77% (b=0.57, OR=1.77, 95% CI=1.68-1.87, P<.001). Within those who completed the Next Steps survey, tailoring resources to intended next steps and combining a tailored response to perceived need with tailored resources to intended next steps did not significantly reduce the odds of disengaging (P=.51 and P=.52, respectively) but increased the odds of clicking a featured resource by 19% (b=–0.05, OR=1.19, 95% CI=1.10-1.29, P<.001) and 29% (b=0.25, OR=1.29, 95% CI=1.19-1.40, P< .001), respectively. Tailoring resources to demographics was significantly more effective in improving engagement than tailoring to perceived need and/or intended next steps (P≤.004).

Conclusions:

The benefits of tailoring outweighed the costs of adding tailoring questions, and tailoring to demographics was the most effective strategy for increasing engagement. This study demonstrates how personalization may increase engagement with mental health websites and provides design implications for future research. Clinical Trial: ClinicalTrials.gov NCT04507360.