JMIR Publications

ABSTRACT

Background:

Digital health programs are becoming increasingly important in the treatment and prevention of mental health problems in young children. However, such programs are often limited by suboptimal family engagement, which can hamper their effectiveness. Moreover, engagement in digital mental health programs is a multifaceted construct that is poorly understood, and the relationships among program outcomes and cognitive, affective, and behavioral indices of engagement are important yet ill-defined. Finally, little is known in particular about barriers and facilitators to effective engagement in families at risk for anxiety, who may not be actively treatment-seeking.

Objective:

Making Mistakes is a novel, web-based, cognitive-behavioral preventive program for caregivers and their 5-7-year-old children, which aims to reduce risk for anxiety by targeting family transmission of perfectionism or error sensitivity—i.e., negative over-reactivity to mistakes. This mixed-methods study examined multiple facets of parent-and-child engagement in Making Mistakes, including adherence, cognitive and affective engagement, barriers, facilitators, and perceived outcomes associated with engagement.

Methods:

87 dyads were included in a quantitative analysis of adherence and engagement with the program. Eighteen dyads completed qualitative interviews, which were subjected to a thematic analysis of parent and child interview content. Finally, a sampling of Making Mistakes activity journals was qualitatively reviewed and synthesized with interview data (n = 32).

Results:

Quantitative findings revealed parent and child adherence were strongly positively correlated, r(85) = .94. Dyads showed relatively low adherence to the weekly modules, with completion rates averaging 20%, and adherence declining over time. In contrast, qualitative data indicated high levels of engagement with program content and topics, elucidated barriers and facilitators to program engagement, and highlighted numerous psychosocial benefits from program participation.

Conclusions:

Findings have important implications for engagement in digital mental health interventions, particularly those focused on prevention, parent-child dyads, and anxiety and perfectionism. Cognitive and affective engagement with content in a digital health program may be more important than rote adherence to prescribed activities. Making Mistakes shows promise as a low-cost, disseminable strategy to reduce intergenerational risk for anxiety.