JMIR Publications

ABSTRACT

Background:

While technology can widen access to mental health treatments, digital mental health interventions (DMHIs) frequently have low engagement and high dropout rates. Better understanding user engagement with DMHIs can help researchers design technologies that users are more likely to benefit from. However, a major challenge is that the term “engagement” is very broad, not well-understood, and operationalized differently in different projects. Different communities, such as Behavioral Science and Human-Computer Interaction, have different perspectives on user engagement for DMHIs, which have led to challenges when designing for engagement.

Objective:

This study investigated clinical researchers’ views of user engagement when designing DMHIs.

Methods:

We conducted qualitative semi-structured interviews with 12 clinical mental health researchers who have developed DMHIs using Human-Centered Design (HCD) methods.

Results:

We identified different user engagement dimensions for DMHIs: digital mental health components (i.e., intervention, technology, and human support); levels of engagement (micro and macro); and visibility of the engagement (visible and invisible). We also describe the challenges of designing DMHIs for engagement.

Conclusions:

Our study highlights how clinical researchers operationalize engagement by focusing on macro-engagement activities but, when measuring engagement, primarily measure micro-engagement activities. Furthermore, to appropriately capture engagement, we need to include more qualitative methods to complement other measurement methods.