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Understanding what drives long-term engagement in digital mental health interventions : Secondary causal analysis of the relationship between social networking and therapy engagement
O'Sullivan, Shaunagh van Berkel, Niels Kostakos, Vassilis Schmaal, Lianne D'Alfonso, Simon Valentine, Lee Bendall, Sarah Nelson, Barnaby Gleeson, John F. Alvarez-Jimenez, Mario
O'Sullivan, Shaunagh
van Berkel, Niels
Kostakos, Vassilis
Schmaal, Lianne
D'Alfonso, Simon
Valentine, Lee
Bendall, Sarah
Nelson, Barnaby
Gleeson, John F.
Alvarez-Jimenez, Mario
Abstract
Background:
Low engagement rates with digital mental health interventions are a major challenge in the field. Multicomponent digital interventions aim to improve engagement by adding components such as social networks. Although social networks may be engaging, they may not be sufficient to improve clinical outcomes or lead users to engage with key therapeutic components. Therefore, we need to understand what components drive engagement with digital mental health interventions overall and what drives engagement with key therapeutic components.
Objective:
Horyzons was an 18-month digital mental health intervention for young people recovering from first-episode psychosis, incorporating therapeutic content and a private social network. However, it is unclear whether use of the social network leads to subsequent use of therapeutic content or vice versa. This study aimed to determine the causal relationship between the social networking and therapeutic components of Horyzons.
Methods:
Participants comprised 82 young people (16-27 years) recovering from first-episode psychosis. Multiple convergent cross mapping was used to test causality, as a secondary analysis of the Horyzons intervention. Multiple convergent cross mapping tested the direction of the relationship between each pair of social and therapeutic system usage variables on Horyzons, using longitudinal usage data.
Results:
Results indicated that the social networking aspects of Horyzons were most engaging. Posting on the social network drove engagement with all therapeutic components (r=0.06-0.36). Reacting to social network posts drove engagement with all therapeutic components (r=0.39-0.65). Commenting on social network posts drove engagement with most therapeutic components (r=0.11-0.18). Liking social network posts drove engagement with most therapeutic components (r=0.09-0.17). However, starting a therapy pathway led to commenting on social network posts (r=0.05) and liking social network posts (r=0.06), and completing a therapy action led to commenting on social network posts (r=0.14) and liking social network posts (r=0.15).
Conclusions:
The online social network was a key driver of long-term engagement with the Horyzons intervention and fostered engagement with key therapeutic components and ingredients of the intervention. Online social networks can be further leveraged to engage young people with therapeutic content to ensure treatment effects are maintained and to create virtuous cycles between all intervention components to maintain engagement.
Trial Registration:
Australian New Zealand Clinical Trials Registry: ACTRN12614000009617; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12614000009617
Keywords
digital intervention, digital health, youth mental health, psychotic disorders, usage metrics, log data, social networking
Date
2023
Type
Journal article
Journal
JMIR Mental Health
Book
Volume
10
Issue
Page Range
1-11
Article Number
Article e44812
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
DOI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY 4.0
File Access
Open
Notes
© Shaunagh O'Sullivan, Niels van Berkel, Vassilis Kostakos, Lianne Schmaal, Simon D'Alfonso, Lee Valentine, Sarah Bendall, Barnaby Nelson, John F Gleeson, Mario Alvarez-Jimenez. Originally published in JMIR Mental Health (https://mental.jmir.org), 22.05.2023.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and license information must be included.