Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil

Front Digit Health. 2024 Sep 25:6:1383999. doi: 10.3389/fdgth.2024.1383999. eCollection 2024.

Abstract

Digital mental health interventions (DMHIs) have surged in popularity over the last few years. However, adherence to self-guided interventions remains a major hurdle to overcome. The current study utilized a phased implementation design, incorporating diverse samples and contexts to delve into the engagement challenges faced by a recently launched online mental health platform in Brazil with self-evaluation forms. Employing an iterative mixed-methods approach, including focus groups, online surveys, and think-aloud protocols, the research aims to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions. Engagement in the platform was evaluated by descriptive statistics of the number of instruments completed, and qualitative interviews that were interpreted thematically. In the fully self-guided mode, 2,145 individuals registered, but a substantial majority (88.9%) engaged with the platform for only 1 day, and merely 3.3% completed all activities. In another sample of 50 participants were given a choice between online-only or a hybrid experience with face-to-face meetings. 40% of individuals from the hybrid group completed all activities, compared to 8% in the online-only format. Time constraints emerged as a significant barrier to engagement, with suggested improvements including app development, periodic reminders, and meetings with healthcare professionals. While the study identified weaknesses in the number and length of instruments, personalized results stood out as a major strength. Overall, the findings indicate high satisfaction with the mental health platform but underscore the need for improvements, emphasizing the promise of personalized mental health information and acknowledging persistent barriers in a digital-only setting.

Keywords: mental health; mental telehealth; self-care; self-knowledge; telepsychiatry.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by The São Paulo Research Foundation [grant number 21/08774-1]. FM received a post-doc financial support from FAPESP [process 22/08017-9] and National Council for Scientific and Technological Development - CNPq [process 150946/2024-4] related to the project. The project was supported by IDOR and Open D´OR intramural grant.