Engagement and attrition in digital mental health: current challenges and potential solutions
Abstract In digital mental health engagement rates are consistently low, which may limit its effects. Using an international multidisciplinary consensus method, including lived experience expertise and a systematic review, we identified three key challenges: (i) lack of agreed metrics for engagement...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-07-01
|
| Series: | npj Digital Medicine |
| Online Access: | https://doi.org/10.1038/s41746-025-01778-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849767364640374784 |
|---|---|
| author | Katharine A. Smith Thomas Ward Sinéad Lambe Edoardo G. Ostinelli Charlotte Blease Thomas Gant Stefan M. Gold Emily A. Holmes Ivana Paccoud Anastasia Vinnikova Jochen Klucken Peter J. Uhlhaas Carolina Garcia Sanchez Kate Haining Kerem Böge Sofiia Lahutina Luisa Tomelleri Sean Ryan John Torous Andrea Cipriani |
| author_facet | Katharine A. Smith Thomas Ward Sinéad Lambe Edoardo G. Ostinelli Charlotte Blease Thomas Gant Stefan M. Gold Emily A. Holmes Ivana Paccoud Anastasia Vinnikova Jochen Klucken Peter J. Uhlhaas Carolina Garcia Sanchez Kate Haining Kerem Böge Sofiia Lahutina Luisa Tomelleri Sean Ryan John Torous Andrea Cipriani |
| author_sort | Katharine A. Smith |
| collection | DOAJ |
| description | Abstract In digital mental health engagement rates are consistently low, which may limit its effects. Using an international multidisciplinary consensus method, including lived experience expertise and a systematic review, we identified three key challenges: (i) lack of agreed metrics for engagement; (ii) lack of evidence on how better engagement improves outcomes; (iii) lack of standards for user involvement. Three potential solutions encompassed: (i) standardisation of frameworks for reporting engagement metrics and optimal doses of digital tools, (ii) measuring engagement with more precise reporting of outcomes, including potential harms; (iii) defining standards of user involvement (including appropriate diversity, and clinician as well as user input). Digital interventions have real potential in meeting the shortfall in service provision for mental health, but this will require focus on high quality research studies of the underlying mechanisms of engagement and optimal outcomes. Our findings identify and highlight the next best steps in this process. |
| format | Article |
| id | doaj-art-42183b06da8d4dc2ba97281e66e79517 |
| institution | DOAJ |
| issn | 2398-6352 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Digital Medicine |
| spelling | doaj-art-42183b06da8d4dc2ba97281e66e795172025-08-20T03:04:15ZengNature Portfolionpj Digital Medicine2398-63522025-07-01811910.1038/s41746-025-01778-wEngagement and attrition in digital mental health: current challenges and potential solutionsKatharine A. Smith0Thomas Ward1Sinéad Lambe2Edoardo G. Ostinelli3Charlotte Blease4Thomas Gant5Stefan M. Gold6Emily A. Holmes7Ivana Paccoud8Anastasia Vinnikova9Jochen Klucken10Peter J. Uhlhaas11Carolina Garcia Sanchez12Kate Haining13Kerem Böge14Sofiia Lahutina15Luisa Tomelleri16Sean Ryan17John Torous18Andrea Cipriani19Department of Psychiatry, University of OxfordDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonOxford Health NHS Foundation Trust, Warneford HospitalDepartment of Psychiatry, University of OxfordDepartment of Women’s and Children’s Health, Uppsala UniversityDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonCharité – Universitätsmedizin Berlin, Dept Psychiatry and Dept Psychosomatic Medicine, Campus Benjamin FranklinDepartment of Women’s and Children’s Health, Uppsala UniversityLuxembourg Centre for Systems Biomedicine (LCSB), University of LuxembourgIndependent researcher (Patient and Public Involvement and Engagement (PPIE) representative)Luxembourg Centre for Systems Biomedicine (LCSB), University of LuxembourgDept. of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – UniversitätsmedizinDepartment of Women’s and Children’s Health, Uppsala UniversitySchool of Psychology and Neuroscience, University of GlasgowCharité – Universitätsmedizin Berlin, Dept Psychiatry and Dept Psychosomatic Medicine, Campus Benjamin FranklinGerman National Academy of Sciences LeopoldinaSanta Giuliana HospitalDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical SchoolDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical SchoolDepartment of Psychiatry, University of OxfordAbstract In digital mental health engagement rates are consistently low, which may limit its effects. Using an international multidisciplinary consensus method, including lived experience expertise and a systematic review, we identified three key challenges: (i) lack of agreed metrics for engagement; (ii) lack of evidence on how better engagement improves outcomes; (iii) lack of standards for user involvement. Three potential solutions encompassed: (i) standardisation of frameworks for reporting engagement metrics and optimal doses of digital tools, (ii) measuring engagement with more precise reporting of outcomes, including potential harms; (iii) defining standards of user involvement (including appropriate diversity, and clinician as well as user input). Digital interventions have real potential in meeting the shortfall in service provision for mental health, but this will require focus on high quality research studies of the underlying mechanisms of engagement and optimal outcomes. Our findings identify and highlight the next best steps in this process.https://doi.org/10.1038/s41746-025-01778-w |
| spellingShingle | Katharine A. Smith Thomas Ward Sinéad Lambe Edoardo G. Ostinelli Charlotte Blease Thomas Gant Stefan M. Gold Emily A. Holmes Ivana Paccoud Anastasia Vinnikova Jochen Klucken Peter J. Uhlhaas Carolina Garcia Sanchez Kate Haining Kerem Böge Sofiia Lahutina Luisa Tomelleri Sean Ryan John Torous Andrea Cipriani Engagement and attrition in digital mental health: current challenges and potential solutions npj Digital Medicine |
| title | Engagement and attrition in digital mental health: current challenges and potential solutions |
| title_full | Engagement and attrition in digital mental health: current challenges and potential solutions |
| title_fullStr | Engagement and attrition in digital mental health: current challenges and potential solutions |
| title_full_unstemmed | Engagement and attrition in digital mental health: current challenges and potential solutions |
| title_short | Engagement and attrition in digital mental health: current challenges and potential solutions |
| title_sort | engagement and attrition in digital mental health current challenges and potential solutions |
| url | https://doi.org/10.1038/s41746-025-01778-w |
| work_keys_str_mv | AT katharineasmith engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT thomasward engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT sineadlambe engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT edoardogostinelli engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT charlotteblease engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT thomasgant engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT stefanmgold engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT emilyaholmes engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT ivanapaccoud engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT anastasiavinnikova engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT jochenklucken engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT peterjuhlhaas engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT carolinagarciasanchez engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT katehaining engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT keremboge engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT sofiialahutina engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT luisatomelleri engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT seanryan engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT johntorous engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions AT andreacipriani engagementandattritionindigitalmentalhealthcurrentchallengesandpotentialsolutions |