The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis
Abstract BackgroundDigital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than face-to-face therapy. While efficacious dMH interventions are available for adolescents, premature dropout and low engagement are common, especially...
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JMIR Publications
2025-06-01
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| Series: | JMIR Pediatrics and Parenting |
| Online Access: | https://pediatrics.jmir.org/2025/1/e60523 |
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| author | Emma-Leigh Senyard Arlen Rowe Govind Krishnamoorthy Susan H Spence Caroline Donovan Sonja March |
| author_facet | Emma-Leigh Senyard Arlen Rowe Govind Krishnamoorthy Susan H Spence Caroline Donovan Sonja March |
| author_sort | Emma-Leigh Senyard |
| collection | DOAJ |
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Abstract
BackgroundDigital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than face-to-face therapy. While efficacious dMH interventions are available for adolescents, premature dropout and low engagement are common, especially if delivered on a self-help basis without any form of therapist guidance. This is concerning, given that higher engagement, in terms of the number of sessions completed, has been repeatedly associated with improved clinical outcomes. The reasons for poor adolescent engagement in dMH programs are unclear. A clear understanding of when and why disengagement occurs is important in order to seek to improve engagement rates. Contemporary models consider engagement as multifaceted, comprising both “use” (eg, amount of content completed, frequency of use, duration spent logged into the dMH program, and depth of use, such as word or character count) and “user experience” (eg, interest and satisfaction in the program and affect and attention whilst engaging in the program).
ObjectiveThis study investigated the role of demographic and early engagement (EE) factors, specifically program use, in predicting overall program engagement and continued engagement, respectively, in a self-directed, internet-based cognitive behavioral therapy program for adolescent anxiety, namely, BRAVE Self-Help. It examined multiple measures of program use, including task completion, homework completion, and depth of response (character count of responses typed into program tasks). It also examined the moderating role of baseline anxiety severity.
MethodsData collected between July 2014 and May 2020 from 2850 adolescents aged 12 to 18 years who participated in BRAVE Self-Help were analyzed via a series of moderated regressions.
ResultsResults showed that EE (in terms of program use) was associated with continued engagement, demonstrated by early tasks (tasks completed in the first two sessions; R2PR2P
ConclusionsThese findings highlight the need to investigate ways to (1) enhance EE and (2) better understand how to measure and capture all aspects of program engagement. |
| format | Article |
| id | doaj-art-cf2f22e7e456473090b35f59684b4298 |
| institution | OA Journals |
| issn | 2561-6722 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Pediatrics and Parenting |
| spelling | doaj-art-cf2f22e7e456473090b35f59684b42982025-08-20T02:09:03ZengJMIR PublicationsJMIR Pediatrics and Parenting2561-67222025-06-018e60523e6052310.2196/60523The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression AnalysisEmma-Leigh Senyardhttp://orcid.org/0000-0002-9246-4499Arlen Rowehttp://orcid.org/0000-0002-1880-8513Govind Krishnamoorthyhttp://orcid.org/0000-0003-1515-1103Susan H Spencehttp://orcid.org/0000-0002-7022-6676Caroline Donovanhttp://orcid.org/0000-0001-6380-635XSonja Marchhttp://orcid.org/0000-0001-8425-7126 Abstract BackgroundDigital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than face-to-face therapy. While efficacious dMH interventions are available for adolescents, premature dropout and low engagement are common, especially if delivered on a self-help basis without any form of therapist guidance. This is concerning, given that higher engagement, in terms of the number of sessions completed, has been repeatedly associated with improved clinical outcomes. The reasons for poor adolescent engagement in dMH programs are unclear. A clear understanding of when and why disengagement occurs is important in order to seek to improve engagement rates. Contemporary models consider engagement as multifaceted, comprising both “use” (eg, amount of content completed, frequency of use, duration spent logged into the dMH program, and depth of use, such as word or character count) and “user experience” (eg, interest and satisfaction in the program and affect and attention whilst engaging in the program). ObjectiveThis study investigated the role of demographic and early engagement (EE) factors, specifically program use, in predicting overall program engagement and continued engagement, respectively, in a self-directed, internet-based cognitive behavioral therapy program for adolescent anxiety, namely, BRAVE Self-Help. It examined multiple measures of program use, including task completion, homework completion, and depth of response (character count of responses typed into program tasks). It also examined the moderating role of baseline anxiety severity. MethodsData collected between July 2014 and May 2020 from 2850 adolescents aged 12 to 18 years who participated in BRAVE Self-Help were analyzed via a series of moderated regressions. ResultsResults showed that EE (in terms of program use) was associated with continued engagement, demonstrated by early tasks (tasks completed in the first two sessions; R2PR2P ConclusionsThese findings highlight the need to investigate ways to (1) enhance EE and (2) better understand how to measure and capture all aspects of program engagement.https://pediatrics.jmir.org/2025/1/e60523 |
| spellingShingle | Emma-Leigh Senyard Arlen Rowe Govind Krishnamoorthy Susan H Spence Caroline Donovan Sonja March The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis JMIR Pediatrics and Parenting |
| title | The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis |
| title_full | The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis |
| title_fullStr | The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis |
| title_full_unstemmed | The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis |
| title_short | The Role of Early Engagement in a Self-Directed, Digital Mental Health Intervention for Adolescent Anxiety: Moderated Regression Analysis |
| title_sort | role of early engagement in a self directed digital mental health intervention for adolescent anxiety moderated regression analysis |
| url | https://pediatrics.jmir.org/2025/1/e60523 |
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