Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review
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Abstract
Background: Digital interventions offer a solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness; however, retaining users’ engagement throughout the intervention is challenging. It remains unclear what strategies facilitate engagement with digital interventions that target mental health promotion. Objective: Our aim is to conduct a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions that target mental health promotion in adults. Methods: This scoping review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The search was conducted in 7 electronic databases from inception to April 2020. The inclusion criteria for studies were as follows: adult (aged ≥18 years) users of digital interventions for mental health promotion from the general population; any digital intervention for mental health promotion; and user engagement strategies described in the intervention design. We extracted the following data items: study characteristics, digital intervention (type and engagement strategy), evaluation of engagement strategy (method and result specifying whether the strategy was effective at facilitating engagement), and features of engagement (extent of use and subjective experience of users). Results: A total of 2766 studies were identified, of which 16 (0.58%) met the inclusion criteria. The 16 studies included randomized controlled trials (6/16, 37%), studies analyzing process data (5/16, 31%), observational studies (3/16, 19%), and qualitative studies (2/16, 13%). The digital interventions for mental health promotion were either web based (12/16, 75%) or mobile app based (4/16, 25%). The engagement strategies included personalized feedback about intervention content or users’ mental health status; guidance regarding content and progress through e-coaching; social forums, and interactivity with peers; content gamification; reminders; and flexibility and ease of use. These engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires or tools (4/16, 25%), usability data (5/16, 31%), or both (7/16, 44%). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, personalized feedback, or joint videoconference sessions as an engaging feature. Conclusions: Personalized support during the intervention, access to social support, and personalized feedback seem to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness of different strategies required to facilitate user engagement in digital interventions for mental health promotion.
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Recent reviews on engagement with digital mental health interventions [40,41] identified that tailored digital technologies with personalized videos and avatars increased user engagement and demonstrated effectiveness.
“Likewise, recent reviews on engagement with digital mental health interventions [40,41] identified that tailored digital technologies with personalized videos and avatars increased user engagement and demonstrated effectiveness.”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [40]
The Results (Randomized Controlled Trials; page not available) report that avatar personalization improved task-specific engagement, and the Discussion says tailored content can increase engagement. The review mentions videos, but does not identify personalized videos as an effective engagement feature or demonstrate that the specified features improved mental health outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredUser-centered design processes are increasingly incorporated to attain direction and input from users across all stages of DMHI design and development.
“User-centered design processes are increasingly incorporated to attain direction and input from users across all stages of DMHI design and development”
From A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype (2023) · cites this paper as Saleem et al., 2021
The Results section on recommended engagement strategies says the review used usability data and user feedback to identify effective strategies, while the Discussion describes tailoring interventions to users’ needs. Neither passage addresses whether user-centered design processes are increasingly incorporated or whether users provide input across all stages of DMHI design and development. Searches for user-centered and participatory design, development stages, and user input found no passage establishing that claim; the indexed passages provide no page numbers. (LLM, conf=0.75)
Experimental — accuracy not yet measuredVarious features, functionality, and design considerations can promote user engagement with DMHIs, including perceived usefulness, positive impact and relevance, content promoting health and social connection, design aspects, personalized content and choice, data security and privacy, and therapist guidance.
“Reviews of the existing literature also show that various features, functionality, and design considerations can promote user engagement with DMHIs.”
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Digitale Technologien zur Verbesserung der psychischen Gesundheit
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Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study
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“Likewise, recent reviews on engagement with digital mental health interventions [40,41] identified that tailored digital technologies with personalized videos and avatars increased user engagement and demonstrated effectiveness.”
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A Hybrid Chatbot to Promote Pneumococcal Vaccination Among Older Adults
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Leveraging machine learning to examine engagement with a digital therapeutic
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“…positive impact and relevance of DMHIs; content that promotes good mental, physical, and cognitive health [33,34] and social connection [25,31]; design aspects (eg, ease of use and interface); personalized content and choice [35-37]; data security and privacy; and therapist guidance [25].”
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Evaluation of Digital Public Health Interventions
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User-engagement in digital health applications: a scoping reviewPreprint
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- Authors
- Saleem, M., Kühne, L., De Santis, K. K., Christianson, L., Brand, T., & Busse, H.
- Affiliations
- Leibniz Institute for Prevention Research and Epidemiology - BIPS (DE)
- Corresponding author
- Saleem, Maham
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2021-12-20
- Volume
- 8
- Issue
- 12
- Pages
- e30000
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC8726056
- OpenAlex
- W3195929293
- Cited by
- 199
- References
- 47
- Citations by year
- 2026: 47 · 2025: 68 · 2024: 41 · 2023: 38 · 2022: 5
- FWCI
- 3.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Human-Computer Interaction › Innovative Human-Technology Interaction
- Keywords
- user engagement, digital interventions, mental health promotion, e-coaching, personalized feedback, gamification, peer support, social support, mobile health apps, online intervention, engagement evaluation, usability, user experience, adults, COVID-19 restrictions, access to mental health care, videoconferencing, reminders
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