Examining Strategies for Increasing Engagement with Digital Mental Health Interventions Among Anxious Individuals

Digital mental health interventions (DMHIs) have the potential to increase access to effective mental health care. Yet, people do not frequently or consistently use DMHIs when they are delivered outside the laboratory in real-world settings (Mohr et al., 2017). This underscores the need to identify effective strategies to promote interest and use of these tools in real-world contexts, particularly among traditionally underserved populations. To this end, this dissertation examines different approaches to increase engagement with a web-based DMHI for anxiety (called MindTrails; https://mindtrails.virginia.edu/) through three complementary studies. Study 1, which has already been published (Silverman et al., 2023), tested the effectiveness of different ways of marketing MindTrails to promote uptake and engagement among N=1,600 anxious patients in a large healthcare system (identified and recruited via the healthcare systems’ electronic health record system) to use MindTrails as an adjunct to usual care. Overall, 19.4% of patients clicked a link to visit the MindTrails website, 6.7% enrolled in the program, and 4.2% started the first session. None of the marketing strategies were significantly associated with greater rates of clicks on a link to visit the MindTrails website, enrollment, or starting the first session. Study 2 tested the effectiveness of different culturally informed marketing messages for increasing uptake and use of a culturally enhanced, Spanish-translated version of MindTrails among N=1,151 Spanish-speaking Latinx individuals with a history of anxiety (identified by a research panel). Overall, 8.3% of individuals clicked the link to visit the MindTrails website, 2.1% enrolled, and 1.7% started the first session. As with Study 1, none of the culturally informed marketing strategies were significantly associated with greater rates of clicks on a link to visit the MindTrails website, enrollment, or starting the first training. Study 3 evaluated the pilot feasibility, acceptability, and preliminary effectiveness of the culturally enhanced, Spanish-translated version of MindTrails among N=27 Spanish-speaking Latinx individuals with a history of anxiety (identified by a research panel). Results indicated that the Spanish-translated version of MindTrails was feasible and acceptable, and led to improvements in negative interpretation bias and anxiety symptoms from pre- to post-intervention. Taken together, findings suggest that brief, emailed promotional marketing messages may not be sufficient on their own to attract and retain DMHI users in the real-world, and underscore the need for multifaceted approaches to promote DMHI engagement among individuals who need and desire effective anxiety supports.