4 - (IOP 15) Improving Engagement in Self-guided Digital Mental Health Treatments: A Comparative Analysis of Digital Treatment as Usual vs. the Mind-us Program

Background: With four decades of research supporting their effectiveness, digital mental health treatments (DMHTs) hold the promise to make evidence-based interventions more widely available by addressing traditional barriers to care, such as provider shortages, financial and transportation burdens, and stigma toward seeking services. However, DMHTs, especially those that are fully self-guided, often face poor uptake, limited treatment engagement, and high attrition, jeopardizing the feasibility of using digital tools to provide mental health care. These implementation problems may be even more pronounced when DMHTs are intended to serve marginalized groups who often face socially complex needs. Therefore, implementation strategies that facilitate uptake, promote engagement, and reduce attrition in DMHTs are sorely needed. This study compared the implementation outcomes (i.e., uptake, engagement, attrition) of two versions of a self-guided, app-based mindfulness intervention for racially and ethnically minoritized individuals with mental health needs due to race-based stressors.

Methods: Participants (n = 160, Mage = 27.28, 39% Latinx, 37% Asian, 12% Black, 10% Multiracial, 2% Native American) received the commercially available 10% Happier meditation app. In the digital treatment as usual (d-TAU) group, participants (n = 80) received written instructions on how to download and use the app throughout the 4-week program. In the Mindfulness for Us (Mind-Us) group, participants (n = 80) underwent a 30-minute onboarding procedure in which they were assisted in downloading the app, problem-solving potential barriers to engagement, and discussing potential cultural mismatches with the app content. This group also received automated daily text messages with reminders and educational and motivational content.

Results: In d-TAU, 61% of participants downloaded the app vs. 100% in Mind-Us (χ2(1) = 38.45, p < .001). In d-TAU, participants used the app on average 3.19 days vs. 15.06 in Mind-Us (t(158) = -8.22, p < .001), completed on average 4.73 meditations vs. 22.46 in Mind-Us (t(158) = -5.09, p < .001), and meditated on average 45.43 minutes vs. 218.89 in Mind-Us (t(158) = -4.32, p < .001). In d-TAU, 89% of participants dropped out of treatment vs. 14% in Mind-Us (χ2(1) = 90.06, p < .001).

Conclusion: Low-intensity engagement strategies, such as a brief onboarding procedure with study staff and automated daily text messages, effectively increased uptake and engagement and reduced attrition in a self-guided DMHT. Importantly, these outstanding implementation outcomes were observed among racially and ethnically minoritized individuals, a group that is often characterized as “hard to reach” and “difficult to engage” in both brick-and-mortar and DMHT research. Considering the recent addition of new Healthcare Common Procedure Coding System codes that allow for the medical billing of technological devices, the initial education and onboarding necessary to use them, and the ongoing treatment management services directly related to the patient’s use of DMHTs, the engagement strategies used in this study could become even more relevant to increase access to mental health care in the United States.