An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings
BackgroundDigital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys....
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-04-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2023/1/e41428 |
| _version_ | 1797734090663788544 |
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| author | James M Zech Morgan Johnson Michael D Pullmann Thomas D Hull Tim Althoff Sean A Munson Nicole Fridling Boris Litvin Jerilyn Wu Patricia A Areán |
| author_facet | James M Zech Morgan Johnson Michael D Pullmann Thomas D Hull Tim Althoff Sean A Munson Nicole Fridling Boris Litvin Jerilyn Wu Patricia A Areán |
| author_sort | James M Zech |
| collection | DOAJ |
| description |
BackgroundDigital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. User engagement, or client behaviors and therapeutic relationships that facilitate positive treatment outcomes, is a necessary condition for the effectiveness of any digital treatment. Developing a better understanding of the factors that impact user engagement can impact the overall effectiveness of digital psychotherapy. Mapping the user experience in digital therapy may be facilitated by integrating theories from several fields. Specifically, health science’s Health Action Process Approach and human-computer interaction’s Lived Informatics Model may be usefully synthesized with relational constructs from psychotherapy process–outcome research to identify the determinants of engagement in digital messaging therapy.
ObjectiveThis study aims to capture insights into digital therapy users’ engagement patterns through a qualitative analysis of focus group sessions. We aimed to synthesize emergent intrapersonal and relational determinants of engagement into an integrative framework of engagement in digital therapy.
MethodsA total of 24 focus group participants were recruited to participate in 1 of 5 synchronous focus group sessions held between October and November 2021. Participant responses were coded by 2 researchers using thematic analysis.
ResultsCoders identified 10 relevant constructs and 24 subconstructs that can collectively account for users’ engagement and experience trajectories in the context of digital therapy. Although users’ engagement trajectories in digital therapy varied widely, they were principally informed by intrapsychic factors (eg, self-efficacy and outcome expectancy), interpersonal factors (eg, the therapeutic alliance and its rupture), and external factors (eg, treatment costs and social support). These constructs were organized into a proposed Integrative Engagement Model of Digital Psychotherapy. Notably, every participant in the focus groups indicated that their ability to connect with their therapist was among the most important factors that were considered in continuing or terminating treatment.
ConclusionsEngagement in messaging therapy may be usefully approached through an interdisciplinary lens, linking constructs from health science, human-computer interaction studies, and clinical science in an integrative engagement framework. Taken together, our results suggest that users may not view the digital psychotherapy platform itself as a treatment so much as a means of gaining access to a helping provider, that is, users did not see themselves as engaging with a platform but instead viewed their experience as a healing relationship. The findings of this study suggest that a better understanding of user engagement is crucial for enhancing the effectiveness of digital mental health interventions, and future research should continue to explore the underlying factors that contribute to engagement in digital mental health interventions.
Trial RegistrationClinicalTrials.gov NCT04507360; https://clinicaltrials.gov/ct2/show/NCT04507360 |
| first_indexed | 2024-03-12T12:39:15Z |
| format | Article |
| id | doaj.art-4bd49665281c44bda37325c8898b5db4 |
| institution | Directory Open Access Journal |
| issn | 2561-326X |
| language | English |
| last_indexed | 2024-03-12T12:39:15Z |
| publishDate | 2023-04-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj.art-4bd49665281c44bda37325c8898b5db42023-08-28T23:57:37ZengJMIR PublicationsJMIR Formative Research2561-326X2023-04-017e4142810.2196/41428An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group FindingsJames M Zechhttps://orcid.org/0000-0001-8726-1884Morgan Johnsonhttps://orcid.org/0000-0002-2081-6176Michael D Pullmannhttps://orcid.org/0000-0001-8404-864XThomas D Hullhttps://orcid.org/0000-0001-8275-6765Tim Althoffhttps://orcid.org/0000-0003-4793-2289Sean A Munsonhttps://orcid.org/0000-0002-0472-6138Nicole Fridlinghttps://orcid.org/0000-0002-3647-0181Boris Litvinhttps://orcid.org/0000-0003-4710-8417Jerilyn Wuhttps://orcid.org/0000-0003-2576-4456Patricia A Areánhttps://orcid.org/0000-0001-5971-6319 BackgroundDigital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. User engagement, or client behaviors and therapeutic relationships that facilitate positive treatment outcomes, is a necessary condition for the effectiveness of any digital treatment. Developing a better understanding of the factors that impact user engagement can impact the overall effectiveness of digital psychotherapy. Mapping the user experience in digital therapy may be facilitated by integrating theories from several fields. Specifically, health science’s Health Action Process Approach and human-computer interaction’s Lived Informatics Model may be usefully synthesized with relational constructs from psychotherapy process–outcome research to identify the determinants of engagement in digital messaging therapy. ObjectiveThis study aims to capture insights into digital therapy users’ engagement patterns through a qualitative analysis of focus group sessions. We aimed to synthesize emergent intrapersonal and relational determinants of engagement into an integrative framework of engagement in digital therapy. MethodsA total of 24 focus group participants were recruited to participate in 1 of 5 synchronous focus group sessions held between October and November 2021. Participant responses were coded by 2 researchers using thematic analysis. ResultsCoders identified 10 relevant constructs and 24 subconstructs that can collectively account for users’ engagement and experience trajectories in the context of digital therapy. Although users’ engagement trajectories in digital therapy varied widely, they were principally informed by intrapsychic factors (eg, self-efficacy and outcome expectancy), interpersonal factors (eg, the therapeutic alliance and its rupture), and external factors (eg, treatment costs and social support). These constructs were organized into a proposed Integrative Engagement Model of Digital Psychotherapy. Notably, every participant in the focus groups indicated that their ability to connect with their therapist was among the most important factors that were considered in continuing or terminating treatment. ConclusionsEngagement in messaging therapy may be usefully approached through an interdisciplinary lens, linking constructs from health science, human-computer interaction studies, and clinical science in an integrative engagement framework. Taken together, our results suggest that users may not view the digital psychotherapy platform itself as a treatment so much as a means of gaining access to a helping provider, that is, users did not see themselves as engaging with a platform but instead viewed their experience as a healing relationship. The findings of this study suggest that a better understanding of user engagement is crucial for enhancing the effectiveness of digital mental health interventions, and future research should continue to explore the underlying factors that contribute to engagement in digital mental health interventions. Trial RegistrationClinicalTrials.gov NCT04507360; https://clinicaltrials.gov/ct2/show/NCT04507360https://formative.jmir.org/2023/1/e41428 |
| spellingShingle | James M Zech Morgan Johnson Michael D Pullmann Thomas D Hull Tim Althoff Sean A Munson Nicole Fridling Boris Litvin Jerilyn Wu Patricia A Areán An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings JMIR Formative Research |
| title | An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings |
| title_full | An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings |
| title_fullStr | An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings |
| title_full_unstemmed | An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings |
| title_short | An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings |
| title_sort | integrative engagement model of digital psychotherapy exploratory focus group findings |
| url | https://formative.jmir.org/2023/1/e41428 |
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