(PS10-A16) Barriers and Facilitators of Youth and Caregiver Engagement in Guided Digital Mental Health Interventions: A Systematic Review and Meta-analysis

Background: Digital mental health interventions (DMHIs) are a promising pathway to increasing accessibility to mental health care for youth and can address common barriers to in-person care, such as transportation challenges, high costs, limited provider availability, and stigma. Recent reviews suggest that DMHIs may be as efficacious as in-person care for youth (Hollis et al., 2017; Lehtimaki et al., 2021). While DMHIs are an affordable and accessible treatment option, engagement in DMHIs remains a challenge. Prior literature proposes barriers and facilitators of engagement at both intervention-specific (e.g., acceptability of delivery mode, content) and person-specific (e.g., motivation, digital literacy, symptom severity) levels (Liverpool et al., 2020). However, there is limited research assessing the impact of intervention design on engagement and overall efficacy of DMHIs for youth and their caregivers. Although the potential utility of DMHIs has been highlighted, the rapid development of digital technologies calls for an updated understanding and evaluation of DMHIs. 

The primary aims of this meta-analysis include (1) identifying barriers and facilitators to engaging youth and caregivers in DMHIs and (2) examining intervention design factors as moderators of engagement and intervention efficacy. Secondary aims include exploring differences in engagement across delivery modalities and evaluating the impact of the onset of the COVID-19 pandemic and subsequent shift to remote healthcare. 

Method: We will conduct a systematic search of databases (PsycInfo, PubMed, Cochrane Library, and ProQuest Dissertation and Theses) for randomized controlled trials (RCTs) of DMHIs for youth ages 0-18 with elevated levels of stress and/or symptoms of psychopathology, including those focused on caregivers if the intervention targets youths’ symptoms. DMHIs may be standalone or adjunctive to in-person care if there are core intervention components delivered digitally. Only interventions that involve regular intervention content-related contact with a therapist or coach will be included (I.e., technology cannot only be used for administrative purposes). 

Results: Pre-screening and full-text review are ongoing. Study characteristics, outcomes, and findings will be extracted from study documents, including but intervention target, delivery method, comparator group, engagement measures, mental health outcome measures, and key findings of facilitators and barriers of engagement examined by authors. Pre- and post-intervention means, standard deviations, and other data from included studies will be used to compute standardized mean differences between intervention and comparator groups. Candidate moderators of engagement will also be assessed. 

Discussion: This meta-analysis will clarify the factors that facilitate and impede youth and caregiver engagement in DMHIs. Identified intervention- and person-specific factors of engagement will help to inform intervention design and implementation, as well as provide insights into how to address challenges related to DMHIs and guidance on determining what interventions best suits which youth.