# Sustained engagement with a digital youth mental health platform: A mixed-methods study

## TL;DR

This study explores what keeps young people engaged with a digital mental health platform, finding that feeling connected and applying therapy in daily life are key.

## Contribution

The study identifies specific experiential factors linked to sustained engagement in digital youth mental health platforms using mixed methods.

## Key findings

- Relational experiences like normalization and belonging are significantly associated with higher engagement.
- Practical application of therapeutic insights in daily life correlates with sustained platform use.
- Low motivation and cognitive overload are barriers to engagement but do not significantly differentiate high and low users.

## Abstract

Digital mental health interventions offer a scalable means of expanding access to youth mental health care. However, their capacity to achieve population-level impact is limited by persistently low and varied user engagement. A more nuanced understanding of experiential factors associated with sustained engagement is needed to inform the design of digital interventions that are both clinically effective and engaging to young people.

To identify experiential factors associated with sustained engagement with a large-scale, real-world digital youth mental health platform implemented across Australian youth mental health services.

A convergent mixed-methods approach integrated platform usage data and qualitative interviews with young people aged 16–25 years (mean = 19; n = 36) classified as either high or low engagers. The sample comprised 53 % female, 31 % male, and 8 % trans and/or gender diverse; 3 % identified as First Nations, and 19 % as culturally and linguistically diverse. Most participants lived in metropolitan areas (82 %), with 8 % from regional locations. Interview transcripts were thematically coded for experiential features of engagement. Code presence was quantified and tested for association with engagement level (high vs low) using Fisher's exact test. Themes were then iteratively refined, with explicit consideration of experiential patterns significantly associated with engagement.

Two experiential factors were significantly associated with sustained engagement: (1) relational experiences, including normalisation and validation (P = 0.038) and, community and belonging (P = 0.01); and (2) the practical application of therapeutic insights in everyday life (P = 0.03). Low motivation was commonly reported as a barrier but did not significantly differentiate high from low engagers (P = 0.467).

This mixed methods study offers preliminary insights into experiential factors associated with engagement with a large-scale digital mental health intervention for young people. Indications suggest two experiential pathways to sustained use: relational experiences characterised by feeling understood, normalisation, and belonging, and functional utility reflected in the practical application of therapeutic strategies in daily life. Challenges reported by low-engaged young people, including cognitive overload, low motivation, and limited reminder prompting from the intervention, highlight opportunities for adaptive, low-effort re-engagement strategies. As digital mental health services continue to scale, understanding engagement as an emotional, social, and practical process may help support more sustained and inclusive participation.

•High and low engagers reported qualitatively different experiences of use.•Relational experiences and practical utility were associated with higher engagement.•Young people described passive use as meaningful.•Low motivation and cognitive overload contributed to disengagement.

High and low engagers reported qualitatively different experiences of use.

Relational experiences and practical utility were associated with higher engagement.

Young people described passive use as meaningful.

Low motivation and cognitive overload contributed to disengagement.