# Evaluating User Engagement and Satisfaction With Digital Mental Health Interventions: Randomized Controlled Trial of a Text Messaging Program and e-Mental Health Resources

## TL;DR

A study found that daily supportive text messages improved user satisfaction and engagement more than e-mental health resources alone.

## Contribution

This study demonstrates the effectiveness of daily supportive SMS messaging as a low-cost mental health intervention.

## Key findings

- Participants in the Text4Support group reported significantly higher satisfaction scores compared to the control group.
- A higher proportion of Text4Support users found the messages supportive, positive, and helpful for coping with stress and loneliness.
- Daily text messaging increased engagement and positive actions compared to a single message with eHealth resources.

## Abstract

Digital mental health tools, such as SMS text messaging and online resources, are increasingly used to support well-being. However, user satisfaction across these formats remains insufficiently explored.

The study assessed participants’ engagement, perceived impact, and overall satisfaction with the Text4Support program and the e-mental health resources.

This randomized controlled study was conducted in Nova Scotia, Canada. Participants were assigned to either the Text4Support group, which received daily supportive text messages, or the control group, which received a single text message with a link to the Nova Scotia Mental Health and Addiction Program e-mental health resources. Responses to various aspects of the interventions were evaluated using a 5-point Likert scale, while overall satisfaction was measured on a scale from 0 to 10. The chi-square test and Fisher exact test were employed for data analysis.

A total of 69 participants in the control group and 130 in the Text4Support group completed the satisfaction survey. The overall mean (SD) satisfaction score in the control group was 5.1 (2.3), and the overall mean (SD) satisfaction score for the Text4Support group was 7.1 (2.2). Compared to the control group, participants in the Text4Support group reported greater engagement and positive program impact. While 53.8% (70/130) of Text4Support recipients always read the messages, only 39.1% (27/69) of the control group rarely accessed the eHealth resources. When compared to the control group, participants allocated to the Text4Support group were reported to sometimes take positive action upon reading the messages (42.3% vs 33.3%). A significantly higher proportion of Text4Support users strongly agreed or agreed that the messages were supportive (81.4% vs 41.5%), positive (88.4% vs 49.2%), and helpful in coping with stress (44.2% vs 11.9%), loneliness (40.3% vs 13.4%), and improving mental well-being (51.2% vs 17.9%). In contrast, the majority of responses from the control group were largely neutral.

Results showed that Text4Support group participants were significantly more satisfied with the program than those receiving standard eHealth resources. This highlights that daily supportive SMS text messaging is an effective, low-cost adjunct to care delivery and mental health improvement. These findings suggest that aggregate, brief, and low-cost text-based interventions have great potential for increasing health access and engagement, particularly among traditionally disadvantaged populations with limited access to traditional services.