# Exploring the Role of App Features in Providing Continuity of Care to Users on a Digital Mental Health Platform (Wysa): Retrospective Mixed Methods Observational Study

## TL;DR

This study shows that using additional features in a mental health app helps users stay engaged and complete more therapy sessions.

## Contribution

The study demonstrates that adjunct app features significantly improve session adherence in digital mental health interventions.

## Key findings

- Users who accessed app features completed significantly more sessions than non-users.
- Users were almost three times more likely to complete sessions after using app features.
- Qualitative feedback showed users found the app and MHCs helpful.

## Abstract

Despite digital mental health services growing at a rapid pace to address global mental health needs, there exist challenges of low engagement and attrition. Ensuring continuity of care in the digital context can positively impact mental health care delivery and adherence to treatment, helping to establish digital mental health interventions (DMHIs) as a viable option for mental health support.

This study aimed to examine the impact of adjunct app features of the mental health app Wysa and their ability to promote engagement and adherence to the text-based coaching sessions.

This retrospective mixed methods observational study was based on real-world app data from users (n=1213) who subscribed to text-based sessions with mental health coaches (MHCs) between February 1 and July 31, 2022. Their engagement with the adjunct app features, such as brief interventions with the conversational agent, self-management tools, and journaling, was analyzed quantitatively using descriptive statistics. Acceptability of the app features was also assessed using qualitative feedback data. Adherence to sessions with MHCs was compared between app feature users (n=1042, 85.9%) and nonfeature users (n=171, 14.1%) using inferential statistics. Subgroup analysis was not feasible in the absence of demographic and clinical user data, potentially limiting the generalizability of the findings.

Findings demonstrated high use of the adjunct app features, which allowed communication with the MHCs in between sessions. The thematic analysis captures user experiences of helpfulness within the app and with the MHCs. The Mann-Whitney U test indicated that users who accessed one or more features completed significantly more sessions compared with users who did not use any feature (Mann-Whitney U=154,085.0; P<.001; rB=0.73) with a large effect size. The odds ratio analysis indicated that users were almost thrice as likely to complete sessions after using the adjunct app features (odds ratio 2.91, 95% CI 2.24-3.38; P<.001).

Inclusion of adjunct app features enhances continuity in care delivery between sessions with MHCs and is associated with improved engagement with DMHIs. Further efforts are needed to assess the impact of this approach in DMHIs on clinical mental health outcomes.