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. 2020 Jun 23;22(6):e16317.
doi: 10.2196/16317.

Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers

Shaun Liverpool  1 , Catarina Pinheiro Mota  2   3 , Célia M D Sales  4 , Anja Čuš  5 , Sara Carletto  6 , Camellia Hancheva  7 , Sónia Sousa  8 , Sonia Conejo Cerón  9 , Patricia Moreno-Peral  9 , Giada Pietrabissa  10   11 , Bettina Moltrecht  1 , Randi Ulberg  12 , Nuno Ferreira  13 , Julian Edbrooke-Childs  1
Affiliations

Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers

Shaun Liverpool et al. J Med Internet Res. .

Abstract

Background: There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible.

Objective: This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs.

Methods: A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts "child and adolescent mental health," "digital intervention," and "engagement." Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively.

Results: This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP's engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs.

Conclusions: The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.

Keywords: adolescent mental health; children; eHealth; mHealth; mobile phone; smartphone; technology.

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Conflict of interest statement

Conflicts of Interest: JE-C is an author of one of the reviewed articles.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of the study selection process.
Figure 2
Figure 2
A framework of factors influencing engagement in children and young people’s mental health digital intervention.
See this image and copyright information in PMC

References

    1. Perou R, Bitsko R, Blumberg S, Pastor P, Ghandour R, Gfroerer J, Hedden S, Crosby A, Visser S, Schieve L, Parks S, Hall J, Brody D, Simile C, Thompson W, Baio J, Avenevoli S, Kogan M, Huang L, Centers for Disease Control and Prevention (CDC) Mental health surveillance among children-United States, 2005-2011. MMWR Suppl. 2013 May 17;62(2):1–35. - PubMed
    1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011 Oct 22;378(9801):1515–25. doi: 10.1016/S0140-6736(11)60827-1. - DOI - PubMed
    1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015 Mar;56(3):345–65. doi: 10.1111/jcpp.12381. - DOI - PubMed
    1. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in US adolescents: results from the national comorbidity survey replication--adolescent supplement (NCS-A) J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980–9. doi: 10.1016/j.jaac.2010.05.017. http://europepmc.org/abstract/MED/20855043 - DOI - PMC - PubMed
    1. Lawrence D, Johnson S, Boterhoven DH, Ainley J, Zubrick S. Australian Government Department of Health. 2015. [2020-05-06]. The Mental Health of Children and Adolescents: Report on the Second Australian Child and Adolescent Survey Of Mental Health and Wellbeing https://www1.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21....

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