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. 2023 Sep 9:34:100667.
doi: 10.1016/j.invent.2023.100667. eCollection 2023 Dec.

A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype

Rachel Kornfield  1 , Caitlin A Stamatis  1 , Ananya Bhattacharjee  2 , Bei Pang  2 , Theresa Nguyen  3 , Joseph J Williams  2 , Harsh Kumar  2 , Sarah Popowski  1 , Miranda Beltzer  1 , Christopher J Karr  4 , Madhu Reddy  5 , David C Mohr  1 , Jonah Meyerhoff  1
Affiliations

A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype

Rachel Kornfield et al. Internet Interv. .

Abstract

Background: Young adults have high rates of mental health conditions, but most do not want or cannot access treatment. By leveraging a medium that young adults routinely use, text messaging programs have potential to keep young adults engaged with content supporting self-management of mental health issues and can be delivered inexpensively at scale. We designed an intervention that imparts strategies for self-managing mental health symptoms through interactive text messaging dialogues and engages users through novelty and variety in strategies (from cognitive behavioral therapy, acceptance and commitment therapy, and positive psychology) and styles of interaction (e.g., prompts, peer stories, writing tasks).

Methods: The aim of this mixed-methods study was to pilot 1- and 2-week versions of an interactive text messaging intervention among young adults (ages 18-25), and to obtain feedback to guide intervention refinements. Young adults were recruited via a mental health advocacy website and snowball sampling at a North American University. We used Wizard-of-Oz methods in which study staff sent messages based on a detailed script. Transcripts of interviews were subject to qualitative analysis to identify aspects of the program that need improvements, and to gather participant perspectives on possible solutions.

Results: Forty-eight individuals ages 18-25 participated in the study (mean age: 22.0). 85 % responded to the program at least once. Among those who ever responded, they replied to messages on 85 % of days, and with engagement sustained over the study period. Participants endorsed the convenience of text messaging, the types of interactive dialogues, and the variety of content. They also identified needed improvements to message volume, scheduling, and content.

Conclusions: Young adults showed high levels of engagement and satisfaction with a texting program supporting mental health self-management. The program may be improved through refining personalization, timing, and message volume, and extending content to support use over a longer timeframe. If shown to be effective in randomized trials, this program has potential to help address a substantial treatment gap in young adults' mental health.

Keywords: Anxiety; Depression; Digital mental health; Text messaging; User-centered design; Young adults.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David C. Mohr, PhD has accepted honoraria and consulting fees from Otsuka Pharmaceuticals, Optum Behavioral Health, Centerstone Research Institute, and the One Mind Foundation, royalties from Oxford Press, and has an ownership interest in Adaptive Health, Inc. Jonah Meyerhoff, PhD, has accepted consulting fees from Boehringer Ingelheim.

Figures

Fig. 1
Fig. 1
Examples of (a) prompt, (b) story, (c) writing, and (d) modular dialogues.
Fig. 1
Fig. 1
Examples of (a) prompt, (b) story, (c) writing, and (d) modular dialogues.
Fig. 2
Fig. 2
a: Daily engagement with a 1-week system prototype (N = 30). b: Daily engagement with a 2-week system prototype (N = 11).
See this image and copyright information in PMC

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