Factors influencing engagement with digital mental health interventions from the perspective of university students with mental health difficulties: A qualitative study

While mental health difficulties are increasing in prevalence among university students, novel solutions such as digital mental health interventions (DMHIs) provide a cost-effective, accessible and scalable solution to reduce this burden. However, engagement with these interventions is often challenging and is typically lower in real world-use than in research studies. Several factors are likely involved, including the degree to which an intervention is fully automated or involves human guidance. Our recent meta-analysis indicated that the amount of guidance necessary may in turn depend on the difficulties presented (e.g. anxiety versus depression). Using qualitative methods and the Theoretical Domains Framework (TDF) as a guiding tool, this study aims to more broadly identify and describe the barriers and facilitators that university students with mental health difficulties perceive when engaging with DMHIs. Thus, we expect to find barriers and facilitators at both an individual level, including perceived need and motivation, and at an intervention level, including program features and costs, level of guidance and user interface.Moreover, we also expect to find barriers related to concerns about replacing in-person therapies, and accessibility of DMHIs as a facilitator of engagement.