Minimal Effect of Messaging on Engagement in a Digital Anxiety Intervention

This study evaluated the effectiveness of different recruitment messages for encouraging enrollment in a digital mental health intervention (DMHI) for anxiety among 1,600 anxious patients in a large health care system. Patients were randomly assigned to receive a standard message, or one of five messages designed to encourage enrollment: three messages offered varying financial incentives, one message offered coaching, and one message provided consumer testimonials. Patients could then click a link in the message to visit the DMHI website, enroll, and start the first session. We examined the effects of message features and message length (short vs. long) on rates of site clicks, enrollment, and starting the first session. We also tested whether demographic and clinical factors derived from patients' electronic health records were associated with rates of enrollment and starting the first session to understand the characteristics of patients most likely to use DMHIs in this setting. Across messages, 19.4% of patients clicked a link to visit the DMHI website, but none of the messages were significantly associated with rates of site clicks, enrollment, or starting the first session. Females (vs. males) had a greater probability of enrollment. No other demographic or clinical variables were significantly associated with enrollment or starting the first session. Findings provide guidance for resource allocation decisions in larger scale DMHI implementations in health care settings. Public Significance Statement Among anxious patients in a large health care setting, resource-intensive methods of promoting DMHI engagement (e.g., offering financial incentives or coaching) did not affect rates of clicks on a link to visit a DMHI website, enrollment, or starting the first session. Findings suggest these high-cost promotional methods may not add value in terms of increasing DMHI uptake or use when offering DMHIs at a larger scale.