If you build it, will they stay? Improving user engagement with digital health tools in mental health contexts

One in four Canadians reported experiencing mental health issues, such as depression and anxiety, during the COVID-19 pandemic. The unprecedented demand for mental health services has placed tremendous stress on the current mental health system, and the social distancing restrictions have greatly limited the utility of conventional, in-person mental health services. Digital health tools, such as patient portals and mobile apps, are well-positioned to increase capacity for the mental health system and to reduce the burden of mental health challenges in Canada. However, sustained usage with these tools in the real-world environment remain suboptimal. As such, identifying and implementing strategies to improve user engagement with digital health tools is critical to enabling the national and provincial investments in these technologies. The proposed research aims to address this unmet need by examining user engagement with a patient portal that is implemented at a large academic teaching hospital to identify the mechanisms that enhance or detract user engagement with these tools. Using a sequential, explanatory mixed methods approach, a retrospective analysis will be conducted on the usage data of the patient portal to characterize user engagement patterns on the portal for patients seeking mental health care. Based on the usage patterns identified, patients with high and low usage of the portal, as well as clinicians that use the portal with their patients, will be invited to a semi-structured interview to learn about their experiences and factors that may lead to repeated engagement or disengagement with the solution. These findings will inform the identification of strategies that enhance or detract user engagement with digital health tools, which will be of great relevance to mental health clinicians and health system administrators.