Boosting the Benefits of Mobile Technology-Delivered Interventions: A Randomized Controlled Trial Examining Human Support to Enhance Engagement, Skill Integration, and Learning (Preprint)

BACKGROUND Mobile technology-delivered interventions (TDIs), or mTDIs, have great promise for maximizing reach, but struggle with low rates of uptake and engagement. Among other evidence-based mTDIs, mindfulness apps such as Headspace have demonstrated numerous benefits for both community and clinical samples. People with depression or other mental health problems can experience many benefits from mTDIs, yet also may face even greater challenges in engaging with app-based interventions. Although users usually value the self-guided nature of mTDIs, they also might benefit from social connection with peers, and instructional guidance from a knowledgeable source, around mTDI use. College students are often studied as mTDI users given their high level of engagement with technology. Students also benefit from ample opportunities for social connection with peers, and instructional settings. OBJECTIVE This randomized controlled trial evaluated the impact of two human support enhancements – a one-time interactive orientation, with or without placement into a peer supportive accountability group – on mTDI engagement, skill integration, and learning among a sample of 123 depressed college students. METHODS Participants authorized access to their recorded app use data, provided by Headspace. Additionally, at midpoint (1 month), post (2 months) and follow-up (3 months) assessments, participants reported on the extent to which they had been using the intervention’s skills outside of the app, how likely they were to continue using the app and related skills in the future, and the extent to which they learned from the intervention. RESULTS As compared to those who were simply given access to the app without these enhancements, participants who were randomized to attended orientation, regardless of additional randomization to the peer support group, demonstrated significantly greater mTDI engagement (e.g., more minutes meditated, F=11.20, p<.001) and rated multiple aspects of skill integration and learning more favorably (e.g., increased awareness of thoughts and feelings, F=6.05, p=.004), indicating potential implications for amplifying the benefits of mTDIs through increased user engagement. CONCLUSIONS The results of this study illustrate that an initial face-to-face orientation boosts mTDI engagement, enhances integration of intervention skills in everyday life, and increases learning. Future work is needed to determine the active ingredients of the orientation that might drive increased levels of engagement and the associated positive intervention benefits. CLINICALTRIAL Open Science Framework (OSF): https://osf.io/3trzk