Perspectives of Children and Adolescents on Engaging With a Web-Based Mental Health Program: Focus Group Study

Background: Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%. Objective: The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI. Methods: In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety. Results: Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned. Conclusions: The study's findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized.