The Role of Personalization, Engagement, and Feedback in Digital Health Interventions for Anxiety

The prevalence of anxiety symptoms in university students is increasing, however, many do not receive treatment due to barriers in healthcare. While digital mental health interventions (DMHIs) are a prospective treatment option, they often remain ineffective, which may be due to a low user-engagement. Personalizing interventions may increase engagement. Hence, this research aimed to investigate the effect of a personalized DMHI on user’s engagement and anxiety, and if engagement mediates the link between personalization and anxiety. It was also explored if prescripted video feedback of a counselor is related to higher engagement and lower anxiety scores than other feedback types. A randomized controlled trial was conducted. The experimental group received a personalized, and the control group a random 2-week-micro-intervention version. Personalization was not linked to anxiety, nor engagement scores at post-intervention. A higher engagement was linked to lower anxiety scores at post-intervention and follow-up. Prescripted video feedback was not associated with lower anxiety, nor higher engagement scores. Future research is provided with recommendations for imporving the personalization approach. With the finding that a higher engagement may predict lower anxiety scores several weeks after completing the treatment, it is advised to investigate how engagement can be maintained to increase intervention effectiveness.