Make It Stick: Exploring the Influence of User Experience and User Interface on Adolescent Engagement for the Digital Mental Health Intervention ‘SPARX’

Background

Adolescents in Aotearoa are experiencing high rates of mental health challenges and psychological distress. Partly in response, digital mental health interventions (DMHIs) have emerged as an innovative approach to support young people over the past decade. These interventions offer unique advantages, including 24/7 accessibility, the ability to support multiple users simultaneously, and often being available without GP referral or large cost barriers. Subsequently, they present a promising solution for providing support within a strained healthcare system.

Although evidence suggests that these digital tools can be effective when used consistently, real-world engagement rates remain below optimal levels. This discrepancy highlights a critical research gap: understanding the factors that motivate adolescents to engage more consistently with DMHIs. Particularly, there is a need to explore how the intersection of psychotherapy and digital design elements, specifically user experience (UX) and user interface (UI), might influence adolescent engagement and ultimately clinical outcomes.

Aim

The aim of this research is to explore how UX and UI influence adolescent engagement during the early stages of SPARX, an evidence based gamified DMHI for adolescent depression which is publicly available to anyone with a New Zealand Internet Protocol address.

Method

Qualitative data were collected throughout seven think-loud semi-structured interviews and were thematically analysed through a critical realist lens. Participants were aged between 16-20 years old and asked to sign up and begin using level one of SPARX. While interacting with SPARX, participants were coached through the think-aloud process and asked open ended questions and prompts to trigger reflection about how the look and feel of the intervention was impacting their behaviour and attitude towards engaging.

Findings

Three main themes were identified, each with three sub-themes. Theme one highlighted the importance of the participants’ onboarding experience to the DMHI, where participants needed to feel a connection and excitement to the tool, early. Theme two uncovered striking the balance between gamification and serious therapeutic elements, with sub-themes of positioning, the perceived seriousness of the game and the power of gamified collectables. The final key theme related to operational influences at play and included sub-themes of therapeutic elements and gaming working harmoniously together in the DMHI to improve engagement, clear and cohesive DMHI set up experiences and the power of immersive digital experiences such as music.

Conclusion

This is one of few studies that explores the contribution of UX and UI on user engagement for adolescent DMHIs. Findings and literature suggest UX and UI designers should be consulted from the beginning of DMHI design, along with including the voices of adolescents via a co-design process. Optimising the first 10 minutes of a DMHI for engagement through music, interactive education and short registration processes could positively influence effectiveness and adherence for existing DMHIs and therefore enhance health outcomes for adolescents across Aotearoa and beyond. This research recommends adjustments from designing a shorter initial module that establishes a clear, measurable goal for the user to enabling users to interact with the tool before completing the registration process such as a trial.