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Albán Varela, Soledad

University of British Columbia

Mental health apps are increasingly proposed as scalable and accessible tools for delivering digital mental health interventions (DMHIs). However, their effectiveness depends on users’ ability to meaningfully engage with their therapeutic components. Early research on user engagement with digital apps operationalized engagement through adherence, a measure of continued use, overlooking the complexity of how individuals interact with these tools and their contribution to people’s well-being. Recent scholarship calls for more comprehensive, multidimensional approaches to understanding engagement with DMHIs. This thesis builds on the CREST.BD research group’s real-world deployment of the PolarUs app, which supports individuals with bipolar disorder through self-management strategies and psychoeducational resources. My research examined the relationship between five behavioural engagement indicators (i.e. daily and monthly quality of life (QoL) tracker adherence, consecutiveness in monthly tracking, and the number and duration of psychoeducational resources accessed) and QoL outcomes. QoL was operationalized as each participant’s score on the second monthly QoL.BD self-assessment, where scores could range from 48 to 240, with higher scores indicating greater overall life satisfaction. QoL outcomes were adjusted for participants’ baseline scores obtained during their initial monthly assessment. Multiple linear regression models were used to assess how each engagement indicator contributed to QoL outcomes while controlling for baseline QoL. Baseline QoL was the strongest predictor, accounting for 41.7% of the variance in second-month QoL scores. Of the five engagement indicators, only daily tracker adherence made a statistically significant contribution, explaining an additional 4.7% of the variance (p = .003). Differences in cognitive processing and behavioural patterns may partially account for the limited association between behavioural engagement and QoL outcomes in the present study. Although daily adherence may suggest a direct link to quality of life (QoL) improvements, this interpretation does not account for broader behavioural patterns that may influence QoL as a long-term outcome. These findings highlight the limitations of relying solely on usage-based metrics to evaluate engagement and emphasize the need for more nuanced frameworks in digital health research. Implications are discussed in relation to real-world DMHI implementation and future directions for evaluating engagement in digital mental health research.

Text

2025-06-26

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/91448

Library and Information Studies

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/