Engagement is a multifaceted construct and a likely mechanism by which digital interventions achieve clinical improvements. To date, clinical research on digital mental health interventions (DMHIs) has overwhelmingly defined engagement and assessed its association with clinical outcomes through the objective/behavioral metrics of use of or interactions with a DMHI, such as number of log-ins or time spent using the technology. However, engagement also entails users' subjective experience. Research is largely lacking that tests the relationship between subjective metrics of engagement and clinical outcomes. The purpose of this study is to present a proof-of-concept exploratory evaluation of the association between subjective engagement measures of a mobile DMHI with changes in depression and anxiety. Adult primary care patients (N = 146) who screened positive for depression or anxiety were randomized to receive a DMHI, IntelliCare, immediately or following an 8-week waitlist. Subjective engagement was measured via the Usefulness, Satisfaction, and Ease of Use (USE) Questionnaire. Across both conditions, results showed that individuals who perceived a mobile intervention as more useful, easy to use and learn, and satisfying had greater improvements in depression and anxiety over eight weeks. Findings support our proposed experimental therapeutics framework that hypothesizes objective/behavioral and subjective engagement metrics as mechanisms that lead to changes in clinical outcomes, as well as support directing intervention design efforts for DMHIs to target the user experience.

参与是一个多方面的构建，也是数字干预实现临床改进的可能机制。迄今为止，数字心理健康干预 (DMHI) 的临床研究已经绝大多数定义了参与度，并通过使用 DMHI 或与 DMHI 交互的客观/行为指标（例如登录次数或使用时间）评估了其与临床结果的关联。技术。然而，参与度也需要用户的主观体验。很大程度上缺乏测试参与度主观指标与临床结果之间关系的研究。本研究的目的是对移动 DMHI 的主观参与测量与抑郁和焦虑变化之间的关联进行概念验证探索性评估。抑郁症或焦虑症筛查呈阳性的成人初级保健患者 ( N  = 146) 被随机分配立即接受 DMHI、IntelliCare 治疗或在等待 8 周后接受治疗。主观参与度通过有用性、满意度和易用性 (USE) 问卷来衡量。在这两种情况下，结果表明，那些认为移动干预更有用、更容易使用和学习、更令人满意的人在八周内的抑郁和焦虑症状有更大的改善。研究结果支持我们提出的实验治疗框架，该框架假设客观/行为和主观参与指标作为导致临床结果变化的机制，并支持指导 DMHI 的干预设计工作以瞄准用户体验。