Is digital alliance associated with engagement & outcomes in guided digital interventions? An analysis of data from...

Digital interventions have the potential to increase access to care. Despite their demonstrated efficacy in clinical trials, however, they often suffer from low sustained engagement in real-world contexts. Digital alliance (i.e., therapeutic alliance between user and app) may enhance engagement and outcomes, but its role in guided digital interventions (i.e., those with human support) is little understood.

Using data from two studies involving the mental health app mindLAMP, we examined digital alliance and its association with engagement and outcomes.

In Study 1, mindLAMP was offered as a standalone app with several brief check-ins by a digital navigator (aka coach). In Study 2, mindLAMP was integrated into a brief teletherapy program supported by a clinician and a digital navigator. Digital alliance was assessed near study midpoint with a validated measure.

Digital alliance was associated with engagement in both studies. In Study 1, digital alliance predicted subsequent app engagement, b = 0.18, p < .01, adjusting for prior engagement, which remained significant, b = 0.62, p < .001. Similarly, in Study 2, digital alliance predicted subsequent engagement, b = 0.21, p < .01, adjusting for prior engagement, b = 0.22, p < .05. Digital alliance also predicted co-morbid anxiety and depressive symptoms at post-intervention, after adjusting for baseline symptoms, in Study 1, b = -0.27, p < .001, but not in Study 2.

Participant demographics were not representative of the general population.

Findings underscore the potential of digital alliance in enhancing engagement and outcomes in digital interventions.