Journal article

Engagement and attrition in digital mental health: current challenges and potential solutions

Abstract:: In digital mental health engagement rates are consistently low, which may limit its effects. Using an international multidisciplinary consensus method, including lived experience expertise and a systematic review, we identified three key challenges: (i) lack of agreed metrics for engagement; (ii) lack of evidence on how better engagement improves outcomes; (iii) lack of standards for user involvement. Three potential solutions encompassed: (i) standardisation of frameworks for reporting engagement metrics and optimal doses of digital tools, (ii) measuring engagement with more precise reporting of outcomes, including potential harms; (iii) defining standards of user involvement (including appropriate diversity, and clinician as well as user input). Digital interventions have real potential in meeting the shortfall in service provision for mental health, but this will require focus on high quality research studies of the underlying mechanisms of engagement and optimal outcomes. Our findings identify and highlight the next best steps in this process.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Smith, K. A., Ward, T., Lambe, S., Ostinelli, E. G., Blease, C., Gant, T., Gold, S. M., Holmes, E. A., Paccoud, I., Vinnikova, A., Klucken, J., Uhlhaas, P. J., Sanchez, C. G., Haining, K., Böge, K., Lahutina, S., Tomelleri, L., Ryan, S., Torous, J., & Cipriani, A. (2025). Engagement and attrition in digital mental health: current challenges and potential solutions. Npj Digital Medicine, 8(1).

MLA Style

Smith, KA, et al. “Engagement and Attrition in Digital Mental Health: Current Challenges and Potential Solutions.” Npj Digital Medicine, vol. 8, no. 1, 2025.

Chicago Style

Smith, KA, T Ward, S Lambe, et al. 2025. “Engagement and Attrition in Digital Mental Health: Current Challenges and Potential Solutions.” Npj Digital Medicine 8 (1).
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Publisher copy:: 10.1038/s41746-025-01778-w

Authors

+ Smith, KA More by this author

Institution:: University of Oxford
Division:: MSD
Department:: Psychiatry
Sub department:: Psychiatry
Role:: Author

+ Ward, T More by this author

Role:: Author

+ Lambe, S More by this author

Institution:: University of Oxford
Division:: MSD
Department:: Experimental Psychology
Sub department:: Experimental Psychology
Role:: Author

+ Ostinelli, EG More by this author

Institution:: University of Oxford
Division:: MSD
Department:: Psychiatry
Sub department:: Psychiatry
Role:: Author

+ Blease, C More by this author

Role:: Author

More authors...

Publisher:: Nature Research
Journal:: npj Digital Medicine More from this journal
Volume:: 8
Issue:: 1
Article number:: 398
Publication date:: 2025-07-02
Acceptance date:: 2025-06-06
DOI:: 10.1038/s41746-025-01778-w
EISSN:: 2398-6352

Language:: English
Pubs id:: 2134304
Local pid:: pubs:2134304
Source identifiers:: 3081941
Deposit date:: 2025-07-03
ARK identifier:: ark:/29072/ora_c0e81c5d9b1d4ad3b995725336e84b6c

Terms of use

Copyright date:: 2025

Licence:: CC Attribution (CC BY)

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