Understanding Adolescents' Perceived Barriers to Engagement in Online
Cognitive Behaviour Therapy Programs for Anxiety and Their Ideas for
Enhancing User Experience
Abstract
Background: Self-Help Internet Cognitive Behavioural Therapy
(iCBT) interventions are highly efficacious and overcome numerous
barriers adolescents experience when accessing face-to-face
interventions, including stigma, privacy, lengthy wait lists and cost.
Despite this, adolescents struggle to engage in Self-Help iCBT, which is
problematic given that there is a relationship between higher engagement
and better treatment outcomes. The reasons for poor engagement among
adolescents are unclear. Using the iCBT program, BRAVE Self-Help as an
example, this study explored 1) the barriers to engagement directly from
the adolescent’s perspective and, 2) their viewpoints on enhancing
engagement in iCBT. Method: Semi-structured interviews were
conducted with 14 adolescents aged 12-17 years ( M = 14.36,
SD = 2.12) who had participated in BRAVE Self-Help in the
previous 12 months. Reflexive thematic analysis was utilised to analyse
data. Results: Stigma, program factors (program design, content
and length) and environmental factors (competing priorities and
distractions), were identified as adolescent barriers to engagement.
With respect to strategies to enhance engagement, adolescents identified
1) specific program factors (positive reinforcement and
personalisation), and 2) support factors (reminders and optional
support). Conclusions: Co-design methods with adolescents at
both the design and implementation stages of iCBT programs is imperative
for engagement.