Patterns of Engagement With the mHealth Component of a Sexual and Reproductive Health Risk Reduction Intervention for Young People With Depression: Latent Trajectory Analysis
Bibliographic record
Abstract
Background: Mobile health (mHealth) interventions are increasingly used to reduce risk and promote health in real-time, real-life contexts. Engagement is critical for effectiveness of mHealth interventions but may be challenging for young people experiencing depressive symptoms. Objective: We examined engagement with the 4-week mHealth component of a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk among young people with depression (Momentary Affect Regulation - Safer Sex Intervention [MARSSI]) to determine (1) mHealth engagement patterns over time and (2) how sociodemographic characteristics, SRH risks, and depressive symptom severity were associated with these engagement patterns. Methods: We undertook secondary analysis of data collected from June 2021 to September 2023 in a randomized controlled trial of MARSSI versus a breast health podcast. Eligibility included age 16-21 years, ability to become pregnant, smartphone ownership, English fluency, past-3-month penile-vaginal sex ≥1x/week and ≥1 SRH risk, and Patient Health Questionnaire-8 item score ≥8. Intervention participants received one-on-one telehealth counseling and then used an app for 4 weeks, responding to surveys (3 prompted at quasi-random, 1 scheduled daily) about affect, effective contraception and condom use self-efficacy, sexual and pregnancy desire, and recent sex, and receiving tailored messages reinforcing the counseling. We computed mHealth engagement days (responding to ≥1 app survey) by week and overall. Latent trajectory analysis identified engagement patterns over the 4 mHealth weeks among participants with any engagement. Using regression analysis, we examined the associations of sociodemographic characteristics, SRH risks, and depressive symptom severity with mHealth engagement patterns and examined moderation by depressive symptom severity. Of the 201 intervention participants, 194 (96.5%) enrolled in the app. Results: Among those responding to app surveys (167/194, 86.1%), the median engagement was 14 (IQR 4-23) days; 32.9% (55/167) responded on ≥20 days. Overall app engagement (median) declined from 5 (IQR 3-7) days in week 1 to 1 (IQR 0-5) day in week 4. On latent trajectory analysis, 4 patterns of app engagement emerged: high-throughout (48/167, 28.7%), high-then-declining (40/167, 23.9%), mid-then-declining (47/167, 28.1%), and low-throughout (33/167, 19.7%). Participants identifying gender other than female and those perceiving higher socioeconomic status were more likely to have high-throughout or high-then-declining engagement. Asian or Black non-Hispanic participants and those using low-effectiveness contraception were more likely to have no engagement. In the multivariable model, Asian (adjusted odds ratio [AOR] 0.28, 95% CI 0.10-0.81), Black non-Hispanic (AOR 0.28, 95% CI 0.12-0.66), and higher perceived socioeconomic status (AOR 1.24, 95% CI 1.05-1.48) remained significantly associated with engagement. Engagement patterns showed no differences by depressive symptom severity and no significant moderation. Conclusions: Young people with depressive symptoms showed initial high engagement with the intervention's mHealth app to reduce adverse SRH outcomes. Methods to increase and sustain mHealth engagement and differences in engagement by sociodemographic characteristics warrant further studies to optimize the reach of mHealth interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".