Factors Influencing Engagement with Digital Mental Health Interventions from the Perspective of University Students with Mental Health Difficulties: A Qualitative Study

While mental health difficulties are increasing in prevalence among university students, novel solutions such as digital mental health interventions (DMHIs) provide a cost-effective, accessible and scalable solution to reduce this burden. However, engagement with these interventions is often challenging and is typically lower in real world-use than in research studies. Understanding the factors that affect engagement among college students is critical for the effectiveness of digital mental health interventions. This study aimed to explore the perspectives of college students with ongoing mental health difficulties, on their use of and engagement with existing digital mental health interventions. Interviews took place between August 2024 and February 2025. Interviews were audio-recorded and transcribed verbatim. The data were analysed inductively using reflexive thematic analysis. To identify factors related to engagement with DMHIs, the data were then deductively coded to the Theoretical Domains Framework (TDF) and organised into themes. Four out of the 14 TDF domains were supported by the interview data as factors that impact engagement with DMHIs: knowledge, beliefs about consequences, goals, and environmental context and resources. This study offers valuable insights into the barriers and facilitators that university students with existing mental health difficulties face when engaging with digital mental health interventions. Knowledge gaps about what DMHIs are available, as well as beliefs about their effectiveness were identified as key areas to improve engagement with digital mental health interventions.