Why Youth Click, Stay, or Leave: Applying the COM-B Model to Digital Dissemination of Single-Session Interventions

Background. Despite increasing availability of digital mental health interventions, most adolescents with mental health needs do not access effective care. Digital, self-guided single-session interventions (SSIs) offer a scalable, low-burden option, yet little is known about how youth engage with dissemination strategies designed to promote their uptake. Dissemination efforts are often ad hoc and insufficiently grounded in behavioral theory, limiting their effectiveness. This study applied the Capability, Opportunity, and Motivation–Behavior (COM-B) model to examine factors shaping adolescents’ engagement with dissemination strategies for digitally delivered SSIs.Methods. Using a formative qualitative design, semi-structured interviews and focus groups were conducted with adolescents with mental health needs. The interview guide, informed by the COM-B model, explored youths’ anticipated responses to encountering SSI-related information online and in community settings. Nineteen participants completed a demographic survey (mean age = 15.63 years; range = 13-19). Data were transcribed by a third party and analyzed using a structured codebook, with multiple coders contributing to iterative analysis.Results. Youth engagement with SSI dissemination was shaped by interrelated capability, opportunity, and motivational processes at the point of exposure. Limited awareness of SSIs and difficulty distinguishing them from other digital mental health services inhibited interpretation of SSI messaging. Opportunity-related barriers included limited time, inconsistent internet access, and reliance on social media-only dissemination, while trusted physical contexts and endorsements from peers or authority figures facilitated engagement. Motivational determinants included privacy concerns, anticipated enrollment burden, and affective reactions to mental health–related and algorithmically targeted advertisements, which often prompted disengagement.Conclusions. Dissemination should be conceptualized as a modifiable behavioral process rather than a passive delivery mechanism. Theory-driven dissemination strategies that reduce cognitive and procedural friction, expand access across trusted contexts, and address both reflective and affective motivational processes may improve youth engagement with scalable digital mental health interventions.