As many are acutely aware, mental health services are increasingly unable to keep up with the growing demand for support, particularly within child and adolescent mental health services. It has been widely suggested that digital platforms offer potential to alleviate at least some of this pressure by providing access to interventions at scale and at lower cost compared to traditional in-person care. We are now seeing an unprecedented rise in the number and diversity of platforms available.
Evidence suggests that digital platforms can be just as effective as in-person care. Perhaps unsurprisingly, individuals who engage more with these platforms tend to experience better mental health outcomes than those who engage less (Gan et al, 2021; Löchner et al, 2025). However, despite the promise, engagement with digital platforms remains consistently low (as recently summarised in this blog), including among those aimed at children and young people, who are often assumed will be more adept at using these technologies (Fernández-Batanero et al, 2025).
To address poor engagement and promote uptake, we need to understand young people’s experiences of using these platforms and how these experiences relate to engagement. These insights will help us design the type of platforms that young people actually want to use.
Valentine and colleagues (2026) aimed to address this by examining factors influencing engagement with a real-world digital mental health platform – Moderated Online Social Therapy (MOST). MOST is a well-established Australian platform developed by Orygen which, similar to Kooth (Stevens et al, 2022) in the UK, offers a professionally moderated online peer support community alongside self-guided psychoeducation resources and access to clinical support.
Digital platforms offer the potential to provide interventions at scale, but many young people do not engage with them.
Methods
The researchers recruited young people aged 15-26 years from the MOST platform. Young people were categorised into high engagement (12 or more days using the platform) and low engagement (1-4 days using the platform) groups. They were invited to take part in the study via text message, with additional reminders sent to the low engagement group to ensure sufficient recruitment. The researchers also reported efforts to include representation from minoritised and historically underrepresented groups, including First Nations young people, culturally and linguistically diverse young people, LGBTQIA+ young people, and young men.
Of those approached (n=711), the researchers interviewed 22 high and 14 low engagement participants, exploring their expectations of the platform, and their experiences of joining and using its different components. The data were analysed using an inductive, reflexive thematic analysis approach. Themes that were most frequent and considered relevant to engagement were selected for further analysis.
A mixed-methods matrix was used to organise themes by engagement level and enable comparison of the similarities and differences between the two groups. Fisher’s Exact Test was then applied to test whether differences in theme endorsement between groups were statistically significant. The authors advised that the analyses were exploratory and, as such, no adjustment for multiple comparisons was applied.
Interviews were conducted with 22 high and 14 low engagement participants.
Results
Six themes describing young people’s experiences of using the MOST platform were identified, with notable differences between the high and low engagement groups:
- Normalisation and validation
- Access to social support
- Learning coping strategies
- Crisis support
- Accessibility
- Low motivation
Young people in the high engagement group were significantly more likely than those in the low engagement group to report that seeing posts about others’ mental health difficulties helped normalise and validate their own experiences. This helped young people feel less isolated and encouraged self-reflection and often happened without the need for any direct interaction with others.
The high engagement group more often described the online community as supportive compared to the low engagement group, and this difference was statistically significant. This could be through even simple gestures, such as another user reacting to a post they had shared with an emoji. The social benefits were particularly valued by those who had difficulties sharing their mental health difficulties with family and friends known offline, as it helped fill this gap.
Those in the high engagement group were also statistically more likely to report that engaging with the different platform features (including the self-guided psychoeducation resources, advice from clinicians and content shared by peers) increased their understanding of their mental health difficulties and helped them learn different coping strategies. Some examples of young people successfully applying these strategies in their everyday lives were also provided, highlighting the importance of creating simple, relevant and practical resources that young people can work through at their own pace.
Many young people reported using the platform during periods of high anxiety and low mood, with no statistically significant difference between the two groups. They noted the ability to access it late at night, when other support was often unavailable, was really helpful. Some used the platform simply as a distraction during these times, while others made use of the peer support and practical guidance.
Young people reported that the self-guided nature of the platform was easily accessible and fitted into their everyday lives. This was slightly more common among those in the high engagement group compared to the low engagement group, although the difference was not statistically significant.
On the other hand, some participants described feeling poorly motivated, particularly during periods of high anxiety or low mood, often only accessing the platform after being reminded to do so during in-person treatment. Some young people also spoke about difficulties engaging with self-guided support in general, which they related to their depressive symptoms. There was no evidence of a significant difference between the two groups.
Young people described six themes from using the MOST platform, with higher engagers more likely to benefit from peer normalisation, social support and coping strategies.
Conclusions
Using a mixed methods approach, this study offers useful insights into factors that facilitate and hinder young people’s engagement with digital mental health interventions. The authors concluded that:
Designing interventions that incorporate peer support, accommodate varied modes of participation, and minimise complexity could help promote sustained and inclusive use, particularly for those facing greater barriers to engagement.
This study offers useful insights into factors that facilitate young people’s engagement with digital mental health.
Strengths and limitations
The main strengths of this study include the linking of real-world platform usage with interview data, as well as the combination of thematic analysis and techniques, to identify common reasons for young people engaging with the platform. The authors also purposively recruited young people from marginalised and historically underrepresented groups to ensure diverse perspectives were included.
The limitations include a low recruitment rate among those approached, with no comparison between those who took part and those who did not, making it difficult to reflect on the representativeness of the relatively small interview sample. Young people who were referred to the platform but didn’t sign up were not included in the study, and their views may differ from those who enrolled on the platform. Therefore, further work to understand their reasons for non-engagement could help inform future developments.
We also know very little about the clinical profiles of the sample and this could be an interesting avenue for further research. Finally, as acknowledged by the authors, the study design precluded the ability to determine the direction of the associations identified.
The study purposively recruited young people from marginalised groups.
Implications for practice
The findings from this study have important implications for the design and delivery of digital mental health interventions. Passive use of digital interventions is often dismissed as being ineffective, however, this does not appear to be the case according to the young people in this study, prompting us to rethink how we understand and measure engagement. The findings really highlight the benefits of young people reading about the mental health experiences of their peers, expressed in their own words. This was one of the most important components linked to platform engagement, helping young people feel validated and prompting them to reflect on their own experiences and ways of coping. Many mental health platforms (including those that are not delivering an intervention) share personal stories, whether through standalone testimonial accounts or interactive message boards. Ensuring these lived experience narratives are clearly visible and accessible, particularly for new or less engaged users, appears crucial for engagement.
Likewise, increasing opportunities for social connection within digital mental health interventions – but also potentially mental health services more widely, for example through group-based work – appears central to reducing social isolation and encouraging engagement with treatment. Professional moderation is essential for ensuring that platforms provide safe spaces for peer-support, but there are also other safety (particularly in the event of mental health crisis) and data privacy concerns to be considered, highlighting the need for effective regulatory oversight, ongoing evaluation and links with emergency services (Löchner et al, 2025).
Clinicians supporting young people also appear to have a key role in facilitating their engagement with digital mental health interventions. The findings suggest the importance of them framing platforms as spaces that offer social connection, rather than just treatment, proactively helping young people plan how they can integrate them into daily life, and proactively checking in to ask young people how they are finding them. As such, these platforms should be considered tools they can use to support their work, rather than as replacements for in-person care.
The findings also show that even less motivated young people and those experiencing periods heightened anxiety and low mood will engage with these platforms. Therefore, it’s important that platforms are designed in a way that minimises cognitive or emotional burden through features such as clear navigation, accessible and engaging content, and personalised reminders to support engagement.
Intervention designers should minimise cognitive and emotional burden. Designing digital mental health tools that work means rethinking what “engagement” looks like and who it’s for.
Statement of interests
Amanda Bye has no interests to declare.
Edited by
Simon Bradstreet.
Links
Primary paper
Lee Valentine, Jennifer Nicholas, Rory Sorenson, Nicola A. Chen, Carla McEnery, Shona Louis, Shane Cross, Shaminka Mangelsdorf, Shaunagh O’Sullivan, Thomas Wren, Sandra Bucci, John Gleeson, Sarah Bendall, Mario Alvarez-Jimenez (2026). Sustained engagement with a digital youth mental health platform: A mixed-methods study. Internet interventions, 43, 100899. https://doi.org/10.1016/j.invent.2025.100899
Other references
Fernández-Batanero, J. M., Fernández-Cerero, J., Montenegro-Rueda, M., & Fernández-Cerero, D. (2025). Effectiveness of Digital Mental Health Interventions for Children and Adolescents. Children, 12(3), 353.
Gan, D.Z.Q., McGillivray, L., Han, J., Christensen, H., Torok, M., 2021. Effect of engagement with digital interventions on mental health outcomes: a systematic review and meta-analysis. Front. Digit. Health. 4;3:764079
Löchner, J., Carlbring, P., Schuller, B., Torous, J., & Sander, L. B. (2025). Digital interventions in mental health: An overview and future perspectives. Internet interventions, 40, 100824.
Stevens, M., Cartagena Farías, J., Mindel, C., D’Amico, F., & Evans‑Lacko, S. (2022). Pilot evaluation to assess the effectiveness of youth peer community support via the Kooth online mental wellbeing website. BMC Public Health, 22, 1903.
