Human-Centered Digital Nudging to Promote Youth Mental Health: A Serendipitous Natural Experiment Enabled by a Digital Health Platform

Abstract

Background  Health systems are struggling to deliver timely preventive care, necessitating a shift towards systems integration across sectors (e.g. health, education, social services). Digital health platforms can enable systems integration with citizen/patient and care provider/decision-maker remote interaction. This study investigated a serendipitous (unplanned) natural experiment that enabled assessment of varying digital health platform nudging on youth compliance to a longitudinal mental health intervention.Methods  The digital health platform featured customized computer interfaces for youth and scientists that enabled real-time engagement via a nudging system. An unplanned interruption of non-personalized scientist-triggered and personalized scientist-triggered nudges transformed this study into a serendipitous natural experiment, with four phases: 1) consistent comprehensive nudging (Phase 1); interruption of non-personalized and personalized scientist-triggered nudges (Phase 2); reintroduction of consistent comprehensive nudging (Phase 3); interruption of personalized scientist-triggered nudges (Phase 4). Using R statistical package, data analyses were conducted to empirically assess changes in youth compliance across phases. Results  Comprehensive nudging (Phase 1) was significantly associated with the highest youth compliance, which declined in Phase 2. Reintroducing comprehensive nudging partially recovered engagement in Phase 3. Interrupted nudging in Phase 4 was associated with further decline in youth compliance. Significant differences were found in the total volume as well as the time taken by youth to provide responses across all four phases. Conclusions  The findings show that human-centered digital health platforms that prioritize consistent and personalized nudging increase citizen compliance to health interventions by facilitating remote human-to-human interaction – an important step in systems integration and human-centered artificial intelligence.

Note:
Funding Information: This study was funded by the Canadian Institutes of Health Research’s Project Grant (#153226) and the Saskatchewan Health Research Foundation’s Establishment Grant (3779). This research is also supported by the Canada Research Chairs Program (TRK).

Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethics Approval Statement: Ethics approval was obtained from the Research Ethics Boards of Universities of Regina and Saskatchewan through a synchronized review protocol (REB # 2017–29). Parents/guardians were required to provide implied informed consent for their children’s participation. Participation in the study was voluntary, and all youth citizen scientists provided informed consent via the smartphone app before joining the study.

Keywords: Digital citizen science, Digital transformation of health systems, human-computer interaction, Indigenous youth health, Integrated knowledge translation, Systems integration