Retention and Engagement in Culturally Adapted Digital Mental Health Interventions: Systematic Review of Dropout, Attrition, and Adherence in Non-Western, Educated, Industrialized, Rich, Democratic Settings
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Le résumé fourni par la source
Background: Digital mental health interventions (DMHIs) offer scalable and cost-effective support for mental health but are predominantly developed in WEIRD (western, educated, industrialized, rich, democratic) contexts, raising questions about their global applicability. Dropout, attrition, and adherence rates critically influence DMHI effectiveness yet remain poorly characterized in culturally adapted formats. Objective: This systematic review aimed to (1) synthesize evidence on dropout, attrition, and adherence in culturally adapted DMHIs delivered to non-WEIRD adult populations and (2) assess the methodological quality of the included studies. Methods: PsycINFO, PubMed, and ScienceDirect were systematically searched for randomized controlled trials published in English between January 2014 and April 2024. Screening and data extraction followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and methodological quality was evaluated using the Appraisal Tool for Cross-Sectional Studies tool. Extracted variables included dropout, attrition, adherence, adaptation techniques, and clinical outcomes. Results: Twenty-three randomized controlled trials (n=4656) from diverse regions met inclusion criteria. Attrition ranged from 5.3% to 87% (median 18.4%), dropout from 0% to 66% (median 18.7%), and adherence from 26.3% to 100% (median 71%). Deep, participatory adaptations-such as language translation combined with culturally resonant content, stakeholder engagement, and iterative refinement-were consistently associated with lower dropout (<11%) and higher adherence (>75%). In contrast, surface-level adaptations (eg, translation only) showed higher dropout (up to 56%). Studies that incorporated both cultural tailoring and human support reported the most favorable engagement and clinical outcomes (eg, reductions in insomnia, depression, and anxiety). Most studies (91%) were rated as "Good" quality, although some lacked representative sampling or objective engagement metrics. Conclusions: Comprehensive and participatory cultural adaptation is associated with engagement and effectiveness of DMHIs among non-WEIRD populations. Future research should integrate hybrid human-digital delivery models, objective engagement metrics, and larger multicenter trials to improve generalizability and scalability.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Retention and Engagement in Culturally Adapted Digital Mental Health Interventions: Systematic Review of Dropout, Attrition, and Adherence in Non-Western, Educated, Industrialized, Rich, Democratic Settings
- Date Crossref
- 28/01/2026
- Éditeur
- JMIR Publications Inc.
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Fribourg Department of Clinical and Health Psychology pays non établi dans la noticeUniversité ou école supérieure
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Indian Institute of Technology Bombay Koita Centre for Digital Health pays non établi dans la noticeUniversité ou école supérieure
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HES-SO University of Applied Sciences and Arts Western Switzerland pays non établi dans la noticeUniversité ou école supérieure
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HES-SO Fribourg pays non établi dans la noticeUniversité ou école supérieure
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School of Engineering and Architecture of Fribourg pays non établi dans la noticeUniversité ou école supérieure
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University of Bern Institute of Psychology pays non établi dans la noticeUniversité ou école supérieure
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Cognitive and Behavioural Neuroscience Laboratory pays non établi dans la noticeStructure de recherche
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HES-SO University of Applied Sciences Western Switzerland HumanTech Institute pays non établi dans la noticeUniversité ou école supérieure
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Haute École d'Ingénierie et d'Architecture de Fribourg pays non établi dans la noticeInstitution
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Department of Research pays non établi dans la noticeInstitution
Department of Clinical and Health Psychology — University of Fribourg, Koita Centre for Digital Health — Indian Institute of Technology Bombay et HES-SO University of Applied Sciences and Arts Western Switzerland, avec 7 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.